Friends, a few days back, I came across a medical term in a newspaper, which is related to heart health, and it is called CORONARY ARTERY CALCIUM (CAC). Although I have been suffering from heart disease, I have never come across this earlier. This instigated me to explore more about this condition.
Actually, Coronary Artery Calcium (CAC) refers to the buildup of calcium deposits within the walls of the coronary arteries. These blood vessels supply oxygen-rich blood to the heart muscle. The presence of calcium in these arteries is a hallmark of atherosclerosis, a condition where fatty plaques accumulate and can eventually lead to heart attacks, angina, or other cardiovascular diseases (CVDs).
The Coronary Artery Calcium Score (CACS), derived from a special imaging test known as Coronary Calcium Scan or Cardiac CT for Calcium Scoring, is one of the most reliable predictors of future heart disease risk.
Understanding the Science Behind CAC
Calcium buildup in the coronary arteries occurs as part of the body’s natural response to arterial injury. Over time, cholesterol and inflammatory cells accumulate within the arterial walls. The body tries to stabilize these plaques by depositing calcium effectively hardening the plaque.
While this may sound protective, the amount of calcium reflects the extent of atherosclerosis-the more calcium detected, the greater the plaque burden and, consequently, the higher cardiovascular risk.
The Coronary Calcium Scan
It is non-invasive CT test that measures the amount of calcified plaque in the coronary arteries.
Procedure
- The test takes about 10-15 minutes.
- No contrast dye or injection is required.
- The patient lies on a CT scanner bed while X-rays capture detailed images of the heart.
- Specialised software calculates the total amount of calcium, generating a calcium score.
Interpreting the Coronary Artery Calcium Score
Calcium Score-0, no identifiable plaque-very low risk of CAD
Calcium Score 1-99, Mild plaque-low to moderate risk, early stage antherosclerotic buildup.
Calcium Score 100-399, Moderate plaque- Moderate risk, significant antherosclerotic buildup.
Calcium Score > 400, Extensive plaque-High risk, likely presence of CAD.
A higher CAC score indicates a higher likelihood of coronary events such as heart attack, even in people without symptoms.
Who Should Get a Coronary Calcium Scan
The test is not for everyone, but it is particularly useful for individuals who are at immediate risk for heart disease-those who may not have symptoms but have some risk factors.
Ideal candidates include
- Adults aged 40-70 with risk factors (smoking, hypertension, diabetes, family history).
- Individuals with borderline cholesterol or blood pressure levels.
- Patients uncertain about the need for statin therapy.
- Those with strong family history of premature heart disease.
The scan is usually not recommended for
- Individuals with known heart disease.
- People with very low risk ( young adults without risk factors).
- Pregnant women (due to radiation exposure).
Clinical Significance of CAC
CAC scoring provides unique insights beyond traditional risk assessments like cholesterol tests or blood pressure readings. It helps personalize prevention strategies:
- Guiding statin therapy- A zero CAC score may allow doctors to safely defer statin treatment in some individuals.
- Predicting risk of heart events- Studies show that people with higher CAC scores have up to 10-fold risk of heart attacks or cardiac death compared to those with zero scores.
- Monitoring disease progression- Serial scans (every 3-5 years) can track plaque growth and response to lifestyle or medical interventions.
Benefits of CAC Testing
- Quick, painless, and non-invasive.
- No contrast or injections needed.
- Provides direct measurement of coronary atherosclerosis.
- Helps in early detection before symptoms.
- Improves patient motivation to adopt lifestyle changes.
Limitations
- Radiation exposure-Although minimal, it’s still a consideration, especially for younger individuals.
- Does not detect soft plaque-the scan measures only calcified plaque, missing non-calcified plaques that can still rupture.
- Not suitable for everyone- May not alter treatment decisions in high or low risk individuals.
How to Reduce CAC
1 Lifestyle modifications
- Eat a heart-healthy diet (low in saturated fats, high in fibre and omega- 3s)
- Regular aerobic exercise.
- Maintain healthy body weight.
- Quit smoking.
- Limit alcohol intake.
2 Medical Management
- Statins- Lower LDL cholesterol and stabilize plaque.
- Blood pressure control- Prevent further endothelial damage.
- Blood sugar management- Especially in diabetics.
- Aspirin therapy- In select cases, to reduce clot formation risk.
In the end, CAC is a powerful marker of subclinical heart disease and a valuable tool in prevention of cardiovascular disease. The CAC test empowers individuals to adopt preventive strategies-ultimately aiming for better and healthier life with stronger heart.
Waiting for your views on this blog.
Anil Malik
Mumbai, India
12th November 2025