Heart Attack Risk: Test to Determine Hidden Plaque Buildup

February is Heart Month, a time to consider one’s risk for a heart attack. The Non-contrast Coronary Artery Calcium (CAC) Score Screening test accurately detects subclinical (silent) buildup months or years before the heart attack may occur. However, few healthcare providers prescribe it for high-risk patients. Most people are completely unaware of this life saving technology.

Are You at Risk?
The major risk factors for a heart attack are:

1. Men over 45, women over 55
2. History of a heart attack in a mother before the age of 55 and a father before 45
3. Smoking
4. High blood pressure
5. High blood glucose
6. Elevated LDL cholesterol
7. Excess weight
8. Unhealthy diet
9. Inactivity
10. Stress
11. Excess alcohol
12. Inadequate sleep
    It’s often been said that genetics loads the gun, but lifestyle pulls the trigger. However, living a heart healthy lifestyle is a challenge for most of us. If your blood pressure, glucose or LDL cholesterol remains too high it’s time to consider medications to protect your heart, brain and kidneys from damage.
    
    The calcium score test is the tie breaker. If the number is 0 or low, it will buy you some time. However, if it is higher, it’s time to get more aggressive to prevent further buildup.

How Do Blockages Develop?
Blockages develop from a variety of factors. High blood pressure causes a sandpaper effect to occur on the inside lining of the arteries. Higher blood glucose scratches the lining as it moves through the blood. The body recognizes the danger and launches an assault to repair the damage. Those areas become red and swollen and white blood cells move in to heal it. LDL cholesterol traveling through the blood becomes lodged in the damaged areas.

With any inflammation that has gone on long enough (TB, cancer or coronary artery disease) calcium deposits are left behind to wall off the area. Plaque buildup is just another name for this inflammatory process. The calcium deposits are measured on this test and provide a window into how much damage may be occurring.

 

Non-contrast Coronary Artery Calcium (CAC) Score Screening Test
This test became available 30 years ago. During one breath hold, approximately 40 images are taken of the 4 main coronary arteries that surround the heart. The radiation dose in a non-contrast CAC screening scan is about equal to a mammogram. The accuracy of the CAC score test is a strong predictor of future events.

What Do the Results Mean?

0 CAC Score                          Encourage a healthy lifestyle, consider a statin if LDL cholesterol >190 mg/dL, repeat in 3 to 5 years depending on risk factors.

1 to 99 CAC Score                 Healthy lifestyle, treat LDL cholesterol to <100 mg/dL and treat high blood pressure and other risk factors.

100 to 299 CAC Score           All above + treat LDL cholesterol to <70 mg/dL and consider low dose aspirin (some people are at risk for bleeding- always check with your doctor before taking).

300 to 999 CAC Score           All above + treat LDL to < 55 mg/dL and use low dose aspirin in people who can tolerate it.

Over 1,000 CAC Score         All above + consider other tests and treatment options.

It indicates the level of plaque buildup (none, small, moderate or large amount). It doesn’t mean there is a blockage but the higher the number the greater the buildup and the bigger the problem.

However, remember the best stress test may only detect a blockage > 70%. Heart attacks may occur in much smaller blockages. If someone has a normal stress test and several risk factors, it’s a good idea to get a CAC score to rule out potential buildup unseen by the stress test.

Who Should Get a Calcium Score Test?

—Men 55 to 80 years old, women 60 to 80 years old.

—People 40 to 55 years old with multiple risk factors.

—People with abnormal cholesterol levels concerned about taking a statin.

Who Should Not Get a Calcium Score Test
If you’ve already had a heart attack or stroke you have plaque buildup and should be treated aggressively. The score will not add any value.

Where Can I Get the Test?
Most radiology centers provide this screening. It may be covered by insurance or Medicare if you have a strong secondary plan. The cost out-of-pocket is around $200. Some states require a healthcare provider’s order while others do not. The test is ordered as Non-contrast Coronary Artery Calcium Score Screening or simply Cardiac Calcium Score. The screening non-contrast test has a much lower dose of radiation exposure than the contrast test.

On A Personal Note:
I counseled nearly 1,000 people in Chicago after they had this test. We measured their blood pressure, cholesterol and glucose, asked them about their lifestyle habits and provided information on their findings. We found many people who were living normal lives completely unaware of the silent danger building up in their arteries.

In the early 2000’s minimal research existed on what happens when you give people that information. I enrolled nearly 200 high risk people and measured how the results changed their lives.

Whether they were CEO’s of major Fortune 500 companies, farmers or housewives they had similar questions. I found that the higher the CAC score motivation to take prescribed medications and make healthier choices was enhanced. 

Frankly, I’m frustrated that physicians in my area are not ordering this test for at risk people. It’s quick, easy and painless and provides incredible information. The guidelines recommend it in high-risk individuals.  

If you’re at risk…speak with your healthcare provider today. Provide a hard copy of this article. If you’re in a state that doesn’t require an order…call and get more information. I’d love to hear your experiences in the comments below and answer any questions.

Finally, my book Wake Up Call 911: It’s Time to Reduce your Risk for a Heart Attack and Stroke is available through my website for $10 (jenniejohnsonrn.com), email (ask@jenniejohnsonrn.com), Amazon or Ebay. It includes the information that I gave my patients: the simple steps to change your life.

The oldest and strongest emotion of mankind is fear, and the oldest and strongest kind of fear is fear of the unknown(science fiction writer, H. P. Lovecraft).

Reference:

Lifestyle Changes to Prevent a Heart Attack, American heart Association (January 2, 2025). https://www.heart.org/en/health-topics/heart-attack/life-after-a-heart-attack/lifestyle-changes-for-heart-attack-prevention

10. J. Maron et al. “Coronary Artery Calcium Staging to Guide Preventive Interventions: A Proposal & Call to Action,” JACC Advances (November 11, 2024). https://www.jacc.org/doi/10.1016/j.jacadv.2024.101287

Cardiac Stress Testing: What It Can & Cancot Tell You, Harvard Health Publsihing, Harvard Medical School (April 15, 2020). https://www.health.harvard.edu/newsletter_article/cardiac-exercise-stress-testing-what-it-can-and-cannot-tell-you

1. E. Johnson et al. “Does Knowledge of Coronary Artery Calcium Affect Cardiovascular Risk Perception, Likelihood of Taking Action, and Health-Promoting Behavior Change?” Journal of Cardiovascular Nursing (2015). https://pubmed.ncbi.nlm.nih.gov/24434820/

   I’m a Christian nurse who helps people navigate through the murky waters of healthcare.

Paperback copies of both books for sale. Email me for details at:  ask@jenniejohnsonrn.com.