Should I have a coronary artery calcium test?
By Roberta Cannon, RN
A friend who has diabetes and had a heart attack a few years ago recently told me she was going to ask her cardiologist if she could have a CAC (coronary artery calcium) CT (computed tomography) scan to check her arteries for calcium. Her understanding of the test was that it would give her cardiologist more information about her heart that could be helpful with her treatment going forward.
“The CAC test/score is a screening tool to help assess your intermediate and long-term risk for coronary artery disease and can be used in conjunction with blood work and other risk factor analysis to determine your best course of treatment,” said Michael Levangie, MD, FACC, a cardiologist with Cape Cod Healthcare Cardiovascular Center in Hyannis. “The test looks for calcification within the coronary arteries, which are the small blood vessels that bring blood supply to the muscle of the heart. The reason we look for calcium is because it goes where plaque goes. The old term ‘hardening of the arteries’ was used to describe this because calcium is hard. If you don’t have any calcification, then you likely don’t have plaque, but if you have a lot of calcifications, it is indicative of a lot of plaque.”
Plaque is a sticky material made up of cholesterol, fat, blood cells, cellular waste products, calcium and fibrin, according to the American Heart Association. When the plaque builds up in the arteries, the condition is called atherosclerosis, which causes the walls of the arteries to thicken and slow blood flow. If one of those arteries that leads to the heart or brain becomes blocked, it can lead to a heart attack or stroke.
“The CAC test is not great at telling you how much blockage the plaque is creating,” said Dr. Levangie. “You could have a lot of calcification and not a lot of blockage or you could have a fair amount of calcification and a very tight blockage.”
The coronary calcium scan results, (Agatston score) are usually defined by a number that is the score of the total area of calcium deposits and density of the calcium, according to the Mayo Clinic.
The Mayo Clinic lists the following scores:
Determining Cardiovascular Risk
“Generally speaking, patients who already have known cardiovascular risks, including heart disease, diabetes, smoking, history of a heart attack, are not candidates for this test,” said Dr. Levangie. “They are already being treated for plaque and cardiovascular disease and this test will not give any additional information. Patients who are a low risk won’t benefit from the test because they do not need treatment.”
The test is geared more towards patients who are in the middle for risk, he said. “We can calculate a patient’s cardiac risk using certain formulas, one of which is the Framingham Risk Score, to determine the risk for developing heart disease in the next 10 years.
The Framingham Risk calculator asks for your gender, age, total cholesterol, HDL cholesterol, systolic blood pressure, if you are a smoker and if you are being treated for high blood pressure. The results give you a score and the percentage of your 10-year risk of developing heart disease.
“If the risk value is under 5 percent, that is not the patient who needs this test because they don’t need treatment,” said Dr. Levangie. “If the percentage is over 10 percent or very high, it’s also not the patient who would benefit from this test, either, because they are going to be treated to decrease their risk. It’s the patient with a 5 to 10 percent risk who may benefit from the information provided by the CAC to find out if they have calcium in their coronary arteries that may lead us to further testing to assess their need for treatment.”
The CAC test is generally not covered by health insurance and the out of pocket cost runs about $100-$200, depending on where you have it done, said Dr. Levangie.
My friend may not benefit from this test because she is considered high risk and is already being treated for cardiovascular disease. I will give her a call.
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Originally published on Cape Cod Health News, February 4, 2025
“The CAC test/score is a screening tool to help assess your intermediate and long-term risk for coronary artery disease and can be used in conjunction with blood work and other risk factor analysis to determine your best course of treatment,” said Michael Levangie, MD, FACC, a cardiologist with Cape Cod Healthcare Cardiovascular Center in Hyannis. “The test looks for calcification within the coronary arteries, which are the small blood vessels that bring blood supply to the muscle of the heart. The reason we look for calcium is because it goes where plaque goes. The old term ‘hardening of the arteries’ was used to describe this because calcium is hard. If you don’t have any calcification, then you likely don’t have plaque, but if you have a lot of calcifications, it is indicative of a lot of plaque.”
Plaque is a sticky material made up of cholesterol, fat, blood cells, cellular waste products, calcium and fibrin, according to the American Heart Association. When the plaque builds up in the arteries, the condition is called atherosclerosis, which causes the walls of the arteries to thicken and slow blood flow. If one of those arteries that leads to the heart or brain becomes blocked, it can lead to a heart attack or stroke.
“The CAC test is not great at telling you how much blockage the plaque is creating,” said Dr. Levangie. “You could have a lot of calcification and not a lot of blockage or you could have a fair amount of calcification and a very tight blockage.”
The coronary calcium scan results, (Agatston score) are usually defined by a number that is the score of the total area of calcium deposits and density of the calcium, according to the Mayo Clinic.
The Mayo Clinic lists the following scores:
- Zero: No calcium seen in the heart. Low chance of developing a heart attack.
- 100-300: Moderate plaque deposits. Relatively high risk of a heart attack or other heart disease over the next 3-5 years.
- >300: signals more extensive disease and a higher risk of heart attack.
Determining Cardiovascular Risk
“Generally speaking, patients who already have known cardiovascular risks, including heart disease, diabetes, smoking, history of a heart attack, are not candidates for this test,” said Dr. Levangie. “They are already being treated for plaque and cardiovascular disease and this test will not give any additional information. Patients who are a low risk won’t benefit from the test because they do not need treatment.”
The test is geared more towards patients who are in the middle for risk, he said. “We can calculate a patient’s cardiac risk using certain formulas, one of which is the Framingham Risk Score, to determine the risk for developing heart disease in the next 10 years.
The Framingham Risk calculator asks for your gender, age, total cholesterol, HDL cholesterol, systolic blood pressure, if you are a smoker and if you are being treated for high blood pressure. The results give you a score and the percentage of your 10-year risk of developing heart disease.
“If the risk value is under 5 percent, that is not the patient who needs this test because they don’t need treatment,” said Dr. Levangie. “If the percentage is over 10 percent or very high, it’s also not the patient who would benefit from this test, either, because they are going to be treated to decrease their risk. It’s the patient with a 5 to 10 percent risk who may benefit from the information provided by the CAC to find out if they have calcium in their coronary arteries that may lead us to further testing to assess their need for treatment.”
The CAC test is generally not covered by health insurance and the out of pocket cost runs about $100-$200, depending on where you have it done, said Dr. Levangie.
My friend may not benefit from this test because she is considered high risk and is already being treated for cardiovascular disease. I will give her a call.
View Physician Profile
Originally published on Cape Cod Health News, February 4, 2025