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Prevention, Wellness

Coronary Artery Calcium Score (CAC)

Published on February 1, 2023 by Dr. Myra Reed

Coronary Artery Calcium Score (CAC) is measured through a CT scan which helps your doctor assess your risk of heart disease. Additionally, the CAC score has been shown to be a more cost-effective way to evaluate cardiovascular disease risk in healthy people with no active symptoms.

Why is Knowing Your Heart Health Important?

Heart disease kills an estimated 17.9 million people globally each year, accounting for an estimated 32% of all deaths in 2019. Additionally, 38% of premature deaths, meaning deaths that occur in people under age 70, were due to heart disease in 2019. With this in mind, it’s important to protect your heart by improving your lifestyle and seeing your doctor regularly for check-ups.

Ways of Determining Heart Health

Blood tests are one of many ways of checking on your heart health. These tests help your doctor evaluate your blood chemistry, cholesterol, and organ health such as the kidneys which are more susceptible to damage from cardiovascular disease. Another way to check your heart health is by considering imaging studies such as a chest x-ray, cardiac MRI, echocardiogram, and CT scan. Finally, another metric that’s not as commonplace, is finding your coronary artery calcium (CAC) score. The CAC score has been shown to be a more cost-effective way to evaluate cardiovascular disease risk in healthy people with no active symptoms.

What is a Coronary Artery Calcium Score?

Developed in 1990, the CAC score is measured through a CT scan which helps your doctor assess your risk of heart disease. The higher the amount of calcified plaque present in the coronary arteries surrounding your heart, the higher your CAC score. This means your chances of having coronary atherosclerosis goes up the higher your CAC score is. Atherosclerosis refers to a build-up of plaque in the coronary arteries that prevents adequate blood flow to the heart.

The scan itself uses a CT imaging technique that can take hundreds of images of a moving heart from many different angles, leading to higher detection and location of coronary artery calcium deposits.  

What Does Your CAC Score Mean?

The calcium score is rated as follows:

  • 0: No calcium detected in the coronary arteries with a low risk of heart disease
  • 1-10: Small amount of plaque meaning you have a very low risk of having heart disease
  • 11-100: Some plaque is present meaning you have mild heart disease
  • 101-400: Moderate amount of plaque with a risk of the plaque blocking an artery
  • Over 400: Large amount of plaque is present with a more than 90% chance that plaque is blocking one or more coronary arteries

If you have a score over 11, your risk of having a heart attack increases as your score increases. Your doctor may step in at this point recommending diet and lifestyle changes and further testing and/or imaging. The CAC can also be used by your doctor to determine what therapies may be most appropriate for you.

What Leads to a High CAC Score?

First, it’s important to have a basic understanding of how calcium gets into the coronary arteries. Damage occurs in the coronary arteries surrounding the heart which can lead to atherosclerosis and calcification in the arteries. Calcification may be due to the smooth muscle of the heart itself becoming damaged by lifestyle factors and genetics. 

The following factors increase your risk for heart disease and a high coronary artery calcium score:

  • High cholesterol
  • High blood pressure
  • Smoking
  • Blood sugar dysregulation/ insulin resistance
  • Unhealthy Diet
  • Lack of physical activity
  • Sleep apnea
  • Excessive alcohol intake

How to Prevent a High Coronary Artery Calcium Score 

Diet and lifestyle changes are your most powerful tools to help prevent heart disease.

Exercise: A minimum of 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise is recommended to support a healthy heart. Additionally, weightlifting two or more times a week can add additional benefit. 

Healthy Diet: The American Heart Association recommends a diet high in vegetables, fruits, and whole grains, with a minimal amount of sugars and saturated fats. Eating a diet based in whole foods supports overall health and can reduce risk factors associated with cardiovascular disease. 

Reduce Risky Behaviors: Smoking and excessive alcohol intake are major risk factors for cardiovascular disease. Smoking alone can double the risk of dying from heart disease. Drinking more than one drink daily for women and two drinks daily for men has been linked to an increased risk of heart disease as well. 

Get Adequate Sleep: Research shows not getting enough sleep increases the risk of heart disease. Sleeping less than six hours on average has been linked to increased systemic inflammation, potentially increased coronary artery plaque formation, and increased stress hormones. Seven to eight hours of sleep nightly is recommended to support overall health. Plus, being evaluated for sleep apnea or lack of oxygen to the heart, brain and body when airway gets obstructed when sleeping.

Contact Dr. Myra Reed for developing lifestyle changes to help reduce your cardiac risks.


Ajufo, Ezimamaka et al. 2021. “Value of Coronary Artery Calcium Scanning in Association With the Net Benefit of Aspirin in Primary Prevention of Atherosclerotic Cardiovascular Disease.” JAMA Cardiology, 6(2): 179-187. doi:10.1001/jamacardio.2020.4939

Cardiac Calcium Scoring (Heart Scan). Retrieved Jan. 13, 2023.

Centers for Disease Control and Prevention. N.D. “Heart Disease Facts.” Last modified Oct. 14, 2022.

Greenland, Philip et al. 2018. “Coronary Calcium Score and Cardiovascular Risk.” Journal of the American College of Cardiology, 72(4): 434-447. doi:10.1016/j.jacc.2018.05.027

Mori H, Torii S, Kutyna M, et al. 2018. “Coronary Artery Calcification and its Progression.” J Am Coll Cardiol Img. (1): 127–142.

Nagai, Michiaki et al. 2010. “Sleep Duration as a Risk Factor for Cardiovascular Disease- A Review of the Recent Literature.” Current Cardiology Reviews, 6(1): 54-61. doi:10.2174/157340310790231635.

Stewart, Jack et al. 2020. “Primary Prevention of Cardiovascular Disease: Updated Review of Contemporary Guidance and Literature.” JRSM Cardiovascular Disease, (9): 2048004020949326. doi:10.1177/2048004020949326.

Wright, N., Wilson, L., Smith, M. et al. 2017. “The BROAD Study: A Randomized Controlled Trial Using a Whole Food Plant-based Diet in the Community for Obesity, Ischaemic Heart Disease or Diabetes.” Nutr & Diabetes, (7): e256.

World Health Organization. N.D. “Cardiovascular Diseases (CVDs)”. Retrieved Jan. 13, 2023.

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