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Calcium Score and Statins: What’s the Connection?

Key Takeaways

  • Coronary calcium scoring is a CT (computed tomography) scan done to look for calcium deposits, or plaques, in the coronary arteries, which can lead to reduced blood flow to the heart muscle, causing atherosclerotic disease. 
  • Statins help to stabilize the plaques. People with stable plaques are at a lower risk of cardiovascular disease.

Do statins affect calcium score?

Doctors use coronary artery calcium scoring to assess the risk of atherosclerotic disease (ASCVD) and start statin therapy in high-risk patients. Some increase in the cardiac artery calcium (CAC) score is expected with age. However, some studies have shown that people who take statins have a more rapid increase in their CAC score and CAC density.

Statin is generally initiated in individuals who are at high risk for heart disease, stroke, and heart attack. 

However, there are some findings suggesting that statin therapy can cause a more rapid progression in the cardiac artery calcium (CAC) score than what occurs with age. 

Let’s look at the different findings regarding statin therapy and the CAC score of statin users. 

  • CAC score can help clinicians identify individuals who may benefit from a lipid-lowering therapy. CAC score can also provide useful insights for clinicians regarding people with existing risk factors for cardiovascular diseases who don’t need to be on a lipid-lowering therapy like statin. Cardiovascular risk factors can be very broad. Someone with a history of diabetes, high blood pressure, or obesity will be at risk for heart disease and stroke. 
  • In 2018, the American College of Cardiology/American Heart Association (ACC/AHA) introduced the coronary artery calcium score as a tiebreaker when deciding to initiate, postpone, or withhold statin therapy for adults at borderline risk of atherosclerotic artery disease. CAC score can range from 0 (zero) to as high as over 400. The higher the CAC score, the higher the chance of cardiovascular events. 

  • CAC density is another factor that was studied regarding its role in predicting the incidence of cardiovascular events. Studies have shown that CAC density is inversely related to the risk of cardiovascular events in the future. This is the complete opposite of the CAC score. This means denser calcified plaques are more stable and less likely to cause a cardiac event. Thus, the role of CAC density should be considered when evaluating a person’s CAC score. 

  • Experts at the Coronary Artery Calcium Consortium say that statin therapy accelerates the calcification of plaques in the artery walls. This means statins help to stabilize the plaques. People with stable plaques are at a lower risk of atherosclerotic cardiovascular events such as heart attack and have better cardiovascular outcomes. 
  • Studies have found that high-dose statin therapy (atorvastatin 80 mg) reduces LDL cholesterol by about 73 mg/dL after one year compared to low-dose statin therapy (pravastatin 40 mg or atorvastatin 10 mg), which reduces LDL cholesterol by around 46 mg/dL. On average, CAC density increases from around 229 to 233 after one year of statin therapy. There is no difference in CAC density between patients on low- and high-intensity statin therapy.
  • While CAC score has been shown to be a great tool when deciding the treatment approach for patients, more research is needed to establish the role of CAC score and the risk for cardiovascular diseases. The American Academy of Family Physicians (AAFP) makes a case against the use of CAC scores because the findings were never tested in randomized controlled trials, and the decision is an oversimplification.   

So what does this all mean? 

The CAC score was introduced in 2018 with the updated cholesterol guidelines. With such a broad categorization of cardiac risk factors, CAC score and CAC density have great potential to help clinicians initiate lipid-lowering therapy on those who need it without overtreatment. 

However, much more research is necessary to solidify its role and the recommendations. 

If you are prescribed a statin, you should take it exactly as prescribed. Depending on your cholesterol levels, keep in mind that consistent lifestyle changes are sometimes sufficient to achieve the target cholesterol levels.  

What is coronary artery calcium scoring? 

Coronary artery calcium scoring is a special type of electron beam computed tomography (CT) scan. It is also called a coronary calcium score, coronary artery calcium testing, or heart CT calcium scan. 

This test is done to look for calcium deposits in the coronary arteries that supply the heart. The presence of coronary artery calcification can lead to reduced blood flow to the heart muscle. 

Using risk assessment tools like a coronary artery calcium score helps doctors in diagnosing subclinical coronary atherosclerosis (early coronary heart disease before it causes symptoms).

Your doctor may order a coronary artery calcium score if you don’t have symptoms but are at a high or intermediate risk of coronary atherosclerosis because of a family history of premature heart disease. 

They can then use your coronary artery calcium score to determine your ASCVD risk and plan primary prevention and treatment.

What does my CAC score mean?

Your CAC score is a number called the Agatston score. It is a measure of the total area and density of the calcium deposits in your coronary arteries.

  • A CAC score of 0 means zero coronary artery calcium or no calcium deposits seen in your heart. This means you have a low chance of experiencing a heart attack in the future.
  • If calcium deposits are found, the higher your CAC score, the more your risk of heart disease.
  • A CAC score between 100 and 300 indicates a moderate amount of coronary artery calcification. This puts you at a relatively high risk of heart disease and heart attack in the next 3-5 years.
  • A CAC score above 300 indicates extensive coronary artery calcification. It puts you at an even higher risk of suffering cardiovascular events such as a heart attack.

Your coronary artery calcium testing result may also be reported as a percentage. This is the amount of calcium in your heart arteries compared to others of the same age and sex. Scores above 75% are associated with a significantly higher risk of heart attacks.

Do I need a statin if I have a zero calcium score?

According to the CAC score, if you have a zero calcium score, your overall risk of atherosclerotic cardiovascular disease and coronary events is generally not considered high enough to initiate statin therapy. However, coronary calcium measurements are used as an add-on to other risk-enhancing factors. 

In other words, CAC scores are used during the clinician-patient risk discussion to more accurately identify the risk of atherosclerotic disease and decide if a person might benefit from statin therapy.

Do you need to have coronary artery calcium testing on statin therapy?

The American College of Cardiology & American Heart Association have the following recommendations with regard to coronary artery calcium scores and risk prediction in statin candidates:

  • If a person is at a borderline risk of atherosclerotic cardiovascular disease and the decision to use statin therapy is unclear, a CAC score can be used to decide whether to initiate statin therapy or postpone it.  
  • While other risk assessment tools are used to identify high-risk patients, a CAC score of zero can be used to identify low-risk patients who might wish to avoid taking statins.

Keep in mind that many people are treated with statins without undergoing coronary artery calcium measurements. CAC testing is used to aid decision-making when there is uncertainty about a patient’s atherosclerotic disease risk, or a patient wishes to defer statin therapy.

Additionally, CAC measurement is used in older adults (76 to 80 years of age) who have LDL levels between 70 and 189 mg/dL. In these individuals, a CAC score of zero may allow them to avoid statin therapy.

How do statins lower the risk of atherosclerotic cardiovascular disease?

Statin drugs block the action of an enzyme called HMG-CoA (hydroxymethylglutaryl-CoA) reductase that is needed by the liver to make cholesterol. Therefore, by blocking this enzyme, statin helps to lower blood cholesterol levels. 

High cholesterol is one of the traditional cardiovascular risk factors for coronary artery disease and cardiovascular events like heart attacks. 

When there is too much cholesterol circulating in the blood, it can build up in the artery walls. The fatty deposits (plaques) can cause narrowing and blockage of blood vessels that carry blood to the heart muscle. 

This is called atherosclerotic cardiovascular disease (ASCVD) or coronary heart disease. It is a risk factor for coronary heart disease events such as heart attacks.

Can statins reverse plaque buildup?

Yes, by lowering LDL levels (bad cholesterol levels) in the blood, statins can reverse plaque buildup and help stabilize existing plaques. These drugs can also reduce the risk of pieces of plaque breaking off to form blood clots

Blood clots can potentially cause coronary and cardiovascular events such as a heart attack or stroke

What medications reduce calcium score?

If your coronary artery calcification score is very high, your healthcare provider may prescribe lipid-lowering therapy, such as statins, and clot-dissolving medications, such as aspirin. 

Statins are often prescribed to people with high cardiac calcium scores. Reducing cholesterol leads to a stabilization of atherosclerotic plaques and an increase in the coronary artery calcium (CAC) score.

Clinical practice guidelines for a high CAC score also include surgical procedures to remove plaque from the heart and lower the score. 

Your healthcare provider may recommend surgical procedures such as coronary stenting or a heart bypass surgery if the plaque buildup is severe. 

Once you have successfully reduced your CAC score, you should address the root causes of your high CAC score. This includes lifestyle changes and managing health conditions that can lead to coronary artery calcification. 

What is a calcium score?

A cardiac calcium score is used to measure coronary artery calcification, i.e., deposits of calcium in the heart arteries. It helps to assess a person’s risk of cardiovascular events such as heart attacks. 

What are statins used for?

High levels of blood cholesterol, specifically low-density lipoprotein (LDL cholesterol or bad cholesterol), are associated with an increased risk of developing atherosclerotic cardiovascular disease (ASCVD). This is a narrowing or hardening of the arteries that supply blood to the heart. 

Statins are a group of drugs that decrease cholesterol levels and reduce atherosclerotic cardiovascular risk. 

Key Takeaway

A heart calcium score helps doctors in performing a cardiovascular risk assessment. It can aid decision-making about starting or delaying statin therapy. 

Taking statins can lead to an increase in the CAC score due to a plaque stabilization effect. However, testing for coronary artery calcium should be carried out only when necessary because it involves a CT scan and radiation exposure

You should talk to your doctor if you are interested to know your CAC score and CAC density. Continue to take your cholesterol medication exactly as prescribed to lower the risk of heart attacks and stroke, 

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