Do You Need a Calcium Score Test? Why It Matters for Heart Health

In the United States, roughly one in ten adults have high cholesterol. If you’re one of them, you may already be making changes to lower your risk of heart disease, like eating better and exercising. 

How do you know if your efforts are paying off, or if you need to do more to lower your cholesterol? That’s where the calcium score test comes in. This non-invasive CT scan gives you and your healthcare provider a better picture of your heart health today—and in the future.

Why Cholesterol Testing Isn’t Enough

Cholesterol tests are one of the first tools providers use to assess heart health. They measure your LDL (bad cholesterol), HDL (good cholesterol), and triglycerides, giving you a snapshot of what’s circulating in your bloodstream. These numbers matter, but they only tell part of the story. 

While blood tests can measure your cholesterol levels and tell you if they’re high, they can’t detect actual damage or calcification inside your artery walls that could be blocking healthy blood flow. “If you have higher calcium or plaque build up in the heart, there’s less room for normal blood flow within the arteries of the heart,” says Jessica Meisner, NP, a nurse practitioner based in North Carolina and board certified in Family Medicine. More plaque increases your risk of coronary artery disease (CAD), a type of heart disease that’s the leading cause of death worldwide.

To see whether or not plaque is silently building up in your arteries, you need a visual scan of your heart. Enter: the calcium score test.

What is the Calcium Score Test?

At a high level, a calcium score test, also called a coronary artery calcium (CAC) scan, is a CT scan that looks at how much calcium is in the coronary arteries of your heart and restricting blood flow. The test looks for calcium deposits because when fatty plaque builds up in the arteries over time, it often calcifies. Providers call this plaque buildup atherosclerosis, which is why you’ll also see coronary artery disease referred to as coronary atherosclerosis. 

Why Is the Calcium Score Test Important? 

When someone has high cholesterol, their primary care clinician will often assess their risk of developing artherosclerotic heart disease. To do this, they’ll use a pooled cohort equation that accounts for risk factors such as:

• Age
• Sex
• Ethnicity
• Systolic blood pressure
• Blood pressure medication use
• Total cholesterol HDL cholesterol
• Tobacco use
• History of diabetes

Based on these factors, your clinician can determine your risk of experiencing a major cardiovascular event (such as heart attack, stroke, or death) in the next 10 years, in comparison to the general population. If your risk is greater than 7.5–10%, your clinician will likely recommend a cholesterol medication, such as a statin. 

But some people want more information before adding a new medication to their routine, says Kyauna Sanders, MD, a physician based in New Jersey who is board certified in Internal Medicine. “Calcium scores can help them dig further into what their risk might be. If it’s high, that’s indicative that they have a significant amount of plaque disease in their coronary arteries, and now they know they need to start treating their cholesterol with a statin.”

Who Should Get a Coronary Calcium Score Test?

Some people are more likely to benefit from getting a calcium score test, says Meisner, including those who:

• Are 40–70 years old
• Have a family history of heart disease
• Have a history of metabolic syndrome, type 2 diabetes, high cholesterol, or high blood pressure
• Have overweight or obesity
• Smoke or use tobacco

If you have these risk factors, it’s possible you’ve already had a conversation with your provider about your cholesterol levels and risk of heart disease. “In most cases, the calcium score test is most beneficial for people who are trying to make a decision about whether they should take a statin for cholesterol,” says Kyauna Sanders, MD. “It’s not recommended to randomly screen for heart disease or coronary artery disease in an asymptomatic patient.”

Calcium score tests may not be covered by insurance, but they can be relatively affordable out-of-pocket, says Meisner. According to a recent study, it usually averages less than $200.

What Happens During a Coronary Calcium Scan?

The calcium score test is quick and non-invasive. On the day of the exam, you’ll need to avoid drinking, eating, or smoking for 4 hours beforehand. Once you arrive, you’ll get undressed, take off any jewelry, and put on a hospital gown. Then, it’s time for the test.

You’ll lie on a table that slides into a CT (computerized tomography) scanner. Unlike a MRI scanner, which is enclosed on one end, a CT scanner resembles a large donut, so your head and feet will be exposed on either side. The healthcare professionals administering the scan will place sticky electrode patches on your chest so the machine can measure your heart activity. Once the scan begins, you’ll need to lie still as it takes X-rays of your heart and arteries. After about 10 minutes, the test will be finished and you’ll be free to go about your day.

Later, your provider will contact you to review your test results. Typically, you’ll be given a number, called an Agatston score or CAC score, which ranges from 0 to 400+. This number represents the amount of plaque found in your arteries (aka evidence of coronary artery disease) and your risk of experiencing a heart attack in the next 2 to 5 years. Here’s a quick breakdown:

Your CAC score might also be given as a percentile, which represents how your result compares to others of your age and sex. For example, a score of 75% would indicate that you have 75% more plaque in your arteries compared to other people like you, and you have a corresponding higher risk of heart attack in the next few years.

Depending on your CAC score, your provider might recommend:

• Lifestyle changes, such as diet, exercise, or quitting smoking
• Starting or adjusting medication, especially statins
• Additional heart tests or monitoring

The Bottom Line: Do You Need a Calcium Score Test?

To recap, a calcium score test doesn’t guess your risk based on averages—it looks directly at your arteries to see if plaque has already started to form. While blood tests estimate your risk, a calcium score test reveals it. That offers you several benefits:

• A calcium score test gives you a better idea of your cardiovascular risk. This is especially useful if you’re in a “gray area”—not clearly high- or low-risk.
• Your CAC score can guide treatment decisions. If you’re on the fence about taking a statin, your calcium score might make that decision easier. While a calcium score is not used to diagnose coronary artery disease in patients with symptoms, it is used to further elucidate if plaque disease exists in patients with high cholesterol and cardiovascular disease risks.
• Knowing your CAC score can help prevent heart attacks and strokes, since you can now take targeted steps to reduce your risk.

If you’re unsure whether a statin is right for you, or you just want a clearer picture of your heart health, a quick calcium score test can help you and your provider make more informed decisions about your treatment plan.

How K Health Can Help

Are you worried about your heart disease risk? You can visit a primary care provider online.

With the K Health app, you can check your symptoms, explore conditions and treatments, and if needed, text with a healthcare provider in minutes. 

K Health’s AI-powered app is based on 20 years of clinical data.