A coronary Calcium Test is a CT scan of Coronary arteries that looks for evidence of calcified plaque and, hence, endothelial damage within Coronary Arteries.  The existence of any plaque means damage has occurred to the endothelium ( inner lining of arteries ). The higher score indicates plaque that narrows the arteries and, by default, the presence of dangerous soft tissue plaque. Hard plaque is calcified and considered stable, but soft tissue plaque still forms and presents a danger as it can break off, causing a coronary obstruction or stroke.

Soft tissue plaque may not be seen in this test, so a CT coronary Angiogram with dye is often recommended. This test is better suited for those at risk of Coronary Artery disease.

Based on CAC ( coronary Artery Calcium score) results and ten-year event risk, this is the suggested management of asymptomatic patients. The risk value is shown in brackets –

CAC Score : 

O  very low risk (<1%)- no action is required.  Maintain a healthy diet and lifestyle.

 CAC Score:

1-100  Low risk  (<10%)

Medical advice: maintenance of a healthy diet and lifestyle. Consider active intervention of risk factors in younger patients, and depending on the age adjustment, a cardiologist referral may be appropriate.

 Nutritional advice: Any score, even minimal, shows endothelial damage that worsens with age, diet and environmental factors.  Supplements at this stage could be considered, but dietary and lifestyle factors/ whole health counselling should be undertaken. A food diary analysis would be helpful to assess better food choices. An HTMA ( Hair Tissue Mineral Analysis ) would be beneficial in providing information on an appropriate diet and food choices. 

CAC Score :

101-400 Moderate risk  ( 10-20%) 

 Medical Advice: Reclassify as high risk. Statins are considered appropriate. Consider aspirin. Consider referral to a Cardiologist.

Nutritional Advice: Supplements for correcting endothelial damage are advised in addition to previous advice. An HTMA ( Hair Tissue Mineral Analysis ) test + food diary assessment is highly recommended to assess the impact of diet and minerals.  Metabolic risk factors would be evaluated, and a fasting Insulin and ApoB test would be recommended. 

CAC Score : 

400 +   High Risk  (>20%) 

Medical Advice: Statins + aspirin + referral to cardiologist for total workup and risk assessment. 

Nutritional advice: As detailed in previous comments. 

 Investigate Supplements that can be used in co-commitment with statins and aspirin if the situation eventuates. Double-check all risk factors and Metabolic data. Drastic lifestyle changes and the use of Endothelial Healing and cholesterol-lowering supplements are strongly advised. 

Please note: The risk of Cardiovascular disease and events is based on several risk factors, e.g., C relative protein, Uric acid levels, Homocysteine levels, and the insulin fasting test, not just Coronary calcium scores.

 ApoB lipoprotein risk is an independent risk and a significant factor. A less than <  1.0 g/l measurement is considered low risk. A measure target of <.8 g/l is recommended for those of high CVD  risk. Measurement of above > 1.05g/l is regarded as

a higher long-term risk. 

Before Statins are prescribed, both tests should be done to assess overall risk. For example, those with a low Coronary score are still at risk if their ApoB levels are above the norm.

Other issues that play into CVD risk factors are Metabolic health, exercise, and stress levels, which, for some, significantly impact CVD  Health. 

This article does not include specific supplements or lifestyle advice, as each person must be assessed individually according to all risk factor data.

Coronary calcium score risk is often updated, so the figures presented in this article are only a guide. Risk must be adjusted for age. For example, a 70-year-old with a score of 1-100 would be average, but a 30-year-old with this score would be of concern. A low score is not an indication of low CVD risk.  It is one factor, and the overall risk factors must be assessed for informed decisions. 

Sources for preparing this article: 

Dr Dayspring, M.D lipidologist. Dr Ross Walker, Cardiologist.Simon Hill,” The Proof “ podcast. 

For a complete holistic assessment, please consult with me at www.adelaidenaturopath.net.au 

 Peter Farnsworth N.D 10/09/2024