Healthcare providers sometimes use a calcium score to help decide whether to recommend treatment with a statin.
Charday Penn/Getty Images
A “calcium scan” is an X-ray technique used to assess the amount of calcium deposits in the coronary arteries, which indicates thatatherosclerosisis present.Statins are used to treathigh cholesteroland prevent coronary artery disease that leads toheart attacks.
However, in some people, the calcium score increases with statin therapy. This is a point of controversy and concern amongcardiologists(heart experts).
This article explains why statins are used and what their relationship to your calcium score may mean. It also covers why there’s some evidence to suggest a rise in the score may actually indicate a treatment benefit.
What Do Calcium Scores Mean?A calcium score of zero, measured in the coronary arteries, means there is no identifiable disease. You have a low risk for cardiovascular incidents like heart attack,stroke, or related death in the next 10 years. Your healthcare provider may assess treatment with statins on the basis of this score, as well as other factors.Calcium score ranges also include:1 to 99: mild disease100 to 399: moderate disease400 or higher: severe disease
What Do Calcium Scores Mean?
A calcium score of zero, measured in the coronary arteries, means there is no identifiable disease. You have a low risk for cardiovascular incidents like heart attack,stroke, or related death in the next 10 years. Your healthcare provider may assess treatment with statins on the basis of this score, as well as other factors.Calcium score ranges also include:1 to 99: mild disease100 to 399: moderate disease400 or higher: severe disease
A calcium score of zero, measured in the coronary arteries, means there is no identifiable disease. You have a low risk for cardiovascular incidents like heart attack,stroke, or related death in the next 10 years. Your healthcare provider may assess treatment with statins on the basis of this score, as well as other factors.Calcium score ranges also include:
Why Statins Are Prescribed
Statin drugs like Lipitor (atorvastatin) are used to treat your cholesterol level but also any plaque buildup in the walls of your arteries due to atherosclerosis. These plaques can grow large enough to partially block the artery and produce symptoms, such asanginaor claudication.
Claudication occurs when poor blood flow due to arterial disease leads to symptoms of pain and weakness in the legs when you walk.
The real problem with these plaques is that they can suddenly rupture, causing a sudden occlusion (blockage) of the artery—which often leads to a heart attack or a stroke.
What Causes Plaque in the Arteries?
Statins and the Calcium Score
Several studies have now shown that treating a patient who has atherosclerosis with statins canincreasethe cardiac calcium score, even though elevated scores are cause for concern and often the reason for treating with statins in the first place.
In 2015, a study was published in theJournal of the American College of Cardiologywhich helps to clarify what this increase in calcium means.
Investigators reviewed eight separate studies which had used intravascular ultrasound (IVUS, a catheter technique) to assess the size and composition of atherosclerotic plaques in patients treated with statins. They found two things:
After statin therapy, the volume of lipid deposits within plaques diminished, and the volume of fibrotic cells and calcium increased. These changes—converting an unstable “soft” plaque to a more stable “hard” plaque—may render a plaque less prone to sudden rupture.
Researchers think this finding may be linked to the fact that statin therapy significantly reduces the risk of heart attacks in patients with coronary artery disease.
Statins and Higher Calcium ScoresEvidence supports the idea that statin therapy not only reduces cholesterol levels but also changes existing plaques to make them less dangerous. As part of this process, the plaques may become more calcified—and thus, the calcium score goes up. An increasing calcium score with statin therapy, therefore, may indicate treatment success, and should not be a cause for alarm.
Statins and Higher Calcium Scores
Evidence supports the idea that statin therapy not only reduces cholesterol levels but also changes existing plaques to make them less dangerous. As part of this process, the plaques may become more calcified—and thus, the calcium score goes up. An increasing calcium score with statin therapy, therefore, may indicate treatment success, and should not be a cause for alarm.
While this theory is not settled science, at this point it best fits the available evidence.
Summary
A cardiac calcium scan can be a useful tool in assessing the presence or absence of coronary artery disease. If calcium is present, atherosclerosis is present—and aggressive lifestyle changes are in order. Statin therapy and other inventions, like taking a daily aspirin, may be prescribed.
But once statin therapy has begun, interpreting later calcium scans becomes more of a problem. If the calcium score goes up, it may not indicate worsening coronary artery disease, but rather, is likely to be a positive effect of statin treatment.
Talk with your healthcare provider about your screening calcium scan, and why it may be helpful if you are at some risk for coronary artery disease. Keep in mind, though, that higher calcium scores from repeat scans after statin therapy may actually indicate the statins are working.
6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ,et al.2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation. 2019 Sep 10;140(11):e596-e646. doi:10.1161/CIR.0000000000000678.
Lee D, Joo HJ, Jung HW, Lim DS.Investigating potential mediator between statin and coronary artery calcification.PLoS One. 2018;13(9):e0203702. doi:10.1371/journal.pone.0203702
National Heart, Lung, and Blood Institute (NHLBI).Atherosclerosis.
Johns Hopkins Medicine.Claudication.
Desai MY, Cremer PC, Schoenhagen P.Thoracic aortic calcification: diagnostic, prognostic, and management considerations.JACC Cardiovasc Imaging. 2018;11(7):1012-1026. doi:10.1016/j.jcmg.2018.03.023
Puri R, Nicholls SJ, Shao M, et al.Impact of statins on serial coronary calcification during atheroma progression and regression.J Am Coll Cardiol. 2015;65:1273-1282. doi:10.1016/j.jacc.2015.01.036Shaw LJ, Narula J, Chandrashekhar Y.The never-ending story on coronary calcium.J Am Coll Cardiol. 2015;65:1273-1282. doi:10.1016/j.jacc.2015.02.024
Puri R, Nicholls SJ, Shao M, et al.Impact of statins on serial coronary calcification during atheroma progression and regression.J Am Coll Cardiol. 2015;65:1273-1282. doi:10.1016/j.jacc.2015.01.036
Shaw LJ, Narula J, Chandrashekhar Y.The never-ending story on coronary calcium.J Am Coll Cardiol. 2015;65:1273-1282. doi:10.1016/j.jacc.2015.02.024
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
