Is a calcium score of my heart worth doing?
For people aged 40 to 75 in a grey zone regarding statins, a calcium score is a well-supported tool for making a considered decision about medication together with your doctor.
A calcium score, also known as a CAC score, measures how much calcium deposit is visible in the coronary arteries of the heart. Several major guidelines, including those from the American (ACC/AHA), European and various other international organisations, recognise the test as a useful tool in people without known heart disease, specifically to help determine whether you need medication such as statins.
The test is most valuable when it is unclear whether you should start statins. That applies to people between 40 and 75 years old without diabetes, with moderately elevated cholesterol and a ten-year risk of a heart attack of roughly 7.5 to 20 percent. In that grey zone, the score helps to refine that decision in consultation with your doctor. If your risk is very low or clearly high, the test adds less value.
A score of zero provides extra reassurance: no calcium is visible, and if you do not smoke, do not have diabetes and there is no early heart disease in your family, you may, in consultation with your doctor, defer starting statins. A score of 100 or higher, or above the 75th percentile for your age and sex, does make statin treatment indicated. Not only the amount of calcium matters: a study in more than 21,000 people showed that more compact, denser calcium deposits are associated with a lower risk than the same amount of less compact calcium. That adds nuance to the picture.
A long-running study in more than 5,700 asymptomatic adults showed that a higher CAC score was also associated with a greater chance of dying over a twelve-year period, independent of other risk factors. That study also made clear that the CAC score sometimes predicts outcomes slightly less well than other measurements, such as the amount of plaque in the carotid arteries. The test is therefore useful, but not the only tool available.
The CAC measurement itself involves a small radiation dose and costs money. There are fixed costs and the test is not always reimbursed. Discuss with your general practitioner or cardiologist whether your situation (age, risk factors, existing medication) would genuinely benefit from this additional information, or whether the result would not change your treatment.
All claims are based on guideline documents (ACC/AHA, ESC, and various others) and observational cohort data (BioImage study, meta-analysis of 5 cohorts). There are no randomised trials demonstrating that performing a CAC measurement improves clinical outcomes; its value has been established for risk stratification and decision support.
What does my CRP value (inflammation) say about my heart?
A high hsCRP value points to chronic inflammation and predicts a clearly elevated long-term risk of cardiovascular problems, even more strongly than well-known cholesterol values. It is an independent risk factor that deserves serious attention.
Is a high homocysteine level bad for my heart?
Elevated homocysteine is associated with a higher risk of cardiovascular disease, but whether you can reduce that risk by lowering homocysteine with folic acid has not been proven on the basis of these studies. Have an elevated value discussed with your general practitioner.
Does having bad gums affect my heart?
There is a plausible association between severe gum disease and heart problems, but no proven causal relationship. Good oral care is sensible, but whether treating gum disease lowers your cardiac risk has not yet been demonstrated.
Is an ECG from your smartwatch actually useful?
For detecting atrial fibrillation, a smartwatch ECG can be useful, especially as a supplement to medical monitoring. For other heart conditions, the evidence is still too thin.
How much calcium do I need per day, and can too much be harmful?
Calcium requirements range from 800 mg (young children) to 1500 mg per day (older adults, teenagers, postmenopausal women). Up to 2000 mg per day is safe for most people; wherever possible, aim to meet requirements through food.
Do you really need calcium supplements for strong bones?
Whether you need calcium supplements depends strongly on your age and circumstances: for young, healthy women there is no evidence of benefit, while people over 50 may benefit from calcium plus vitamin D, provided the increased risk of kidney stones is taken into account.