Understanding the CT Calcium Score: A Key Tool for Preventive Heart Health
At Gutwell Medical, we’re passionate about helping patients live longer, healthier lives, and that starts with prevention. Dr. Mitchell is especially passionate about longevity and proactive heart health, which is why we’re highlighting a valuable (and underused) tool in preventive cardiology: the CT calcium score.
This simple imaging test can reveal early signs of plaque buildup in the arteries long before symptoms appear. By understanding your calcium score, you can make more informed decisions about lifestyle, nutrition, and preventive care to protect your heart for the long term.
Let’s break it down so you can understand what this test is, and why it might be useful for you.
What Is a CT Calcium Score?
A CT calcium score, also known as a coronary artery calcium (CAC) scan, is a specialized CT (computed tomography) scan of the heart that measures how much calcium is present in the walls of your coronary arteries, the vessels that supply blood to your heart muscle.
The test detects calcified plaque: hardened deposits of cholesterol, fat, and calcium that build up in the arteries. The amount of calcium correlates with the amount of plaque, which is one indicator of the degree of atherosclerosis (narrowing or hardening of the arteries). Calcified plaque builds up slowly over time and is fairly stable.
To get a more complete picture of artery narrowing, you’d also need to look at soft plaque (pictured on the right), which is the more vulnerable type. Soft plaque can build up quickly over a short period of time and is more prone to rupturing and leading to a blood clot and blockage of blood flow.
To see soft plaque non invasively you can use a CT or MRI technology to view the coronary arteries. This is not covered by insurance for screening purposes.
So while a CT Calcium score only shows calcified plaque, it’s an affordable, low-risk way to start to get information about your cardiac risk.
Reminder: The CT calcium score only detects calcified plaque, not soft plaque. Soft plaque can be seen through a cardiac catheterization or a CTA (CT angiogram) of the heart.
How Does It Work?
A CT calcium score uses low-dose X-rays to take cross-sectional images of your heart. A computer combines these images into detailed 3D pictures of your coronary arteries. While the test uses radiation, it’s considered very low-dose - typically 1–3 mSv, depending on the scanner and protocol (confirm with your imaging center).
Data Source: American Cancer Society. (2018, August 3). Understanding radiation risk from imaging tests. cancer.org
What the Test Measures
Calcium appears as bright white spots on the CT images because it’s dense and blocks X-rays more than soft tissue or blood. Specialized software measures both the density and area of these calcified spots to calculate your Agatston score - your total coronary calcium score.
Understanding Your Score
Note: Scores do not always correlate with narrowing, as this only detects calcified plaque and not soft plaque.
As seen in this table, lower scores can correlate with lower risk of heart disease, and higher scores with a higher risk. This doesn’t mean that a score of 0 guarantees your arteries are completely clear; nor does it mean that a high score guarantees you have or will have heart disease.
A recent study found that 25% of those with a CT calcium score of zero had obstructive coronary artery disease, defined as greater than 50% stenosis, which was detected by invasive coronary angiography (Mokhtar et al., 2025). This study also found that 79% of those with a score over 400 had obstructive coronary artery disease. So this tells us that a score over 400 correlates well with disease, but a score of zero could mean additional screening is needed in those at high risk of cardiovascular disease. Again this is because it only measures calcified plaque and doesn’t give any information about the amount of soft plaque that may be contributing to narrowing.
REMINDER: A CT calcium score is a helpful screening tool, but it is not diagnostic, as the score does not always correlate with narrowing.
Who Should Get a CT Calcium Score?
Dr. Mitchell recommends a CT calcium score for anyone with:
A family history of early onset heart disease, heart attack, or stroke
Elevated cholesterol, blood pressure, or inflammation markers
A desire for preventive insight before symptoms appear
The test is quick (about 10 minutes), noninvasive, and doesn’t require contrast dye or IVs.
How Often Should It Be Done?
There isn’t a universal guideline for how often to repeat the test. For most patients, every 3–5 years is reasonable, or sooner if your risk factors change significantly. Always discuss timing with your healthcare provider.
What to Do with Your Results
It’s important to know that calcified plaque cannot be fully reversed, but you can slow or stop its progression. This is where functional medicine and nutrition play a powerful role. At Gutwell Medical, we recommend a comprehensive approach that includes:
Advanced Lab Testing
NMR Lipid Panel: Evaluates cholesterol particle size and number for deeper insight into lipid health.
Omega-3 Index: Measures essential fatty acid balance, which is linked to cardiovascular protection.
Cardiac CRP (hs-CRP): Detects low-grade inflammation that can contribute to arterial damage.
Smart Supplementation
If you take vitamin D3, pair it with vitamin K2. Research shows that K2 helps direct calcium into bones and teeth where it belongs, and away from arteries, where it can contribute to plaque buildup. El Ameen et al. (2024) found that 6 months of K2 supplementation can reduce arterial calcification progression.
Nutritional & Lifestyle Strategies
Eat a Mediterranean-style diet rich in vegetables, omega-3 fatty acids, olive oil, and fiber.
Limit processed foods, refined carbohydrates, and added sugars that can drive inflammation.
Maintain a healthy weight, manage stress, optimize sleep, exercise regularly, and stop smoking.
The Bottom Line
The CT calcium score is a powerful tool in preventive cardiology, especially when paired with functional medicine insight. It gives you a snapshot of your heart’s health today and a roadmap for protecting it in the years ahead. At Gutwell Medical, Dr. Mitchell works to connect the dots between gut health, cardiovascular health, and longevity, helping you live not just longer but better.
References
American Cancer Society. (2018, August 3). Understanding radiation risk from imaging tests. https://www.cancer.org/cancer/diagnosis-staging/tests/imaging-tests/understanding-radiation-risk-from-imaging-tests.html
Israa Mohamed El Ameen, Ahmed Samir Ibrahim, Sherihan Said Madkour, Ahmed Ibrahim Hatata, Effect of Vitamin K2 on Progression of Coronary Artery Calcification by Multislice CT Examination, QJM: An International Journal of Medicine, Volume 117, Issue Supplement_2, October 2024, hcae175.927, https://doi.org/10.1093/qjmed/hcae175.927
Mokhtar, J., Albaree, M., Battistin, V., Asbaita, M., Akbarpoor, F., Lakshmanan, J., & El-Tamimi, H. (2025). Inadequacy of coronary calcium scoring in evaluating coronary artery disease: A call to shifting to high-resolution CT coronary imaging. International journal of cardiology. Cardiovascular risk and prevention, 26, 200476. https://doi.org/10.1016/j.ijcrp.2025.200476