What Does Your Heart Score Mean?

A heart score may sound like something you get for eating the most Valentine's Day candies or being the top contestant on a dating game show.

But it's actually an important number that can tell you a lot about your heart artery health.

You’ll get a heart score, also called a calcium score, after you have a heart CT scan. It’s a simple, low-cost test that doctors may recommend for men age 40 or older and women 45 or older with risks like high cholesterol, high blood pressure, diabetes, smoking or a family history of heart disease.  

You and your doctor may find the test useful if you're deciding whether you need cholesterol medicine. If you already know you have heart disease or have had a stent or bypass surgery, you usually don’t need this test.

So what does your heart score mean for you? And what do you need to do next?

Alan Goldberg, MD, a cardiologist at Rush, explains how you and your physician can use your heart score to learn about your cardiovascular risks and form a care plan.

What is a heart score?

Getting a heart score starts with a heart CT scan.  

"We take a scan of your heart, which gives us a roadmap of any calcium buildup that you might have in your arteries," Goldberg says.  

Your heart score is a measure of the calcium in the plaque that has built up in your heart arteries. It can range from zero, meaning no calcium, to over 1,000. The higher the number, the more calcium buildup you have.

“The more calcium you have, the higher your risk of a heart attack or stroke,” Goldberg says.

Atherosclerosis is a buildup of plaque in the artery walls. Over time, it can narrow the arteries and lead to blockages and serious heart and vascular problems if it goes untreated.

But it's important to remember that a heart score above zero doesn't necessarily show that your arteries are narrowing.

“We’re not testing for the narrowing of your heart arteries,” Goldberg says. “We’re just seeing, is calcium there or is it not?”

With the information from this test, you and your doctor can make a plan. That may involve further testing, prevention or treatment.

"This is much more meant as a preventative test to see what your risk factors are in the future and how we can modify them," Goldberg says.

What is a normal heart score?

"The best possible heart score you can have is zero," Goldberg says. "That means you don't have any calcium buildup going on in your arteries."  

For many people, a score of zero means cholesterol medicine can wait. But it doesn’t rule out the presence of every kind of plaque in your arteries.  

Early plaque that hasn’t hardened with calcium won’t show up on a heart CT scan. That’s more common in younger people and in people who smoke, so your doctor will still look at your other risk factors.

And if your heart score is higher than zero, it may not mean you have an abnormal amount of calcium.

"When we're looking at calcium scores, we also compare them to other people," Goldberg says. "We compare your score against people your same age, your same gender and your same ethnicity."

So even if you have some plaque buildup, your score may be in a low or high percentile for people like you. For example, older adults tend to have some degree of calcium.

If your heart score is in a high percentile compared to others in your group, you may need to take extra steps to control your risks, like lowering your cholesterol.

"In those patients, we know that their risk is going to be higher than other people in their cohort, and we would treat them accordingly," Goldberg says. "And we would be more aggressive about trying to lower their lipids."

What does a low heart score mean?

If your heart score is not zero, it means you have some calcium buildup in your heart arteries.  

A score between one and 99 is still generally considered low, so long as it isn’t high compared with other people your age, gender and ethnicity.

"That puts us in the mild risk category," Goldberg says.  

Patients with scores in this range should often focus on prevention to keep their calcium buildup low. That may mean managing risks like high cholesterol.

Recently, the American College of Cardiology and the American Heart Association released new a cholesterol guideline that ties LDL goals to your heart score.

“When you have that lower score, the new guideline suggests that we need to target your LDL, your so-called bad cholesterol, to get it below 100,” Goldberg says.

Usually lowering cholesterol for people at mild risk involves changing diet and lifestyle first.

"Typically we recommend a Mediterranean diet high in vegetables, beans, lentils, chickpeas and other legumes," Goldberg says. "Try to minimize red meat. And if you are going to eat meat, eat white meat, chicken and fish. Avoid fast food and processed foods. And if you are going to use oil in your cooking, use a healthier oil, like olive oil."

Aside from changing what you eat, you may also need to start exercising more. Patients at mild risk should aim for at least 30 minutes of aerobic activity five days a week.  

"That can be swimming, it can be soccer, it can be Zumba," Goldberg says. "It can be anything as long as you're getting your heart rate up, you're breathing hard and you're sweating a little bit."

Some people with heart scores in the mild risk range may also need medication to manage cholesterol.

"We would probably recommend that someone at mild risk go on a moderate dose of a statin medication to get that LDL below 100 if they're not able to do that with lifestyle changes on their own," Goldberg says.

It's also important to follow up regularly with your cardiologist to monitor your cholesterol.

“I like to see them once a year so that we can check their lipids and make sure their LDLs are where we want them,” Goldberg says. “I also might check other blood tests, like lipoprotein(a), that give us a little bit more clarity as to why a patient’s calcium score might be elevated and what genetic predisposition they might have to atherosclerosis.”

Lipoprotein(a), or Lp(a), is a type of cholesterol that’s mostly inherited. The new guideline recommends that every adult have it checked at least once.

What does a moderate heart score mean?

A moderate heart score is generally between 100 and 299. But a lower score can also count as moderate if it’s high compared with other people your age, gender and ethnicity.  

Either way, it means your risk of a heart attack or stroke is higher.

“That moderate risk means we need to be more aggressive about getting your cholesterol under control,” Goldberg says. “For those patients, the new guideline would recommend that we get your LDL below 70.”

Aside from focusing more strictly on the same diet and lifestyle changes as those at mild risk, those at moderate risk may need a higher-intensity statin.

Your care plan will also likely involve getting other heart and vascular disease risks under control. That can mean quitting smoking, managing blood pressure or treating diabetes.

“And we’re going to take any potential symptom that they talk about that much more seriously because we know they already have plaque in their arteries,” Goldberg says. “We need to make sure that we triage it appropriately and we order the correct tests to make sure that high calcium isn’t starting to cause blockages in their heart arteries.”

Concerning symptoms can appear in patients with any heart score. But some of the symptoms that cardiologists take most seriously, especially in patients with moderate heart scores, include the following:

• Feelings of pressure in the center of the chest
• Shortness of breath, especially going up stairs
• Unusual sweating with light activity, especially with chest discomfort
• Numbness or tingling down the arm or up to the jaw

Patients at moderate risk who have symptoms may need further testing to see if their arteries have narrowed. And all patients at moderate risk will also need to follow up more often to make sure cholesterol and other factors stay under control.

"Everyone will be seen at least once a year to make sure that their cholesterol and other risk factors are properly taken care of," Goldberg says. "If someone is having symptoms, we're going to see them much more frequently to make sure that those symptoms aren't demonstrative of some worse underlying issue and that we get them under control."

What does a high heart score mean?

Patients with a heart score of 300 or higher are considered to be at high risk.

“If your score is 300 or higher, that’s when you definitely need to see a cardiologist and talk about your symptoms and potentially have a different kind of test, like a stress test or a coronary CT scan with contrast, to really figure out if that calcium buildup is causing problems,” Goldberg says.

Patients at high risk will also need to take extra steps to control their cholesterol more aggressively.

“We really need to get your cholesterol down as low as we possibly can,” Goldberg says. “The new guideline says we should get that LDL below 70, and below 55 for patients with the highest scores, over 1,000.”

For these patients, proper diet, lifestyle changes and statins may not be enough.

"We may try other medications such as nonstatins, like ezetimibe, or even injectable cholesterol medications, like PCSK9 inhibitors," Goldberg says. "We're also going to make sure your blood pressure is super well controlled and your diabetes and any other risk factors that might exist are under control."

If you have a very high heart score, you may feel concerned about your health. While it is important to make an appointment with a cardiologist as soon as possible, you don't need to treat it as an emergency if you're not having severe symptoms.

"No matter what your score is, you don't necessarily need to go to the emergency room," Goldberg says. "But it is really important that you meet with a cardiologist to discuss the meaning of the score and talk about any potential symptoms you may not even think are important but may actually imply some degree of heart artery narrowing."

That said, if you ever have chest pain or pressure that doesn’t go away, trouble breathing, or other signs of a heart attack, call 911 right away. Don’t wait for your appointment.

Can your heart score go down?

Once calcium builds up in your arteries, it doesn’t go away on its own, so your heart score will not go down. It also won’t go away with diet and lifestyle changes or medication, even though those are very important for preventing further plaque buildup.

In fact, your score may go up over time even when treatment is working.  

Statins help make plaque more stable, and part of that process can add calcium to it. That’s why a repeat heart CT scan isn’t the best way to tell whether your medicine is working. Your cholesterol numbers are.

But if you have a higher heart score than you expected, it’s important not to feel discouraged. A high score does not mean you’ll have a heart attack or need a procedure. It just means you should work with your cardiologist to take care of your risks.  

And if your plaque is causing problems, your cardiologist can work with you on a treatment plan.

For patients whose plaque is narrowing or blocking the heart arteries, there are also procedures to open or bypass those arteries. Your cardiologist can discuss these options with you and refer you to an interventional cardiologist or cardiac surgeon if needed.

"The great part about Rush and the heart scans that we provide is that the care doesn't stop after the calcium score," Goldberg says. "If there is any concern because of the scan, you'll be directly connected with a cardiologist so you can discuss the results and talk about your next steps. It really is just the beginning of a relationship so that we can come up with a personalized roadmap for each patient based on their score."

If you'd like to know your heart score, you can call Rush at (312) 942-5741 to make an appointment. Rush currently offers the test for only $49 out of pocket, and you do not need a referral. You can also learn more on our Heart CT Scan page.