Heart disease risk: Should I have a coronary calcium scan?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Heart disease risk: Should I have a coronary calcium scan?

Get the facts

Your options

  • Have a coronary artery calcium scan.
  • Don't have a coronary artery calcium scan.

This information is only for people who are curious about their risk for heart disease but don't have any symptoms such as chest pain.

Key points to remember

  • A coronary calcium scan checks for calcium buildup in the coronary arteries. Calcium in these arteries is an early sign of heart disease. A high score on a calcium scan can mean that you have a higher chance of having a heart attack than someone with a low score.
  • The results of a coronary calcium scan may prompt you to make some lifestyle changes, such as exercising, eating better, and quitting smoking. But if you're worried about heart disease, you can do these things even if you don't have this test.
  • People who are at medium risk for heart disease will get the most benefit from this test. Medium risk means that you have a 10% to 20% chance of having a heart attack in the next 10 years, based on your risk factors. You can be at medium risk and not have any symptoms of heart disease. Check your risk with this Interactive Tool: Are You at Risk for a Heart Attack?
  • A calcium scan can give your doctor more information about your risk for heart disease. A high score might prompt your doctor to start or change treatment to help you avoid a heart attack.
  • You could get a high score from the test even if your arteries are not blocked. This could lead to other tests or treatments that you don't need.
  • Not all blocked arteries have calcium. So you could get a low calcium score and still be at risk.
  • Not all health plans will pay for this test. The cost can range from $300 to $500.
FAQs

What is a coronary calcium scan?

A coronary calcium scan is a test for people who have no symptoms of heart disease but may be at risk for getting it. The test uses computed tomography (CT) to check for calcium buildup in plaque on the walls of the coronary arteries. The coronary arteries wrap around the heart and supply it with blood and oxygen. Calcium in these arteries is an early sign of heart disease.

During the test, a CT scan takes pictures of your heart in thin sections. The result is a score based on the amount of calcium seen on the scan. The higher your calcium score, the higher your risk for a heart attack. The test takes about 30 minutes.

Most health insurance plans do not pay for coronary calcium scanning. The cost of the test can range from $300 to $500.

Another test, called CT angiography, can also tell how much calcium has built up in your arteries. This test costs more than a standard coronary calcium scan. It uses a special dye that is injected into a vein (IV) in your arm. CT angiography is best for people who already have symptoms of heart disease, and only if other tests are unclear.1

Talk with your doctor if you want to know more about CT angiography. This Decision Point is about coronary calcium scanning.

Who should get a coronary calcium scan?

In most cases, the results from your physical exam and other tests will give your doctor enough information about your risk for heart disease. This test is not advised for routine screening for coronary artery disease. But your doctor may want you to have a coronary calcium scan if you have several risk factors. Risk factors are things that can increase your risk for heart disease, such as diabetes, high blood pressure, high cholesterol, and smoking.

You don't need to have your doctor refer you for a coronary calcium scan. But if you decide to have the test on your own, talk with your doctor first.

Coronary calcium scanning is most helpful in people who have no symptoms but who are at medium risk for getting heart disease.2 Medium risk means that you have a 10% to 20% chance of having a heart attack in the next 10 years, based on your risk factors. This means that 10 to 20 out of 100 people with this level of risk will have a heart attack in the next 10 years. Both the American Heart Association and the American College of Cardiology agree that people at medium risk can benefit from this test.3 The U.S. Preventive Services Task Force does not recommend this test for people who do not have symptoms of heart disease.4

To find out your risk, see the Interactive Tool: Are You at Risk for a Heart Attack? Or you can talk with your doctor about your risk for heart disease.

This screening test is not for you if:

  • You don't have any risk factors for heart disease.
  • You are at high risk for heart disease. (You should already be under a doctor’s care.)

What do the results mean?

After the scan, you will get a test result that is a number. This is your calcium score. The score can range from 0 to more than 400. Any score over 100 means that you are likely to have heart disease. The higher your score, the greater your chance of having a heart attack.

People who score between 100 and 400 or higher, and who are at medium risk for heart disease, are more likely to have a heart attack in the next 3 to 5 years than people who score 0.1

After you have the test, talk with your doctor about your results.

What are the benefits of a coronary calcium scan?

Many people only learn that they have heart disease when they have a heart attack. A coronary calcium scan is one way to find out if you have early heart disease before it gets worse. After you know your risk, you can make lifestyle changes such as eating a heart-healthy diet, getting more exercise, and quitting smoking. But if you're worried about heart disease, you can make these changes even if you don't have the test.

A coronary calcium scan can give your doctor more information about your risk for heart disease, especially if you already have risk factors. If your score is high, for example, your doctor may prescribe medicines to lower these risks. A high score may also lead to other tests and treatment that could help you avoid a heart attack.

What are the risks?

  • You could get a high score from the test even if your arteries are not blocked. This could lead to extra tests that you don't need. Or it could cause you to worry when there’s no reason. But these kinds of results are most likely to happen in people who are at low risk for heart disease. So if you already know that you're at low risk, you shouldn't get this test.
  • Not all blocked arteries have calcium. A low test score may make you feel safe even though you're still at risk.
  • Over time and after many CT exams, there is a slight chance of cancer from radiation used during the test.

Why might your doctor recommend this test?

  • You are at medium risk for heart disease, based on your risk factors.
  • Your doctor thinks that the results of this test could change your treatment and lower your risk for heart disease.

Compare your options

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have a coronary calcium scan Have a coronary calcium scan
  • You will lie on a table connected to the CT scanner. The table slides into the opening in the machine, and the scanner moves around your body. The test takes about 30 minutes.
  • A coronary calcium scan can give your doctor more information about your risk for heart disease, especially if you have several risk factors.
  • The results of the test may prompt you to make lifestyle changes that can help your heart.
  • The test can give a high score even if your arteries aren't blocked. This might lead to extra tests you don't need.
  • Not all blocked arteries have calcium. So you could get a low test score and still be at risk.
  • The test costs $300 to $500, and most health insurers don't pay for it.
Don't have a coronary calcium scan Don't have a coronary calcium scan
  • Instead of having a CT scan, your doctor gets information about your heart disease risk from a physical exam and other tests.
  • You make healthy lifestyle changes that can help your heart without taking a test.
  • You don't pay for a test you may not need. Most insurers do not pay for this test.
  • If you are at medium risk for heart disease and don't get a coronary calcium scan, you may not have all the information you need to reduce your risk.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

Personal stories about coronary calcium scanning

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

My mom had a heart attack in her early 60s, followed by bypass surgery. She didn't have a clue that she had heart disease. I don't want that to happen to me. I'm going to ask my doctor about getting a coronary calcium scan to check my risk.

Rose, age 48

My wife has been bugging me to get this test. So I asked my doctor about it. He said my risk for getting heart disease is pretty low even though I have high blood pressure. I'm taking medicine for that and for high cholesterol. I'm also trying to eat better and exercise. I just don't think the test is going to tell me more about my risk than I already know.

Jeffrey, age 56

My doctor says I'm headed for a heart attack unless I quit smoking. It's not that I haven't tried. But until something bad happens, it's hard to stay away from cigarettes. My doctor wants me to have a coronary calcium scan to find out if I already have heart disease. Maybe the results will give me the push I need to try to quit again—this time for good.

Tony, age 53

I get a physical exam from my doctor every year, and she says I'm in pretty good shape. But ever since I passed 50, I've been worried about heart disease. I saw an ad for this test in the newspaper and asked my doctor about it. It turns out that in healthy people like me, the test results aren't very reliable. I'm going to just keep getting an annual checkup.

Maria, age 54

For more information, see the topic Coronary Artery Disease.

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a coronary calcium scan

Reasons not to have a coronary calcium scan

I need more information about my risk so I can commit to making lifestyle changes or taking medicines.

I already know that I should make some lifestyle changes to keep my heart healthy.

More important
Equally important
More important

It's worth it to me to pay for this test myself.

My insurance won't pay for this test, and I can't afford it.

More important
Equally important
More important

I want to take any tests that could help me find out my risk for heart disease.

I don't want to take tests I don't need.

More important
Equally important
More important

I want to take this test because I need more information about my risk for having a heart attack.

I already know my risk for having a heart attack, so I don't need this test.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a coronary calcium scan

NOT having a coronary calcium scan

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Can anyone who is worried about heart disease benefit from a coronary calcium scan?

  • Yes No, that's wrong. People who are at medium risk for heart disease will get the most benefit from this test. If you are at low risk, the test results may not be reliable. If you are at high risk, you should already be under a doctor's care.
  • No You're right. People who are at medium risk for heart disease will get the most benefit from this test. If you are at low risk, the test results may not be reliable. If you are at high risk, you should already be under a doctor's care.
  • I'm not sure It may help to go back and read "Who should get a coronary calcium scan?" People who are at medium risk for heart disease will get the most benefit from this test.
2.

Does a high score on a coronary calcium scan always mean that your arteries are blocked?

  • Yes No, that's not right. You could get a high score on the test even if your arteries aren't blocked. That could lead to other tests or treatments you don't need.
  • No That's right. You could get a high score on the test even if your arteries aren't blocked. That could lead to other tests or treatments you don't need.
  • I'm not sure It may help to go back and read "What are the risks?" You could get a high score on the test even if your arteries aren't blocked.
3.

Could you still be at risk for blocked arteries even if you get a low calcium score on the test?

  • Yes That's right. Not all blocked arteries have calcium. So you could get a low score on the test and still be at risk.
  • No Sorry, that's wrong. Not all blocked arteries have calcium. So you could get a low score on the test and still be at risk.
  • I'm not sure It may help to go back and read "What are the risks?" Not all blocked arteries have calcium. So you could get a low score on the test and still be at risk.
4.

Is having a coronary calcium scan the only way to tell if you need to make lifestyle changes to help your heart, such as exercising, eating better, and not smoking?

  • Yes Sorry, that's wrong. Even without taking the test, you can make healthy lifestyle changes that can help your heart.
  • No You are right. Even without taking the test, you can make healthy lifestyle changes that can help your heart.
  • I'm not sure It may help to go back and read "What are the benefits of a coronary calcium scan?" Even without taking the test, you can make healthy lifestyle changes that can help your heart.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and references

Credits
Author Deborah Dakins
Editor Katy E. Magee, MA
Associate Editor Michele Cronen
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer George Philippides, MD - Cardiology

References
Citations
  1. Budoff M, et al. (2006). Assessment of coronary artery disease by cardiac computed tomography: A scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation, 114(16): 1761–1791.
  2. Greenland P, et al. (2004). Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA, 291(2): 210–215.
  3. Greenland P, et al. (2007). ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Circulation, 115(3): 402–426.
  4. U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/uspstf09/coronaryhdrs.htm.

Heart disease risk: Should I have a coronary calcium scan?

You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the facts

Your options

  • Have a coronary artery calcium scan.
  • Don't have a coronary artery calcium scan.

This information is only for people who are curious about their risk for heart disease but don't have any symptoms such as chest pain.

Key points to remember

  • A coronary calcium scan checks for calcium buildup in the coronary arteries. Calcium in these arteries is an early sign of heart disease. A high score on a calcium scan can mean that you have a higher chance of having a heart attack than someone with a low score.
  • The results of a coronary calcium scan may prompt you to make some lifestyle changes, such as exercising, eating better, and quitting smoking. But if you're worried about heart disease, you can do these things even if you don't have this test.
  • People who are at medium risk for heart disease will get the most benefit from this test. Medium risk means that you have a 10% to 20% chance of having a heart attack in the next 10 years, based on your risk factors. You can be at medium risk and not have any symptoms of heart disease. Check your risk with this Interactive Tool: Are You at Risk for a Heart Attack?
  • A calcium scan can give your doctor more information about your risk for heart disease. A high score might prompt your doctor to start or change treatment to help you avoid a heart attack.
  • You could get a high score from the test even if your arteries are not blocked. This could lead to other tests or treatments that you don't need.
  • Not all blocked arteries have calcium. So you could get a low calcium score and still be at risk.
  • Not all health plans will pay for this test. The cost can range from $300 to $500.
FAQs

What is a coronary calcium scan?

A coronary calcium scan is a test for people who have no symptoms of heart disease but may be at risk for getting it. The test uses computed tomography (CT) to check for calcium buildup in plaque on the walls of the coronary arteries. The coronary arteries wrap around the heart and supply it with blood and oxygen. Calcium in these arteries is an early sign of heart disease.

During the test, a CT scan takes pictures of your heart in thin sections. The result is a score based on the amount of calcium seen on the scan. The higher your calcium score, the higher your risk for a heart attack. The test takes about 30 minutes.

Most health insurance plans do not pay for coronary calcium scanning. The cost of the test can range from $300 to $500.

Another test, called CT angiography, can also tell how much calcium has built up in your arteries. This test costs more than a standard coronary calcium scan. It uses a special dye that is injected into a vein (IV) in your arm. CT angiography is best for people who already have symptoms of heart disease, and only if other tests are unclear.1

Talk with your doctor if you want to know more about CT angiography. This Decision Point is about coronary calcium scanning.

Who should get a coronary calcium scan?

In most cases, the results from your physical exam and other tests will give your doctor enough information about your risk for heart disease. This test is not advised for routine screening for coronary artery disease. But your doctor may want you to have a coronary calcium scan if you have several risk factors. Risk factors are things that can increase your risk for heart disease, such as diabetes, high blood pressure, high cholesterol, and smoking.

You don't need to have your doctor refer you for a coronary calcium scan. But if you decide to have the test on your own, talk with your doctor first.

Coronary calcium scanning is most helpful in people who have no symptoms but who are at medium risk for getting heart disease.2 Medium risk means that you have a 10% to 20% chance of having a heart attack in the next 10 years, based on your risk factors. This means that 10 to 20 out of 100 people with this level of risk will have a heart attack in the next 10 years. Both the American Heart Association and the American College of Cardiology agree that people at medium risk can benefit from this test.3 The U.S. Preventive Services Task Force does not recommend this test for people who do not have symptoms of heart disease.4

To find out your risk, see the Interactive Tool: Are You at Risk for a Heart Attack? Or you can talk with your doctor about your risk for heart disease.

This screening test is not for you if:

  • You don't have any risk factors for heart disease.
  • You are at high risk for heart disease. (You should already be under a doctor’s care.)

What do the results mean?

After the scan, you will get a test result that is a number. This is your calcium score. The score can range from 0 to more than 400. Any score over 100 means that you are likely to have heart disease. The higher your score, the greater your chance of having a heart attack.

People who score between 100 and 400 or higher, and who are at medium risk for heart disease, are more likely to have a heart attack in the next 3 to 5 years than people who score 0.1

After you have the test, talk with your doctor about your results.

What are the benefits of a coronary calcium scan?

Many people only learn that they have heart disease when they have a heart attack. A coronary calcium scan is one way to find out if you have early heart disease before it gets worse. After you know your risk, you can make lifestyle changes such as eating a heart-healthy diet, getting more exercise, and quitting smoking. But if you're worried about heart disease, you can make these changes even if you don't have the test.

A coronary calcium scan can give your doctor more information about your risk for heart disease, especially if you already have risk factors. If your score is high, for example, your doctor may prescribe medicines to lower these risks. A high score may also lead to other tests and treatment that could help you avoid a heart attack.

What are the risks?

  • You could get a high score from the test even if your arteries are not blocked. This could lead to extra tests that you don't need. Or it could cause you to worry when there’s no reason. But these kinds of results are most likely to happen in people who are at low risk for heart disease. So if you already know that you're at low risk, you shouldn't get this test.
  • Not all blocked arteries have calcium. A low test score may make you feel safe even though you're still at risk.
  • Over time and after many CT exams, there is a slight chance of cancer from radiation used during the test.

Why might your doctor recommend this test?

  • You are at medium risk for heart disease, based on your risk factors.
  • Your doctor thinks that the results of this test could change your treatment and lower your risk for heart disease.

2. Compare your options

  Have a coronary calcium scan Don't have a coronary calcium scan
What is usually involved?
  • You will lie on a table connected to the CT scanner. The table slides into the opening in the machine, and the scanner moves around your body. The test takes about 30 minutes.
  • Instead of having a CT scan, your doctor gets information about your heart disease risk from a physical exam and other tests.
  • You make healthy lifestyle changes that can help your heart without taking a test.
What are the benefits?
  • A coronary calcium scan can give your doctor more information about your risk for heart disease, especially if you have several risk factors.
  • The results of the test may prompt you to make lifestyle changes that can help your heart.
  • You don't pay for a test you may not need. Most insurers do not pay for this test.
What are the risks and side effects?
  • The test can give a high score even if your arteries aren't blocked. This might lead to extra tests you don't need.
  • Not all blocked arteries have calcium. So you could get a low test score and still be at risk.
  • The test costs $300 to $500, and most health insurers don't pay for it.
  • If you are at medium risk for heart disease and don't get a coronary calcium scan, you may not have all the information you need to reduce your risk.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

For more information, see the topic Coronary Artery Disease.

Personal stories about coronary calcium scanning

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"My mom had a heart attack in her early 60s, followed by bypass surgery. She didn't have a clue that she had heart disease. I don't want that to happen to me. I'm going to ask my doctor about getting a coronary calcium scan to check my risk."

— Rose, age 48

"My wife has been bugging me to get this test. So I asked my doctor about it. He said my risk for getting heart disease is pretty low even though I have high blood pressure. I'm taking medicine for that and for high cholesterol. I'm also trying to eat better and exercise. I just don't think the test is going to tell me more about my risk than I already know."

— Jeffrey, age 56

"My doctor says I'm headed for a heart attack unless I quit smoking. It's not that I haven't tried. But until something bad happens, it's hard to stay away from cigarettes. My doctor wants me to have a coronary calcium scan to find out if I already have heart disease. Maybe the results will give me the push I need to try to quit again—this time for good."

— Tony, age 53

"I get a physical exam from my doctor every year, and she says I'm in pretty good shape. But ever since I passed 50, I've been worried about heart disease. I saw an ad for this test in the newspaper and asked my doctor about it. It turns out that in healthy people like me, the test results aren't very reliable. I'm going to just keep getting an annual checkup."

— Maria, age 54

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have a coronary calcium scan

Reasons not to have a coronary calcium scan

I need more information about my risk so I can commit to making lifestyle changes or taking medicines.

I already know that I should make some lifestyle changes to keep my heart healthy.

More important
Equally important
More important

It's worth it to me to pay for this test myself.

My insurance won't pay for this test, and I can't afford it.

More important
Equally important
More important

I want to take any tests that could help me find out my risk for heart disease.

I don't want to take tests I don't need.

More important
Equally important
More important

I want to take this test because I need more information about my risk for having a heart attack.

I already know my risk for having a heart attack, so I don't need this test.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Having a coronary calcium scan

NOT having a coronary calcium scan

Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Can anyone who is worried about heart disease benefit from a coronary calcium scan?

  • Yes
  • No
  • I'm not sure
You're right. People who are at medium risk for heart disease will get the most benefit from this test. If you are at low risk, the test results may not be reliable. If you are at high risk, you should already be under a doctor's care.

2. Does a high score on a coronary calcium scan always mean that your arteries are blocked?

  • Yes
  • No
  • I'm not sure
That's right. You could get a high score on the test even if your arteries aren't blocked. That could lead to other tests or treatments you don't need.

3. Could you still be at risk for blocked arteries even if you get a low calcium score on the test?

  • Yes
  • No
  • I'm not sure
That's right. Not all blocked arteries have calcium. So you could get a low score on the test and still be at risk.

4. Is having a coronary calcium scan the only way to tell if you need to make lifestyle changes to help your heart, such as exercising, eating better, and not smoking?

  • Yes
  • No
  • I'm not sure
You are right. Even without taking the test, you can make healthy lifestyle changes that can help your heart.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

Credits
Author Deborah Dakins
Editor Katy E. Magee, MA
Associate Editor Michele Cronen
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer George Philippides, MD - Cardiology

References
Citations
  1. Budoff M, et al. (2006). Assessment of coronary artery disease by cardiac computed tomography: A scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation, 114(16): 1761–1791.
  2. Greenland P, et al. (2004). Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA, 291(2): 210–215.
  3. Greenland P, et al. (2007). ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Circulation, 115(3): 402–426.
  4. U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Rockville, MD: Agency for Healthcare Research and Quality. Available online: http://www.ahrq.gov/clinic/uspstf09/coronaryhdrs.htm.

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

Last Updated: May 29, 2008

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