Dr. Keith Roach, syndicated columnist

DEAR DR. ROACH: I’m 67 and in decent shape. I run 3-4 miles three times a week and lift weights three days a week. I take 20 mg of rosuvastatin daily. My LDL cholestrol is 85 mg/dL, and my HDL is over 80 mg/dL. I have controlled blood pressure at 125-130/80 mmHg with an angiotensin II receptor blocker (ARB).

Seven years ago, my provider asked me to do a coronary artery calcium (CAC) scan because it could be performed at no cost to me. I did, and my score was 530. The recommendations were to get on a statin, which I was already on (rosuvastatin), as well as low-dose aspirin.

Recently, a new primary care physician asked me to repeat the test, and my score was 1,200. The higher progressive score alarmed me as the report said that my chances of a cardiac event were extremely high over the next few years. My physician then referred me to a cardiologist.

The cardiologist eased my concerns somewhat, as he said that although this is a high score, it doesn’t mean anything other than lots of calcium in my artery plaque. He did schedule me for a stress test. Can you please provide your take on the interpretation of my calcium score and the potential benefit in getting the test? — R.S.

ANSWER: A CAC scan is an easy way to get additional information about a person’s risk of having a heart attack. I don’t recommend these scans for my low-risk patients, nor do I recommend them for my patients who are already on treatment.

I find them most useful in people where it’s not clear whether they should be on treatment such as a statin (like the rosuvastatin you are on). Sometimes I have a patient who is equivocal about being on a statin (which I understand), and sometimes I’d like to get more information before giving a recommendation to a patient.

The ideal CAC score is zero. However, a high CAC score doesn’t guarantee a heart attack. I use the MESA score (tinyurl.com/MESARisk) in combination with your clinical factors, and the tool estimates your risk of having a cardiac event (heart attack, cardiac arrest, death due to a heart attack or stroke, or confirmed blockages that lead to surgery or a stent placement) at 14.8% in the next 10 years. If you had a calcium score of zero, your risk would only be 2.3%, so the CAC really did make a significant difference in understanding your risk.

In my opinion, a stress test is a reasonable suggestion. The point of a stress test is to see whether there are any blockages that are large enough to restrict blood flow to your heart when you exercise. If there are, then additional information, such as a direct look at your coronary anatomy with an angiogram, can provide your cardiologist with the information needed to recommend a balloon procedure and stent, cardiac surgery, or different medications.

The newest guidelines that were just released this past March recommend an even lower LDL than your current result. (The recommendation is below 70 mg/dL, with consideration to below 55 mg/dL.) The European guidelines recommend an LDL below 55 mg/dL, with a goal of below 40 mg/dL for people who’ve had more than one cardiac event. This can usually be achieved with a maximum-dose statin, usually in combination with ezetimibe or a PCSK9 inhibitor — or both.

The larger the risk you have for heart disease, the more important it is for you to improve other factors, including blood pressure, smoking, diet and exercise.

EDITOR’S NOTE: Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.