Mayo Clinic Q&A: What is a coronary calcium score and how does it affect older endurance athletes?
DEAR MAYO CLINIC: My neighbor is in his 60s and has spent years competing in marathons and long-distance cycling events. Despite being in excellent shape, he recently learned that he has a high coronary calcium score. I thought endurance athletes were less likely to develop heart disease? I'm in my 50s, run regularly and am training for a half-marathon. Should I be worried about this?
ANSWER: It's understandable to wonder how this can happen. Regular exercise is one of the best things you can do for your heart. It lowers the risk of heart disease, improves blood pressure, helps control weight and supports overall health.
However, being physically fit doesn't make someone immune to heart disease. A coronary calcium score can help identify people who may be at increased risk despite having an active lifestyle.
A coronary calcium score measures calcium buildup in the arteries that supply blood to the heart. The test uses a CT scan to identify calcified plaque, which is a marker of atherosclerosis, also known as hardening of the arteries.
The score helps estimate a person's future risk of heart disease and provides additional information about overall cardiovascular health. In general, a score of 0 is associated with a lower likelihood of future heart disease than higher scores. Scores above 100 suggest a higher risk, while scores above 300 may lead healthcare professionals to recommend treatment or other steps to lower that risk.
It's important to understand what the test does and does not show. A high score doesn't mean a heart attack is about to happen, nor does it automatically mean an artery is blocked. Some people have elevated calcium scores but still have enough blood flowing to the heart and may not experience any symptoms. Instead, the score can help guide decisions about prevention, treatment and follow-up care.
Researchers continue to study why some older endurance athletes have higher coronary calcium scores than people who participate in moderate levels of exercise. While this finding has been observed in studies, more work is needed to understand why it occurs and what it means for long-term cardiovascular health.
At the same time, people who regularly participate in endurance activities generally have lower rates of heart-related problems than those who are sedentary and tend to have better overall cardiovascular fitness. Even so, some highly active people still develop elevated calcium scores despite years of regular exercise.
A high calcium score shouldn't be viewed as a reason to stop exercising. Instead, it should prompt a discussion with a healthcare professional about your overall risk for heart disease.
The score is only one piece of the puzzle. Other important factors include:
• High cholesterol.
• High blood pressure.
• Diabetes.
• Obesity.
• Smoking history.
• Family history of heart disease.
• Dietary habits.
Many of these risk factors can be managed through lifestyle changes, medications or both. Addressing them can help lower overall cardiovascular risk and support long-term heart health.
Depending on your symptoms and other risk factors, your healthcare team may recommend additional testing, such as a cardiac stress test.
If you notice any of the following symptoms during physical activity, even if you otherwise feel healthy and active, talk with your healthcare team:
• Chest pain or pressure.
• Unusual shortness of breath.
• Symptoms that seem unusual for your normal level of activity.
The most important takeaway is simple: Don't stop exercising. Instead, use the results as an opportunity to better understand your heart health and work with your healthcare team to address any modifiable risk factors. Understanding your overall risk for heart disease and taking steps to lower it can help you continue exercising safely for years to come.
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Gurpreet Singh, M.D., Cardiology, Mayo Clinic Health System, Eau Claire, Wisconsin
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