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High calcium score warrants a closer look at heart attack risk

Dear Dr. Roach: I am 74 and in good health except for osteoporosis. I’m 5 foot, 3 inches tall and weigh 106 pounds, and have followed a plant-based diet for eight years. I take no medications, walk briskly daily and still work, but my calcium score was 640. What’s happening here?

— D.H.

Dear D.H.: Regular exercise and a plant-based diet are very effective at reducing the risk of heart disease when combined with reduction of other risk factors, especially smoking and blood pressure, but also managing emotional stress, maintaining healthy relationships and sleeping well.

However, a good lifestyle by itself is not a guarantee against heart disease or cancer. When you are living a healthy life and develop a medical issue, then it is time to get evaluation and perhaps treatment.

The high calcium score suggests that there are blockages in the arteries to your heart. While some experts would recommend treatment (such as a statin) at this point based on your calcium score, others recommend further evaluation. A high calcium score does not necessarily equal blockages. It is much more likely, though, approximately doubling your risk of a heart attack.

A risk score is available that uses a coronary calcium score to help predict risk of heart attack. You can calculate this at Using the information you gave me, your estimated risk of having a major heart event is 14%, which is far above the usual recommended threshold for prescribing a statin. I recommend medication therapy to a person like you, but you should of course continue your healthy lifestyle, which is helping you many other ways, whether or not you decide on a statin drug. In fact, if you had been eating a less healthy diet, I suspect you may already have had a heart attack.