Heart disease kills an estimated 17.9 million people globally each year, accounting for an estimated 32% of all deaths in 2019. Additionally, 38% of premature deaths, meaning deaths that occur in people under age 70, were due to heart disease in 2019. As the majority of heart disease is avoidable, it’s important to protect your heart by improving your lifestyle and seeing your healthcare provider regularly for check-ups.

Blood tests are one of many ways of checking heart health. The most basic test panels evaluate blood chemistry, cholesterol, and organ health such as kidney function, which can show damage from cardiovascular disease. Functional medicine lab assessments look "upstream" for additional markers of risk, to more comprehensively identify and target areas of vulnerability in an individual and more effectively prevent and reverse cardiovascular disease.
Other ways to evaluate heart and blood vessel health include imaging studies such as a chest x-ray, cardiac MRI, echocardiogram, and carotid artery ultrasound measurements of plaque (occlusive and non-occlusive) and intimal media thickness (CIMT).

Finally, an important metric that’s joining the mainstream cardiac assessment toolbox (and even getting validation in terms of insurance coverage) is the coronary artery calcium CT scan (CAC CT). Developed in 1990 but slow to gain acceptance, the CAC CT scan has been shown to be a cost-effective way to evaluate cardiovascular disease risk in (apparently) healthy people with no active symptoms, and in people with risk factors such as diabetes and insulin resistance, hypertension, smoking history, and family history of heart disease. (The dramatic 2015 documentary film "The Widowmaker" portrays the story of this technology's contentious journey to legitimacy.)

What is a Coronary Artery Calcium Score?

The CAC CT scan measures the amount of calcified plaque in the coronary arteries, which provide blood and oxygen to the heart muscle. This measurement provides the coronary artery calcium or "CAC" score. The higher the amount of calcified plaque present in the coronary arteries, the higher the CAC score; in other words, the higher the CAC score, the greater the degree of coronary atherosclerosis. Atherosclerosis refers to a build-up of plaque in arteries that prevents adequate blood flow to tissues; in the case of coronary atherosclerosis, the tissue deprived of blood flow is the heart itself.

The scan uses a technique that takes hundreds of images of a beating heart from many different angles, leading to more sensitive detection and more precise localization of coronary artery calcium deposits. Compared to other "preventive" diagnostic tools such as mammography and colonoscopy, CAC scans are inexpensive and easy on the participant. The resulting calcium score is graded as follows:

* 0: No calcium detected in the coronary arteries with a low risk of heart disease.
* 1-10: Small amount of plaque meaning you have a very low risk of having heart disease.
* 11-100: Some plaque is present meaning you have mild heart disease.
* 101-400: Moderate amount of plaque with a risk of the plaque blocking an artery.
* Over 400: Large amount of plaque is present with a more than 90% chance that plaque is blocking one or more coronary arteries.

For a score over 11, the risk of having a heart attack increases as the score increases. Depending on the CAC score, your provider may recommend diet and lifestyle changes, further testing and/or imaging, and other indicated therapies.

What Contributes to a High CAC Score?

The following factors increase your risk for heart disease and a high calcium score:

- High blood pressure

- Smoking

- Blood sugar dysregulation (Glucose or insulin imbalance)

- Unhealthy diet

- Lack of physical activity

- Excessive alcohol intake

How to Prevent a High CAC Score

Diet and lifestyle changes are the most powerful tools to prevent heart disease.

Exercise: A weekly minimum of 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity aerobic exercise is recommended to support a healthy heart - but it doesn't need to be complicated or involve a gym membership. As long as the pace is faster than a stroll, walking works! Weightlifting two or more times a week can add additional benefit.

Healthy Diet: A plant-focused diet of whole foods with minimal sugars and saturated fats supports overall health and can reduce risk factors associated with cardiovascular disease and many diseases of aging. Pro-active, evidence-supported diet and lifestyle guidelines for cardiovascular disease prevention and reversal may be found in books and media (such as YouTube videos) from Dean Ornish, M.D.; Joel Kahn, M.D.; Joel Fuhrman, M.D.; and Caldwell Esselstyn, M.D.

Reduce Risky Behaviors: Smoking and excessive alcohol intake are major risk factors for cardiovascular disease. Smoking alone can double the risk of dying from heart disease. And, disappointing though it may be to proponents of the "French paradox", imbibing more than one drink daily for women and two drinks daily for men has been linked to increased risk of heart disease as well.

Get Adequate Sleep: Research shows that not getting enough sleep increases heart disease risk. Sleeping less than six hours on average has been linked to increased systemic inflammation, increased coronary artery plaque formation, and increased stress hormones. Seven to eight hours of sleep nightly is recommended to support overall health.

Systemic Influences: Increasing evidence points to the significant influence of inflammation and insulin resistance in driving heart and vascular disease. For best support, work with a natural medicine practitioner to identify and manage these subtle but powerful risk factors.