What tests check for plaque in the arteries, like a calcium score?

Detecting plaque buildup in your arteries early can guide treatment to reduce your risk of heart attack and stroke. One of the most well-known screening tools is the coronary artery calcium (CAC) score, but several other tests can help assess plaque in different vascular beds. Below is an overview of the most common tests, how they work, and practical steps on how to reduce plaque in arteries once it’s detected.

Coronary Artery Calcium (CAC) Score
Coronary artery calcium scoring uses a specialized, low-dose CT scan to measure calcium deposits in the walls of your heart’s arteries. Calcium in the arteries generally indicates the presence of plaque.

• What it measures: Total calcium level in coronary arteries
• How it’s reported: Agatston score (0 = no detectable plaque; higher scores = more plaque)
• Who it’s for: People at intermediate risk of heart disease, based on age, cholesterol, blood pressure, smoking and other factors
• Pros: Quick (10–15 minutes), no contrast dye, good predictor of risk
• Cons: Involves low-level radiation; does not show non-calcified (soft) plaque

Coronary CT Angiography (CCTA)
CCTA is a contrast-enhanced CT scan that visualizes both calcified and non-calcified plaque and shows narrowing (stenosis) in your coronary arteries.

• What it measures: Degree of narrowing, plaque composition (soft vs. hard)
• How it’s reported: Percentage of arterial narrowing, location of lesions
• Who it’s for: Patients with chest pain or inconclusive stress tests
• Pros: Detailed images of plaque and vessel anatomy
• Cons: Requires contrast dye, higher radiation dose, potential kidney risk

Carotid Intima-Media Thickness (CIMT) and Carotid Plaque Ultrasound
An ultrasound of the neck vessels measures the thickness of the two innermost walls of the carotid artery and detects plaque.

• What it measures: Thickness of the artery wall (intima-media) and visible plaques
• How it’s reported: Millimeters of wall thickness; presence/size of plaques
• Who it’s for: Patients at risk for stroke or as an adjunct to coronary risk assessment
• Pros: No radiation or contrast; widely available
• Cons: Operator-dependent; does not directly image heart arteries

Ankle-Brachial Index (ABI)
ABI compares blood pressure in your ankle and arm to detect peripheral artery disease (PAD), a sign of atherosclerosis elsewhere in the body.

• What it measures: Ratio of ankle systolic pressure to arm systolic pressure
• How it’s reported: ABI < 0.9 suggests PAD; lower values indicate more severe disease
• Who it’s for: Patients with leg pain, diabetes, smoking history
• Pros: Simple, inexpensive, no radiation
• Cons: Less specific for coronary artery disease

Stress Testing (Exercise ECG, Stress Echo, Nuclear Stress Test)
Stress tests evaluate how well your heart functions under exertion and can suggest the presence of significant blockages.

• What it measures: Electrical activity (ECG), wall motion (echo), or blood flow (nuclear imaging) during exercise or pharmacologic stress
• How it’s reported: Evidence of ischemia (reduced blood flow), arrhythmias
• Who it’s for: Patients with chest pain or known heart disease
• Pros: Functional assessment of heart performance
• Cons: Indirect measure of plaque, may miss non-flow-limiting lesions

Magnetic Resonance Angiography (MRA)
MRA uses magnetic fields and contrast agents to visualize vessels without radiation.

• What it measures: Vessel anatomy and stenosis in carotid or peripheral arteries
• How it’s reported: Degree of narrowing, plaque characteristics
• Who it’s for: Patients who cannot tolerate CT contrast or need detailed vessel mapping
• Pros: No radiation; good soft-tissue contrast
• Cons: Time-consuming; contraindicated with certain implants

Positron Emission Tomography (PET)
PET scanning can measure inflammation within plaques, which may indicate vulnerability to rupture.

• What it measures: Uptake of radioactive tracers in arterial walls
• How it’s reported: Standardized uptake values (SUV); hotspots of inflammation
• Who it’s for: Research settings or complex cases
• Pros: Insight into plaque activity, not just structure
• Cons: Limited availability; high cost; radiation exposure

Cardiac Catheterization (Coronary Angiography)
Invasive angiography remains the gold standard for directly visualizing blockages. A catheter is threaded into the coronary arteries and contrast dye is injected.

• What it measures: Exact location and severity of artery narrowing
• How it’s reported: Percentage stenosis in each coronary branch
• Who it’s for: Patients with acute coronary syndrome or high-risk findings on noninvasive tests
• Pros: Direct view; allows immediate intervention (stents)
• Cons: Invasive; risk of bleeding, vessel damage, contrast reactions

Interpreting Your Results
• CAC Score 0–10: Low risk; focus on lifestyle to prevent plaque formation
• CAC Score 11–100: Mild plaque; consider medication if other risk factors present
• CAC Score 101–400: Moderate plaque; likely benefit from statins and lifestyle changes
• CAC Score >400: High plaque burden; aggressive risk-factor management

How to Reduce Plaque in Arteries
Once tests confirm plaque, the goal shifts to slowing progression, stabilizing existing plaques and even promoting some regression. Here’s how to reduce plaque in arteries through evidence-based strategies:

1. Lifestyle Changes
   • Diet
   – Embrace a Mediterranean-style pattern: plenty of vegetables, fruits, whole grains, beans, nuts and seeds
   – Include fatty fish (salmon, sardines) twice weekly for omega-3 fats
   – Replace saturated fats (butter, fatty meats) with healthy oils (olive, canola)
   – Limit processed foods, sugary drinks and trans fats
   • Exercise
   – Aim for at least 150 minutes of moderate aerobic activity per week (brisk walking, cycling)
   – Add strength training twice a week to build muscle and boost metabolism
   – Break up long periods of sitting with light movement every hour
   • Weight Management
   – Even modest weight loss (5–10% of body weight) can improve cholesterol and blood pressure
   • Smoking Cessation
   – Quitting smoking slows arterial damage; talk to your doctor about nicotine replacement or medications
   • Stress Reduction
   – Practice relaxation techniques: deep breathing, meditation, yoga or mindfulness

2. Medications
   • Statins (e.g., atorvastatin, rosuvastatin)
   – First-line therapy to lower LDL (“bad”) cholesterol and reduce inflammation in plaques
   • Ezetimibe
   – Can be added if statins alone don’t achieve cholesterol targets
   • PCSK9 Inhibitors
   – Powerful drugs for those with high genetic cholesterol or who can’t reach goals on statins
   • Blood Pressure Medications
   – ACE inhibitors, ARBs, beta-blockers or calcium-channel blockers to keep blood pressure in check
   • Aspirin
   – Low-dose aspirin may be recommended for some patients to reduce blood-clot risk (not for everyone)
   • Diabetes Management
   – Control blood sugar with diet, exercise and medications (metformin, SGLT2 inhibitors)

3. Regular Monitoring
   • Follow-up imaging (CAC score every 3–5 years, as advised)
   • Routine lipid panels, blood pressure checks and diabetes screenings
   • Work with your healthcare team to adjust treatments if risk factors change

Next Steps and When to Seek Help
If you have symptoms such as chest discomfort, unexplained shortness of breath or leg pain with walking, it’s important to get evaluated. You might consider a free, online symptom check, using the doctor approved Ubie Symptom Checker (https://ubiehealth.com/) to help clarify which tests or urgencies are most relevant to you.

Remember, the information here is for educational purposes and doesn’t replace medical advice. Always speak to a doctor about any test results or symptoms that could be life threatening or serious. Regular follow-up, honest conversations about your lifestyle and clear goals for “how to reduce plaque in arteries” will give you the best chance to protect your heart and arteries for years to come.