Heart Smart Pt 2: Inside the Arteries — CTCA, Calcium Score & Lp(a)

12 May

If you've ever wondered what’s really going on inside your arteries, you’re not alone. Many people feel perfectly fine until they’re suddenly not. That’s the challenge with heart disease - it’s often silent, until it’s serious.

In this post, we’ll break down three key tests that give us a clearer picture of what’s happening beneath the surface, and how they can guide your long-term heart health.

CT Coronary Angiogram (CTCA)

CTCA is one of the most detailed non-invasive heart scans available. It uses contrast dye and a CT scanner to look at your coronary arteries in real time, showing both calcified and soft plaque - the kind that can rupture and cause heart attacks.

CTCA is ideal when:

You have symptoms like chest discomfort or shortness of breath
You’ve had abnormal results from another test (like an ECG or stress test)
You’re at intermediate-to-high risk and your doctor needs a more complete picture

It helps cardiologists decide whether medication, lifestyle changes or further intervention is needed.

Coronary Calcium Score

This is a quick scan that doesn’t use contrast dye. It calculates the amount of calcified plaque in your arteries and gives you a score - the higher the score, the higher the risk.

It’s most useful when:

You’re between 40 and 70 with risk factors (like family history or high cholesterol)
You want to know your risk even if you feel fine
You’re deciding whether to start medications like statins

A score of zero doesn’t mean zero risk, but it’s reassuring. A higher score helps start the right conversations early.

Lipoprotein(a) - or Lp(a)

Lp(a) is a cholesterol particle that’s mostly genetic - meaning your levels are inherited, not driven by diet or lifestyle. High Lp(a) significantly raises your risk of early heart disease and stroke.

The tricky part? It’s not part of a standard cholesterol test, so many people don’t know they have elevated levels.

Testing for Lp(a) is worth considering if:

You have a strong family history of early heart disease or stroke
You’ve already had a cardiac event without “classic” risk factors
You want a complete understanding of your long-term risk

While there’s no specific medication yet to lower Lp(a), knowing your level allows your cardiologist to manage your other risk factors more aggressively.

Which Test Do You Need?

It depends on your personal risk profile:

CTCA gives the most detailed anatomical picture if symptoms or concerns are present.
Calcium Score is excellent for asymptomatic individuals who want a baseline risk check.
Lp(a) is a powerful addition for those with a family history or unexplained heart events.

At Shore Cardiology, we take your personal risk into account to recommend the right tests at the right time - with the goal of preventing disease before it begins.

Next up in the Heart Smart series:

Managing Risk Before It Becomes Disease

We’ll talk about what to do if early heart disease is found - and how to stop it in its tracks.