Ep. 11: Three Men Walk Onto a Golf Course: Calcium Score Revisited — with Dr. Regina Druz, MD, MBA, FACC, FMCP-M, integrative cardiologist

Three men walk onto a golf course — and compare coronary calcium scores: one is 3,000, one is 75, one is 220. So who should worry most? In this case-based solo episode, inspired by a real patient’s conversation, Dr. Regina Druz revisits the coronary artery calcium (CAC) score and shows why the raw number is nearly meaningless without context. Using the free, public MESA calculators, she walks through how the same score means very different things at different ages, translating it into your “coronary age” and “arterial age” — powerful ways to see how fast your arteries are actually aging. Along the way she clears up what “reversing” plaque really means, when (and when not) to repeat a calcium score, and previews the next tool in the series: carotid intima-media thickness. (This episode is best watched on YouTube to follow the on-screen demonstration.)

Watch on YouTube: A video version of this episode is available on the Own Your Heart Health YouTube channel. Subscribe to be notified of new episodes.

Episode Chapters

[00:00] Introduction: Three Men Walk Onto a Golf Course
[02:00] Why Calcium Score Numbers Feel Meaningless
[06:30] The Man With a Score of 3,000
[07:30] Is 220 Worse Than 75? The Calcium Brackets
[10:00] Meet the MESA Study & Coronary Age
[14:30] Demonstration: A Score of 220 at Age 56
[20:00] Arterial Age: Tripling the Risk
[22:00] Same Score, Different Age: The 66-Year-Old
[26:30] A Score of 75: Context Is Everything
[29:30] “Reversal” vs. Regression: What’s Actually Possible
[32:00] Repeating Scores & Family History
[37:30] A Real Patient: Statins & True Vascular Age
[45:00] Closing: CIMT Teaser & American Heart Month

Transcript

[00:00] Introduction: Three Men Walk Onto a Golf Course

Dr. Regina Druz (00:00): Welcome to Own Your Heart Health. I’m Dr. Regina Druz, your holistic cardiologist. This week we’ll dive into common heart health concerns, uncovering root causes and unpacking scientific discoveries and controversies. The information provided does not constitute medical advice. Please contact your healthcare practitioner before making any changes that may impact your health.

Dr. Regina Druz (00:30): Welcome, everybody. You know the old, corny setup — three men walk into a bar. I’m repurposing it, because a patient recently shared a real conversation he had with two other guys on a golf course (no offense to women — I’m just capturing the true story). The three of them got to talking, and one said, ‘I had a coronary artery calcium score recently — mine was 3,000.’ The second said, ‘I had one too — mine is 75.’ And the third said, ‘I had one as well — mine is 220.’ My patient came in for a comprehensive evaluation wondering what to make of all these numbers.

Dr. Regina Druz (01:30): In our comprehensive evaluations we do extensive vascular scanning — the carotid arteries, an ultrasound of the heart, the abdominal aorta — and depending on risk I often send patients for a calcium score, sometimes combined with a coronary CT angiogram, which we’ll discuss another time. What I keep finding is that the numbers feel meaningless to many people. They get the score but don’t understand what it means.

[02:00] Why Calcium Score Numbers Feel Meaningless

Dr. Regina Druz (02:00): You intuitively know a calcium score of 3,000 isn’t good — most people agree on that, especially since the best case for anyone is a score of zero (we’ll cover what a zero score means for soft plaque another time). But for now, let’s stick with our three men, and let me show you how to take these numbers and put them in context — because today’s ‘calcium score revisited’ is really about vascular age.

Dr. Regina Druz (03:00): Many patients don’t get an explanation from the physician ordering the scan that the number is more than an indicator of how much atherosclerosis or damage is in the coronary arteries. It also tells us something else: the rate of progression of those changes — essentially an estimate of vascular age. I’ll walk you through every step. If you’re listening on audio, this is one of those episodes where YouTube is best, because you’ll want to see the steps in action. The resources are publicly available, I’ll link them in the show notes, and if you have your own numbers you can plug them in and learn what they mean. To own your heart health, you sometimes have to advocate for yourself and use tools that were originally meant for practitioners.

Dr. Regina Druz (05:30): Hi everyone, it’s Dr. Regina. I know there are contradictory opinions about nutrition for heart health and longevity — the discussion gets heated and confusing. Some push low-fat, low-cholesterol; others are fans of ketogenic diets; and there are many voices urging vegan or vegetarian eating. To cut through the clutter, my team and I created Holistic Heart University: on-demand courses, nutrition and lifestyle resources, and supplement guidance to make healthy choices for your heart easier to understand. I’m especially proud of our open office hours and the Q&A feature where you can put us in the hot seat. Head to the show notes for the link and use promo code OWNER20 for 20% off our annual subscription. I’ll see you in office hours.

[06:30] The Man With a Score of 3,000

Dr. Regina Druz (06:30): So, the first man’s score is 3,000. A score of 3,000 — even 1,000 — is high, and as you might expect, this gentleman ended up going for invasive coronary angiography and received a couple of stents. If you’re someone considering a stent, we can talk another time about what stents are and why some people need them and some don’t — there’s a rapidly progressing body of knowledge that, a few years back, shifted the paradigm on who gets stented and who doesn’t. So we understand what happened with the man at 3,000.

[07:30] Is 220 Worse Than 75? The Calcium Brackets

Dr. Regina Druz (07:30): But then the second man says his score is 75, and the third says 220. Is 220 worse than 75? On first pass you’d say yes — more calcium generally means worse. We do use brackets: very roughly, 1 to 100 is mild, 100 to 399 is intermediate, and 400-plus is high. So a man at 75 is in a lower bracket than a man at 220. One is probably a little safer than the other. But what do those numbers actually mean, is your intuition correct, and how do you put them in perspective — not just the amount of atherosclerosis, but the rate at which the arteries are aging? That’s what a calcium score can tell us, and that information usually doesn’t get passed to the patient — or if it does, it’s hard to grasp. Being told you’re in the ‘90th percentile’ for your age, sex, and ethnicity is accurate, but it isn’t very personal.

[10:00] Meet the MESA Study & Coronary Age

Dr. Regina Druz (10:00): To make it personal, we go to the Multi-Ethnic Study of Atherosclerosis, abbreviated MESA — I’ll link it in the show notes, and again, YouTube is better here. MESA is a large study, parts still ongoing, that followed people without known heart disease for cardiovascular events: heart attack (myocardial infarction), stroke, and cardiac death. A proportion of MESA participants had coronary artery calcium scores, so investigators could estimate what’s likely to happen to an individual over the next 10 years — which in cardiology is considered short-term risk, since atherosclerosis is a lifelong process.

Dr. Regina Druz (12:30): They combined the traditional risk factors — high blood pressure, high cholesterol, diabetes, family history — with the coronary calcium score, and then expressed it in a way people can understand: a coronary age. Coronary age is simply the age at which an average, healthy person would have the same calcium score that you have. As we get older, most of us won’t have a score of zero; we accumulate some atherosclerosis, and we know roughly where people should land by age and sex. Just as you might expect your hair to gray in your fifties, you might expect some coronary calcium. Coronary age takes your numbers and tells you how fast your arteries are aging.

[14:30] Demonstration: A Score of 220 at Age 56

Dr. Regina Druz (14:30): Let’s run the exercise. Take the man whose score is 220. For the demo I’ll make him 56 years old and Caucasian (the MESA calculator lets you choose Caucasian, Chinese, African American, or Hispanic). He’s not diabetic, doesn’t smoke, has no family history of heart attack, and his cholesterol is the kind you see all the time — not optimal, but common: total cholesterol 220, HDL 45, systolic blood pressure 120, no blood-pressure or cholesterol medications.

Dr. Regina Druz (16:00): If we ignore his calcium score, the calculator says: not bad — his 10-year risk of coronary heart disease is actually quite low (we typically flag 7.5%), and he looks a touch younger than his age. But once we add the calcium score of 220, everything changes. That score in a 56-year-old gives him a coronary age of 69 — 13 years older than his chronological age — and it nearly doubles his risk, pushing him into the intermediate group. This is where management shifts, because we’re now looking at accelerated atherosclerosis: his heart arteries resemble those of a 69-year-old. He’s well ahead of his peers.

Dr. Regina Druz (19:00): Hi everyone, it’s Dr. Regina. Many of my colleagues and I are seeing patients arrive with self-ordered blood tests. When this trend started, I thought it would help — who doesn’t want more access to their health data? But too often self-ordered labs lead to more confusion and frustration: patients come in with a pile of results and are no better off. That’s why we created HeartWell Toolkits — a curated collection of at-home blood and genetic markers focused on heart and brain health that gives you the data you need to make informed, actionable decisions. You can order them at the shop on holisticheartcenters.com — the link is in the show notes. Use code TESTING10 for 10% off and free shipping.

[20:00] Arterial Age: Tripling the Risk

Dr. Regina Druz (20:00): Now let’s flip to the arterial age calculator. Why use both? Because, as you may know from other episodes, aging doesn’t affect every organ equally — and the same is true across the arterial tree, which is vast. Some segments age faster, some slower, some right on time. Using MESA and the calcium score, investigators derived a more global variable: arterial age. Plugging in the same man — 56, score 220, total cholesterol 220, HDL 45, blood pressure 120, non-smoker, no medications — his estimated arterial age is 78. Remember, his coronary age was 69; his arterial age is 78. So while he’s 56, he’s more like a 70-year-old in terms of the atherosclerotic process.

Dr. Regina Druz (21:30): Here’s the crucial part. In cardiology we distinguish ‘hard’ cardiac events — heart attack, stroke, cardiac death. Based on his chronological age of 56, his 10-year risk of a hard event is about 10%. But using the arterial-age calculation, it’s about 30% — it triples. That’s what I want patients to grasp: on paper he’s 56, but his arteries are those of a 70-something-year-old, and now he has a real opportunity to decide how aggressively and comprehensively he wants to be treated.

[22:00] Same Score, Different Age: The 66-Year-Old

Dr. Regina Druz (22:00): But there were three men on the golf course. Let’s keep everything identical and only change the age — make him 66 instead of 56. A 66-year-old is in a different boat, because we know coronary calcium tends to increase with age. With a score of 220 his arterial age comes out around 78 as well, and using age alone his risk estimate is about 12%, which roughly doubles — not triples — when we add the arterial-age calculation.

Dr. Regina Druz (23:30): Switching to the coronary age calculator for the same 66-year-old: without a calcium score he’d look not bad, even a bit younger. But adding the score of 220 pushes him into the intermediate range, raising his risk substantially, with a coronary age of about 72. So compared with other 66-year-old men, he’s still ahead of the pack — not where we want him — but the same number, 220, means a very different level of accelerated atherosclerosis depending on age. Age is a powerful factor.

[26:30] A Score of 75: Context Is Everything

Dr. Regina Druz (26:30): Now the third man, with a score of 75. At 56, with everything else the same, adding a calcium score of 75 nudges him toward the intermediate range — he’s aging a bit faster than his peers, but far less dramatically than at 220. At 66, that same score of 75 is closer to what’s expected for his age. So lower is better, and it matters even more as you get older. And some people actually do better than their peer group: if we set the score very low — say 10 — the calculator can return a coronary age of 54 for our 56-year-old, meaning they’ve done something right through diet, exercise, supplements, or medication, and their atherosclerosis is progressing slower than expected.

[29:30] “Reversal” vs. Regression: What’s Actually Possible

Dr. Regina Druz (29:30): This is a good moment to address the language of plaque. Patients often say, ‘Doc, I want to reverse my plaque.’ When I ask what they mean, many imagine reversal as a complete restoration of a normal, pristine vessel lining — as if all the inflammation, remodeling, plaque growth, and stabilization could be unwound back to a youthful artery with no buildup. Biologically, that’s not possible. Once you have plaque — in the coronary or carotid arteries — we can slow progression and even achieve regression, meaning improvement through solidification, fibrosis, or calcification that stabilizes the plaque. But we can’t completely erase it. That distinction matters, because there’s a great deal you can do; ‘reversal,’ properly understood, usually means regression and healing.

[32:00] Repeating Scores & Family History

Dr. Regina Druz (32:00): Say five years pass and our 56-year-old, now 61, wants to repeat his calcium score. Most cardiology guidelines — and I — don’t encourage repeating it when the score isn’t zero, because there’s a lot of measurement variability. If your score is zero, repeating at five years can make sense, since up to about 20% of people will progress to a score above zero as they age, and then we’d put it in perspective with coronary and arterial age. But for someone whose repeat score went from 220 to, say, 320, we’d mostly expect that increase with age, and the gap between chronological and coronary age may not have changed much.

Dr. Regina Druz (35:30): Family history is another powerful factor. If our 56-year-old with a score of 75 also has a father who had a heart attack at the same age, that changes the estimate considerably. Family history is tricky — prior generations lived in different times, with less processed food and different environmental exposures — so the comparison isn’t exact, but it matters. Family history often correlates with genetic findings, though not always; environmental influences interacting with our genome are what we call epigenetics. If you want more on that, see my episode on biological aging, where we discuss epigenetics in depth.

[37:30] A Real Patient: Statins & True Vascular Age

Dr. Regina Druz (37:30): Let me use a real patient’s numbers. He’s 56, male, with a recent calcium score of 220. His blood pressure is fine and, on treatment, his cholesterol looked very good — total around 186, HDL around 87 — and he’d been on a lipid-lowering medication since his late twenties for high lipids. No one in the family had a heart attack, but a parent had very high cholesterol. Running his 10-year risk: even with acceptable cholesterol, the algorithm places him in a high-risk group, with a coronary age about 13 years above his chronological age. Importantly, the medication isn’t what’s ‘doing it’ — medications don’t age arteries; if anything they can offset aging — it simply factors into the continuum of risk.

Dr. Regina Druz (39:30): This patient decided, not on my advice, to stop his medication. His total cholesterol rose to about 345, with HDL around 87–90. Recalculating, his risk stays high, and his coronary age comes out around 70. So where’s the truth? The coronary and arterial ages are extremely useful, but they’re still references to a population — a composite of age, sex, ethnicity, blood pressure, family history, smoking, medications, and basic cholesterol. Depending on those inputs, the same person can land in different places. For many years on medication he had an excellent lipid profile; off it, his numbers and his estimated vascular age look very different. So can we know this person’s true vascular age, in a way that not only references a population but lets us monitor progression or regression over time?

Dr. Regina Druz (43:30): There is such a test, and it’s easy to obtain — most of you could ask your doctor for it if you had the right ultrasound. It’s called carotid intima-media thickness, or CIMT. It gives us another, more individualized window on arterial age, and it can be tracked over time to see whether atherosclerosis is progressing or regressing — the healing that people usually mean when they say ‘reversal.’

[45:00] Closing: CIMT Teaser & American Heart Month

Dr. Regina Druz (45:00): I’ll devote my next episode to carotid intima-media thickness, because it’s an involved concept and I don’t want to confuse it with today’s. For now, the takeaway is that there’s more than one way to understand arterial age — and arterial age is powerful, because it shows where a person truly is and how fast they’re moving along the tunnel of atherosclerotic change.

Dr. Regina Druz (46:00): February is American Heart Month. If you join us as a guest in Holistic Heart University, you’ll get two weeks of free access to areas usually reserved for members — and I’d encourage you to watch our queued-up presentation, ‘You Are Only as Old as Your Arteries,’ where I demonstrate the CIMT technique: how it’s done, what’s measured, and why you might want it. For patients in the New York, New Jersey, and Connecticut area — or willing to travel to Long Island or New York City — we now provide full vascular scans, including CIMT, an echocardiogram, and scanning of the abdominal aorta, another place atherosclerotic plaque can hide. The MESA calculators are free and in the public domain, so reach out if you’d like help interpreting your own coronary and arterial age, or come in for the appropriate vascular scanning. That’s what personalized medicine is all about.

Dr. Regina Druz (48:30): To the professionals listening: if you’re thinking of launching a cardiometabolic or integrative cardiology program in your practice, we can help. Holistic Heart Centers helps physicians expand into hybrid or concierge services — head to the show notes and click the application link; your intro call is entirely free. Ready to schedule a practice review? Use code DOC10 for 10% off our Practice Power Hour, a 60-minute coaching session. Thank you for tuning in to Own Your Heart Health with Dr. Regina Druz. This podcast is powered by Holistic Heart Centers. If you enjoyed the show, please rate and review us on your favorite platform, and visit holisticheartcenters.com and subscribe to our YouTube channel. See you next week.

Frequently Asked Questions

What is a coronary artery calcium (CAC) score, and what’s a “good” number?

A coronary artery calcium score measures the amount of calcified plaque in your heart’s arteries, detected on a quick, low-radiation CT scan. The best possible result is zero. In general, scores are grouped into brackets — roughly 1 to 100 (mild), 100 to 399 (intermediate), and 400 or higher (high) — and a higher score is associated with greater risk of cardiovascular events. But as Dr. Druz emphasizes, the raw number is hard to interpret on its own, because what it means depends heavily on your age, sex, and other risk factors. The same score of 220 signals dramatically accelerated aging in a 56-year-old but is closer to expected in someone older. That’s why translating the number into a coronary or arterial “age” makes it far more meaningful. This is educational content, not a substitute for personalized medical advice.

What’s the difference between “coronary age” and “arterial age,” and how do I find mine?

Both translate your calcium score and risk factors into an age you can intuitively understand. Coronary age is the age at which an average, healthy person would have the same coronary calcium score you have. Arterial age is a broader, more global estimate that reflects the wider arterial tree, recognizing that different segments can age at different rates. In Dr. Druz’s demonstration, a 56-year-old man with a score of 220 had a coronary age of about 69 and an arterial age of about 78 — and his estimated 10-year risk of a hard event roughly tripled compared with using his calendar age. You can estimate these yourself using the free, publicly available MESA calculators (linked in the show notes) by entering your age, sex, ethnicity, blood pressure, cholesterol, smoking and medication status, and calcium score. Interpreting the results with your physician is strongly recommended.

Can you actually reverse plaque, or only slow it down?

Dr. Druz draws an important distinction. Many people imagine “reversal” as fully restoring a pristine, youthful artery — erasing all the inflammation, remodeling, and buildup. Biologically, that isn’t possible once plaque has formed. What you can do is meaningful: slow the progression and achieve regression, where plaque stabilizes through solidification, fibrosis, or calcification. So when people say they want to “reverse” their plaque, what’s realistically achievable is healing and stabilization — not erasing it. The encouraging message is that lifestyle changes, and sometimes medication, can move your trajectory in the right direction, which is exactly why understanding your arterial age (and tracking it over time) is so useful. Any treatment decisions should be made with your own physician.

Should I repeat my calcium score over time?

Generally, no — if your score is already above zero. Dr. Druz notes that most cardiology guidelines (and her own practice) discourage routinely repeating a calcium score once it’s non-zero, because there’s substantial measurement variability that can make changes hard to interpret. The exception is a score of zero: repeating it at around five years can be reasonable, since up to roughly 20% of people will progress to a score above zero as they age, at which point it’s worth putting into perspective with coronary and arterial age. For tracking progression or regression over time, she points to a different, more individualized test — carotid intima-media thickness (CIMT) — which she covers in a follow-up episode. As always, decisions about testing should be individualized with your physician.

Show Notes & Resources

Host: Dr. Regina Druz, MD, FACC

Dr. Regina Druz is a board-certified holistic cardiologist and the founder of Holistic Heart Centers. With a background in cardiac imaging, she blends conventional cardiology with integrative, root-cause medicine, focusing on cardiometabolic health, personalized prevention, and cardiovascular longevity. Her practice performs comprehensive vascular assessments — including coronary calcium scoring, carotid intima-media thickness, echocardiography, and abdominal aortic scanning — to estimate and track patients’ arterial age. She is the host of Own Your Heart Health and the creator of Holistic Heart University and the HeartWell Toolkits.

Resources Mentioned in This Episode

MESA Coronary Age and Arterial Age calculators — free and publicly available (from the Multi-Ethnic Study of Atherosclerosis); translate a coronary calcium score into coronary and arterial age
Multi-Ethnic Study of Atherosclerosis (MESA) — the NHLBI cohort underlying the calculators
Previous episode — biological age, DNA methylation, and epigenetics with Ryan Smith of TruDiagnostic
Upcoming episode — carotid intima-media thickness (CIMT) as a way to track arterial age over time
Holistic Heart University presentation: “You Are Only as Old as Your Arteries” (CIMT demonstration); free two-week guest access in February for American Heart Month (use code OWNER20 for 20% off an annual subscription)
Holistic Heart Centers full vascular scans (CIMT, echocardiogram, abdominal aorta) — NY / NJ / CT area
HeartWell Toolkits — at-home heart and brain health lab panels (use code TESTING10 for 10% off and free shipping)
For clinicians: Practice Power Hour coaching with Holistic Heart Centers (use code DOC10 for 10% off)

Holistic Heart Centers

holisticheartcenters.com
HeartWell.ai — AI-powered cardiovascular risk assessment
Address: 55 Bryant Avenue, Suite #6, Roslyn, NY 11576
Phone: 877-511-5166
YouTube: @reginadruzmd
Instagram: @dr.reginadruz
Podcast: Own Your Heart Health — available on Apple Podcasts, Spotify, and all major platforms

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