Serum calcium and coronary artery calcium (CAC) relationship

Serum calcium measured on a basic metabolic panel (BMP) reflects the amount of calcium dissolved in the blood (normally 8.510.5 mg/dL) and is tightly regulated. The calcium that contributes to a coronary artery calcium (CAC) score is calcium deposited in atherosclerotic plaque within the coronary arteries and is detected by cardiac CT; it does not correlate with the BMP calcium value. Therefore a normal or elevated serum calcium does not predict a higher or lower CAC score. Statins primarily lower LDL‑cholesterol and ApoB, reducing plaque formation and cardiovascular events. They do not target serum calcium or other routine metabolic panel values. Some imaging studies have shown that statin therapy can increase the density of plaque calcium, making plaques appear more calcified on CT, which is interpreted as plaque stabilization rather than a harmful rise in CAC. The clinical benefit of statins is related to reduced events, not changes in BMP calcium levels.