Artery plaque is a substance that can build inside your blood vessels. This buildup can narrow your arteries and make it harder for blood to flow through them.
Plaque is made of cholesterol, fat, calcium and other substances and can affect arteries near your heart, neck, brain, legs and other areas. It can develop before you notice any symptoms, so it’s important to know what it is and when you should be checked.
Over time, plaque can cause chest discomfort, shortness of breath and other symptoms. It can eventually lead to heart disease.
What is the difference between hard plaque and soft plaque?
“Not all plaques are created equal. Hard plaque is calcified and shows up on CT scans. Soft plaque is fattier and does not show up on standard imaging. You could also have a mix of hard and soft plaque,” said Kevin Klassen, MD, a cardiologist with Banner - University Medicine.
All types of plaque can get worse and cause symptoms. Soft plaque is more likely to break off, block a blood vessel and cause a heart attack.
Why does plaque type matter?
All types of plaque can narrow an artery over time. Where it builds up also matters:
- Coronary plaque, which develops in the heart's arteries, can block blood flow to the heart and cause a heart attack.
- Carotid plaque, found in the neck arteries, can limit blood flow to the brain and trigger a stroke.
Whether you have hard plaque, soft plaque or a mix affects your risk of health issues. However, there are a lot of other factors that can impact your risk besides plaque buildups. Your provider will also look at your symptoms, medical history and other risk factors. They may order heart scans to see whether you have plaque buildup and, if so, how much.
What scans can show artery plaque?
“All of these types of imaging studies allow us to visualize, diagnose and evaluate diseases of the blood vessels, arteries and heart,” said Beth Allen, director of clinical operations at Banner Imaging.
Your provider may recommend an artery scan if they think it will provide important information to make care decisions.
Calcium score
This type of CT scan looks for hardened or calcified plaque in the heart arteries and gives a number that helps estimate the amount of plaque. Your provider may use it to get more information about your heart disease risk and decide if you need more testing. However, it does not show soft plaque well.
“A CT calcium score is best for screening patients who don’t have symptoms or many heart disease risk factors,” Allen said.
CT angiography
CT angiography, or CTA, uses CT imaging and contrast dye to show blood vessels and narrowed areas. It is good at spotting:
- Blood clots
- Blocked or hardened vessels
- Vessel ruptures or tears
- Malformed vessels and arteries
- Plaque in the arteries
Your provider may order CTA to get more details about symptoms or other test results. They may also recommend:
- CTA with FFRct: Uses artificial intelligence (AI) to check blood flow
- CTA with plaque analysis: Uses AI to check hard and soft plaque for more insight about your risk of a heart attack and for treatment planning
Ultrasound
An ultrasound artery scan uses sound waves to check blood flow and narrowing in your neck or leg arteries. It does not use radiation. Your provider may recommend ultrasound to help decide if you need more testing.
MRI
An MRI uses magnets and radio waves, not radiation. It shows structures in and around the heart, like the heart valves, chambers and pericardium (sac that surrounds the heart).
In some cases, specialized MRI plaque imaging can give more detail about plaque in certain arteries, such as the neck arteries. It’s important to note:
- MRI is not the right test for every plaque
- Imaging the heart arteries with MRI can be more complex because the heart moves and the arteries are small
Why the right scan depends on your symptoms
There is no single plaque scan that is best for everyone and more is not always better. The scan should answer a clear medical question and help guide care.
The best scan depends on:
- Which artery is being checked
- The type of symptoms, such as chest symptoms, stroke-like symptoms or leg pain
- Risk factors like high cholesterol, high blood pressure, diabetes, smoking or family history
When to talk to your provider about artery imaging
Talk to your provider about your imaging options if you have:
- High cholesterol
- High blood pressure
- Diabetes
- Smoking history
- Family history of early heart disease or stroke
- Chest pain or shortness of breath with activity
- Leg pain while walking that improves with rest
- Prior abnormal imaging or heart testing
- Questions about whether a calcium score, CTA, ultrasound or MRI is appropriate
Call 911 for:
- Chest pain or pressure, especially if you are having trouble breathing, sweating, nausea, fainting or pain spreading to the arm, jaw, neck or back
- Stroke symptoms, such as face drooping, arm weakness, speech trouble, sudden vision changes or sudden severe dizziness
- Sudden trouble breathing or fainting
“Listen to your sixth sense. When something feels like it’s not right or is new and persistent or recurring, getting checked can save your life,” Dr. Klassen said.
Bottom line
Hard plaque and soft plaque describe different kinds of artery buildup and blockage. The best test for plaque depends on your symptoms, risk factors and what your provider needs to know.
If you are concerned about plaque buildup or your artery health, make an appointment with a Banner Health provider who can review your symptoms, risk factors and health history and help you decide whether imaging is the right next step.
FAQs about hard and soft plaque
Is hard plaque the same as calcium?
No. Hard plaque contains calcium and tends to be more stable than soft plaque. This type of plaque can often be seen on certain CT scans.
Is soft plaque dangerous?
Yes. Soft plaque is more likely to cause a heart attack than hard plaque. Medical treatment can make it more stable. Your risk depends on many factors, including symptoms, risk factors and scan results.
What scan shows hard plaque?
CT scans show calcified plaque in the heart arteries. A coronary calcium score measures how much calcium is in the artery but it does not measure how much blockage there is.
What scan shows soft plaque?
CT angiography or specialized MRI may show softer plaque in some arteries. The right test depends on which artery is being checked.
Do I need a plaque scan?
Not everyone needs plaque imaging. Your provider can help decide based on your symptoms, risk factors and what the results would change about your care.
