What’s wrong with a study of 30,000 people when this was and still remains the primary cause of death in this country?
Even if the tests come back negative, it is still a good idea to exercise regularly and eat a low-sugar, good-fats diet. I found out the hard way, having a mini-stroke while on vacation last month. That got my attention, and now I am trying to pursue a healthier lifestyle. After only two weeks, my numbers had fallen and I'm hoping for even better results when everything is next checked.
I was asymptomatic but had bad genetics going against me so I had the calcium test and ultimately it led to further testing that found an 81% blockage in the widow maker. But my takeaway from the testing is this: the calcium score is non-specific. Skip it. For a few dollars more the CT scan with contrast is clearer, more specific and showed a much elevated risk. All the calcium scan does is freak people out or give them a false sense of security.
MDs these days regard the endless raft of tests they order more as a a good defense to a malpractice suit than as something we need.
At my fancy cardio prevention clinic Monday, and after going over another battery of blood test results, my MD ran these results through some kind of algorithm from the MESA study. she sat back and solemnly informed me that if I did not change my ways the probability of having a cardiac event in the next ten years was 10%.
Without thinking, I blurted out "why would I want to live till 80?" She stared back solemnly and said "well, that's your personal choice." I don't know about you, but hanging in there to have the privilege of having a hip replacement does not exactly get me warm and fuzzy.
I never thought I'd get this far. 10%? Bring it on.
3
A calcium scan cannot tell the difference betwen calcium deposits inside and on the outside surface of arteries.
Anyone looking for peace of mind should go for a nuclear perfusion test. Specially South Asians.
1
I had nuclear 6 months ago. I am 70 yrs.
Fortunately I "passed".
But still no guarantees going forward.
But we try. The battle goes on.
I had one of these tests (I am in my low 60's). It was very simple, non -invasive and quick! Luckily I had a score of 0, but the report clearly reiterates what you wrote, i.e. that these is always the possibility of loose soft plaque that could loosen and travel thru the the body and cause a blockage. I'm not giving up my cholesterol meds or changing my lifestyle - I will continue to exercise and eat healthier. The test cost $100 and brought great peace of mind.
I am 79 years old and based on my readings, my doctor urged me to take a statin, which would lower my risk of dying from a heart attack in the next ten years from 14% to 7%. That is not much of a difference when reversed and my chances of not dying of a heart attack would go from 86% to 93%. Ten years from now If I am still alive I will be almost 90. My chances of having something else kill me in that span of time are probably greater. So I decided not to take it.
1
Remember that the current guidelines ( https://www.aafp.org/afp/2014/0815/p260.html ) do not apply to those over 75 unless they have LDL over 190 or previously known heart or vascular disease. The true benefits and risks for someone over 75 are speculative only, according to the experts who wrote the guidelines.
And remember that statins have not been shown to prevent death. They do prevent heart attacks. It is not quite accurate to say that they "lower the risk of dying from a heart attack."
2
CT angiography does not use a dye. It uses a contrast agent. Just to keep your language up to date.
1
It is my understanding that a coronary calcium Scan delivers a dose of approximately 2 mSv of radiation, this is not anything like a low dose. It should be considered as part of the risk reward of this test and the author And any person considering the testshould give it more attention.
3
I'll go with the tried and true, thank you, eating a heart-healthy diet with plenty of fruits and vegetables, good plant fats and minimum amounts of red meat, or indeed, any flesh. It's kept me alive and relatively well into my 70s already.
2
I had a CT scan for a calcium score in 2016. Mine was 0. However, this only measures hard calcium. This year I had a CT angio with contrast and had a new score of 1. It also revealed a pulmonary embolism in a pulmonary artery and I am being treated for that now with a prescription anti-coagulant and it will take several months. My only symptom was being tired all the time and a bit of difficulty with my daily 4 flights of stairs. I searched the NY Times for any articles about pulmonary embolism and could only find it in obituaries.
2
Pulmonary embolism is a different disease process from coronary artery disease.
The clot in your pulmonary artery travelled there from a vein in your lower body.
Vein clots are due to things such as sedentary periods ( eg immobilized limb from an injury), bad veins such as varicose veins, genetic hypercoaguable states, certain medications, underlying cancer.
Your medical provider should have done a better job explaining this to you.
2
Cardiologists...I am in continuous atrial fib discovered 20 yrs ago. The rhythm treatment--amiodarone--almost killed me. Days in the hosp. The blood thinner clotted up my right retina instead of preventing clots--four operations later, the eye is sightless. I had nine cardios...when I needed hernia surg, they sent me for heart tests to Dr Number 10--echocardiogram and stress test. It took so long to get appts, the hernia went bad and I needed emergency surgery and lived. Now, this doctor wants yet another echo--he did not mention this calcium scan. But if he does, I won't be surprised. Having read this, I have no idea if I would agree. We all must be our own MDs now.
7
Much like anything else, the cca scores are merely pointers or data signs for the patient to consider in his strategy to be the best he can be! Diet, exercise, control weight, no smoking, and control the booze. It is no more than that---this test can tell you something that is wrong and generally cannot ensure you about what is right. The risk is worth the 150 dollars.
4
I took a treadmill test which supposedly checked for hard deposits and then a calcium scan which supposedly checked for soft deposits in my arteries. I passed both and had a score of zero in the scan.
Although I have high cholesterol I avoided the use of Statins, which work on the liver and didn't seem a good idea.
It's probably time, after 8 years to do the test again. I did the stress test 15 years ago and I was fine then too, although being younger I was able to run on the treadmill longer.
I am now 71 and can play 18 holes of golf and walk up several flights of stairs without breathing hard. I do exercises everyday too so I can play decent golf.
I think getting old means more exercise walking to doctors' offices.
6
I like your thinking.
1
The "calcium score" aka "Agatston score" measures the hard - calcified plaque in heart coronary arteries, does not measure the soft or more worrisome plaque but, both are linked
It is a simple, fast test, a limited chest CT done without IV contrast
Calcium scores correlate with risk for future events (see MESA study-Budoff and online calculator)
Also, Netflix has a movie The Widowmaker advocating use of a screening test for coronary heart disease in individuals with intermediate risk
see
https://www.netflix.com/title/80039437
8
By the same logic used to demonize saturated fats and cholesterol, we should now demonize calcium, because calcium is also found in atherosclerotic plaques! Next the pharma industry will unleash a wave of highly profitable "calcium lowering" drugs.
6
Pooch - See my other comment that, all-other-things-being-equal, calcium is actually GOOD for plaque as it stabilizes it. (And its cites.)
Indeed, some now believe (including myself) that a major reason that STATINS lower CVD events is by accelerating calcification, and so plaque stabilization.
See: “Impact of statins on serial coronary calcification during atheroma progression and regression,” PMID 25835438 and “The Never-Ending Story on Coronary Calcium: Is it Predictive, Punitive, or Protective?” PMID 25835439.
Note that this is just yet one more example of how medicine fools itself by using short-cut SURROGATE outcomes (e.g. easy-to-measure calcium) instead of actual “hard” events in evaluating diagnostics, drugs, and therapies.
5
The CAC Scan is a low-radiation screening test sometimes referred to as a "mammogram of the heart" because the mammogram and CAC Scan use about the same radiation. After having a CAC Scan....you will be given a CAC Score that accurately correlates with risk of heart attack or major cardiac event within 10 years. (MESA Study-Budoff, et al). A perfect score is 0. Minimal risk is 0-99, Moderate 100-399, Severe 400-999 and OMG is 1000+. The scan also shows number of calcified plaques, their density, area and location of the calcified plaques by coronary artery (Right Main, Left Main, Circumflex and Left Anterior Descending). A score of 100+ in the Left Anterior Descending alone will put you in the Severe-OMG Highest Risk for a Major Coronary Event or Heart Attack. The Left Anterior Descending Coronary Artery is also referred to as the LAD or "WidowMaker" as it's the main artery supply for the left ventricle. An LAD plaque rupture/clot can impede the bloodflow to the left venticle....frequently causing death. Location size and density of the calcified plaques is extremely important in evaluating risk. Calcium grossly represents only 10% of total plaque volume. (MESA Study, Budoff, et al). Most of the calcification is located in the space between the walls of the artery in the intimal-medial space. CAC Scores usually increase by 35-55% per year. There are things that can be done (non-statins) to decrease CAC Scores & Calcified plaques. More studies: www.NanoBiotechPpharma.com
5
A comment to writer SRP: Calcium in atherosclerotic plaque does not stabilize plaque. The Nanobacterial calcification is actually the source of waxing-waning inflammatory cascade and lipopolysaccharide biofilm endotoxin that causes amyloid deposition, dead-cell detritus and oxidized VLDL/LDL in the soft-plaque burden. In the cycle of the inflammatory cascade, the comes a point when the plaque is red, warm, swollen and can pop like a pimple into the lumen of the blood vessel.....this expelled plaque detritus causes an immediate clotting event that if in a critical area can cause death. This is how atherosclerotic endovascular disease causes ruptured plaques. Again: Calcium does NOT afford protection or stability to a plaque and does not protect plaque from rupture.
3
Correction: the website for more information and studies on calcium in plaque: www.NanoBiotechPharma.com
1
It is a common misconception, even among most cardiologists, that coronary artery calcium is a bad thing.
Yes, detected calcium is bad in that if calcium is there then it means that (otherwise undetectable) plaque is there. But the calcium—qua calcium—is actually a good thing because, given that the plaque is there, calcium “stabilizes” the plaque, making it less vulnerable to rupture (and so a thrombus and heart attack...). So given a certain volume of plaque, the denser the calcium, the more the calcium, the better. That is what the data actually says.
Unfortunately, Agatston got it wrong when coming up with the calculation method for the “calcium score.” It is calculated by weighting each cross-sectional slice measurement of calcium area by the maximum calcium density of the slice (and then integrated along the plaque length to created a density-weighted calcium volume). But this calcium density-weighting is wrong.
Turns out that calcium volumes are better predictors of future cardiovascular events when NOT density-weighted. (I.e. it’s the higher plaque mass or volume, not the higher calcium mass that’s key.)
And higher average calcium densities actually predict LOWER cardiovascular events!
See: “Calcium Density of Coronary Artery Plaque and Risk of Incident Cardiovascular Events,” PMID 24247483. See also PMID 27903540, 26106881, & 26449405.
Yet cardiology continues to use this wrongheaded calculation of the calcium score, to the detriment of patients...
6
Some corrections to this article:
“cheeseburgers and fries loaded with saturated fat”
Nothing wrong with cheese. In fact, it’s likely slightly protective. See recent meta-analyses PMID 25740747, 27207960, 28140321, & 28374228.
And nothing wrong with saturated fat (for the gazillionth time...). It ain’t good for you, but it ain’t bad for you either. It is basically neutral. See: PMID 26268692, 20071648, 24723079, 28526025, 16467234 and www.youtube.com/watch?v=j2DaqrKq6e0. Where are your counter meta-analyses?
(But OK on french fries being a major obesity culprit. See, e.g. PMID 21696306.)
“can precipitate a heart attack if a piece of plaque breaks loose”
Heart attacks (and strokes) don’t happen by plaque pieces breaking loose and blocking blood flow. They happen when plaques rupture, crack, or abrade, leading to thombi, blood clots, which block blood flow. Such thrombi can break loose...
5
The early deaths of my Dad (age 44) and eldest brother (age 43) made me "aware" that it could happen to me. Then, the death of my remaining sibling (age 56) - all from sudden heart attacks - sent me running to a cardiologist specializing in preventative medicine. After almost ten years of exercise and "watching everything I put in my mouth", I asked my doctor..."is there anything else I can do?" His nonchalant response, "well, you might think of having a heart scan...next month is heart month and the clinic is having a half price special!" That was the nudge I needed. The scan revealed a calcium score that was off the charts!!! The doctor immediately recommended angioplasty...which, when performed, resulted in stenting my LAD - the widow maker - that was 85% blocked! That was performed on April 1, 2008...I just celebrated my 10th Anniversary of a second chance of life. Fortunately, for me, I never had a single symptom of anything being wrong: never smoked, never a heart attack, never had pain, or shortness of breath, only a bad ratio of HDL/LDL...no signs which would suggest a problem existed. I thank my doctor who gave me the nudge to have a heart scan performed. Today, I enjoy good health; exercise regularly, eat fairly healthy (most of the time) and keep my weight down...and am able to enjoy my kids and grandkids! I highly recommend a heart scan...it saved my life! No doubt.
14
@Herb Butrum You should get tested for Lp(a). It sounds like that's the genetic condition that has been ravaging your family. Here's an article on it ...
https://www.nytimes.com/2018/01/09/well/heart-risk-doctors-lipoprotein.html
1
I have been using Heartbeat https://heartbeathealth.com/services for my diagnostic heart tests. They don't offer calcium scans yet, but can provide a quick referral to other cardiologists, if needed. The best part is the same and next day availability.
1
At 61 I found out I had a genetic defect called an atrial septal defect (ASD). I had it taken care of quickly and reverted to my daily exercise schedule (running, spinning, strength training). As part of the process I had a calcium test which showed a score of 125. My cholesterol was 170, HDL 67 and ldl 85. An interventional cardiogist who did a catheterization ( and found no plaque) recommended, that due to the 125 score, I try to get my ldl below 70. He recommended a drug, which I decided not to take. After changing my diet my ldl was 69 and ldl 85. However at my recent checkup. my ldl had gone back to 85 and ldl dropped to 71. I am in very good shape. I ran a 15k in November at age 63 at a 7:40 pace. When I spoke to my primary cardiologist about the results he did not seem overly concerned and could not say whether the recommended statin would be that helpful. I'm going to have another test in a few months and see where my levels are. At present I do not take any medication. But i'm not a medical luddite. If I need it I will take it. But i'm not going to indiscriminately medicate myself if there are no benefits.
5
Watch out for statins. If your legs start to hurt, quit quickly. Everything you're saying seems to indicate low risk; trying to make it even lower may involve new risks.
Many docs do not recognize the myalgia (leg pain) side effect of statins, but it is real, and common.
3
At age 75 my father-in-law's results revealed he had calcium deposits in the chambers of his heart. He called to tell us, "I know what is going to kill me." Well, it didn't. He lived fifteen more years slowly winding down dying at home following a serious fall because he would not go to live in an assisted living facility. Ridiculous.
So he didn't go into assisted living. Who knows if he would have lived a longer life had he done so. Your father-in-law lived the (long) life he wanted. Fifteen years of 'his way.' Fall or no fall--good for him.
5
Why do health writers persist in the inane practice of writing sentences like this:
"having zero coronary calcium is not a license to ignore well-established cardiac risk factors like elevated cholesterol and blood pressure, smoking, overweight and a sedentary lifestyle"?
Is there anyone who, having taken such a text and found a pleasant result, would then go on binges of cheese-fries, pounds of ice-cream, and three packs a day? I wish such journalists would quit quoting doctors who use the same pablum formulas. Give us folks who read the health news a little credit for intelligence.
5
Exactly my thoughts. The writer seems to think cheeseburgers etc are what everyone really wants to eat and anything else is depriving oneself.
I am an internist whose job is primary prevention of disease, most commonly cardiovascular disease. This article speaks to our deep need for more useful tools to risk-stratify people and more precisely target costly attention and therapy. But it greatly misses the mark and encourages the extremely expensive overuse of a unproven therapies. I have seen scores of patients who have had unnecessary stents placed in their hearts downstream from unnecessary (though well-intended) cardiac testing of some sort. There is no proven clinical utility to this test and unknowing patients shouldn't even be presented with the option until there is. The last two paragraphs of this article completely contradict themselves:
A: CaC score is useful to help calm anxiety, yipee!
B: CaC score has been shown to be of no clinical value in the highest quality clinical trials
12
Ben, yes it is a travesty that so many Americans "have had unnecessary stents placed in their hearts downstream from unnecessary (though well-intended) cardiac testing of some sort."
But these tests are not inexpensive calcium scans. They are mostly stress tests leading to ill-advised angiography.
Cardiologists do not order PCI, angioplasty, and stents based on calcium scan tests.
Most informed observers would argue that your claim that "There is no proven clinical utility to this test" is simply false. Calcium scores have very high prognostic value. At the very least, high calcium scores convince many patients to finally take their CVD risks seriously and take their prescribed medications and finally undertake lifestyle changes. Or they signal which patients do not need additional slippery-slope tests.
Please read PMID 28345316, 23058065, 23058066, 26148276, 27665163, 26879946, 19520338, 23449263, 28847895, 17481445, 20501456, 20501456, among many, many others.
1
As an Internist you should be more aware of the current cost of a Cardiac Calcium Scan. According to most people posting here, the Calcium Scan costs around $100 and some insurers cover the cost.
Just what I was looking for. I asked my doctor about a test like this. He didn't suggest anything, perhaps because my medical organization is supposed to provide everything I need. Now I know to buy it elsewhere. Thanks for the info.
1
This addresses a hereditary issue. If you don't have a family history of first degree relatives who have had heart attacks at a relatively early age--30s to 50s--and your lipid panel is normal, your doctor probably doesn't think you need this test. Why look for trouble when you needn't.
"A calcium score of 1 to 99 is considered indicative of mild disease.."
While ignorant of this procedure beyond what I just read, I nonetheless have to question any test of most anything that allows "1" to be indicative of, here, "mild disease".
Really? A reading of one [1] ?
Sorry. That's like statistics where 0.02 can be "significant".
Yeah, right.
One.
Mild disease.
And amazingly 99 times 1 is *still* "mild". Absurd.
3
As a cardiologist, I read your article with great interest. In my practice the coronary calcium score has proven to be one of my most important tests for predicting future coronary disease. Unfortunately, your article contains several egregious errors. The coronary CT scan defines plaque. The coronary calcium score defines only the calcium in the walls of the artery, not the plaque. It defines future risk for coronary events, but not any coronary blockage. The relationship between the coronary wall calcium and future events, while strong, is not completely understood. I am particularly troubled by a paragraph that states “a calcium score of 1-99 is considered indicative of mild disease” and higher scores indicate moderate or severe disease. This misses the point. The calcium score describes risk for future disease, not the presence of disease. In the next paragraph you state that “the test measures arterial plaque that is hardened and firmly attached to the lining of coronary vessels.” In fact, the coronary calcium score does not measure calcium plaque, nor is it in the inner lining of the artery. Most of it is in the middle or media of the arterial wall.
The most important role of the coronary calcium score is to predict future risk in medium or low risk patients. Its accuracy diminishes with age and it is most useful in asymptomatic middle-aged people.
I hope you can rectify these errors.
58
Thanks, Dr. Sidney Alexander
Question: So as a diagnostic test, would this be most useful in asymptomatic middle-aged people who have high LDL cholesterol, low HDL, etc. Or are you suggesting that asymptomatic middle-aged people with normal cholesterol, good eating and exercise habits, should be tested too?
Thanks!
2
Does anyone know the radiation dose a patient receives with a cardiac calcium CT and with the more informative cardiac CT angiogram?
1
I am a radiologist who is currently involved in the interpretation of cardiac ct imaging, including coronary artery calcium scoring. Although coronary artery calcium score can be a very useful tool, we have, through advances in scanner technology and refinement of low dose protocols brought down the level of radiation for a cardiac ct angiogram (where we inject dye to actually see the vessels, and can see not only calcified but non calcified plaques) very significantly over the years. At this time, it is seldom worthwhile to do "just" a calcium score in anybody, even patients with a relatively low risk of disease once we put them on the ct table, and our referral patterns over the years reflects this reality.
10
The dyes used in CT angiography are not risk-free. My own father was revascularized, but ended up requiring dialysis for the rest of his life, most likely due to the dye. No dyes are used to get calcium scores. And calcium scoring is much cheaper than CT angiography (though less profitable...)
Both have their place.
2
Go read Dr. Mandrola's article in Medscape that Ms. Brody highlights without noting that he does NOT support utilizing the scan as a screening test.
8
Yes, but...
At 50 My Cardiac CT scan score was 0.
At 68, with high LDL, a low level statin, normal weight, decent diet, slightly unfavorable ratio and doctors pushing a stronger statin, I insisted on a second scan. Score? 2
One preventative cardiologist said I wasn't off the hook because the scan doesn't show soft plaque. Another guilted me into an extremely low dose.
BUT...
What about adequate representation of women in studies?
I read that women, whose heart attacks present differently, might have clear coronary arteries -but blockages in smaller articles, which this doesn't test, e.g.,
"Small vessel coronary disease is a type of coronary heart disease (CHD) that affects the heart's arterioles and capillaries...
Women are more affected by small vessel coronary disease than men. One reason for this may be due to estrogen levels combined with other risk factors, such as high blood pressure."
AND
Cholesterol is a surrogate marker -it correlates with CVD but has not been proven to cause it. Women are underrepresented in studies and there is controversy about data and results. But it can be measured and Pharma can sell drugs. Hence the controversy about statins, which e.g., do not prevent initial heart attacks in women.
https://well.blogs.nytimes.com/2014/05/05/a-new-womens-issue-statins/
7
Best to eat and exercise as the Tsimane do:
http://www.bbc.com/news/health-39292389
"At the age of 45, almost no Tsimane had CAC in their arteries while 25% of Americans do.
By the time they reach age 75, two-thirds of Tsimane are CAC-free compared with the overwhelming majority of Americans (80%) having signs of CAC.
The researchers have been studying this group for a long time so it is not simply a case of the unhealthy Tsimane dying young.
Michael Gurven, a professor of anthropology at University of California, Santa Barbara, told the BBC: "It is much lower than in every other population where data exists. "The closest were Japanese women, but it's still a different ballpark altogether.""
2
I guess my experience is an outlier. Eight years ago, I was sent to local hospital for a back x-ray, since I had been experiencing chronic back pain. The results came as no surprise -- my back was pretty bad -- but the comments on the report indicated plaques from the descending aorta. My internist said this shouldn't be a problem, but that to make sure, I should have a coronary calcium scan. The results showed major blockage of my descending aorta. As a result, I began taking an aspirin and a statin. I then had a nuclear stress test, which showed nothing. The same test in 2016 also showed nothing.
I suspect that my exercise regime over the years (running 10 miles a week for 30 years) created corollary circulation around the blockage. I have continued to have no symptoms, and I exercise vigorously 3 times a week. Knock on wood. I am 75.
6
I didn't think much of the calcium score until I started using it in clinical practice. The real value of calcium score is to perform two consecutive scores a year apart. This is described in the 2004 study by Dr Paolo Raggi who reported annual calcium score increase of less than 15% per year is associated with a good prognosis regardless of initial high score. On the other hand, greater than 15% annual progression is associated with poor prognosis with increased risk for myocardial infarction. Surprisingly, in his study, the cholesterol levels were the same for heart-attack victims as well as for those free of heart-attack, not very useful for predicting future heart attack.
For more see:http://jeffreydachmd.com/2018/03/calcium-score-paradigm-shift-in-cardiol...
10
Be aware that the numerical scoring of the cardiac calcium CT exam can be highly imprecise. My diagnostician rated scores of 497 and 728 to be essentially the same. "Apparent increase in coronary calcium score since 1/27/17 likely artifact of measurement rather than true progression of calcified plaque." The scan and year-later scan were both done at the same facility. The use of a score implies precision which evidently is not really there.
1
Hurrah for the calcium test! After it found a mass in my lung long before I had any symptoms which was then successfully and completely removed, I don't care what it did for my heart. Actually, it did find moderate plaque buildup which is being treated. More better.
8
Yes, the CT calcium scoring test found an incidental lung nodule which was removed before it grew and metastisized. Lucky!
2
The handful of people I've known who had lung cancer all had it discovered when being scanned for some other reason. The lucky one happened to have it discovered very early.
1
Fortunate for sure.
My husband's lung cancer was discovered through a chest x-ray and was staged at 1A--very early. Those thusly staged have a 50% chance of surviving their cancer. My husband was not among the 50%.
LungGevity is a non-profit that finances scientific research to discover both an effective early detection screening test (outside of the Spiral Catscan) to discover tumors at a stage when it's still possible to cure the disease and to hopefully find a complete cure.
Later this month, I'm attending a LungGevity event to 'meet the scientists' to hear about the latest research. I'll definitely be asking about whether or not there's a 'calcium connection' to lung cancer.
Thanks for your posts.
Ms. Brody's excellent points are undone elsewhere in this paper, namely the food section where articles nearly always feature animal proteins and sweets to the exclusion of vegetables, plant-based (read: cholesterol free) proteins.
Today it's beef stew, soda bread (almost no nutrition there) and lamb shanks. It is a public disservice to continually push food that is not the kind of diet that is good for us or the planet. The food section should reflect the kind of balance that should be on our plates most of the time.
Ms. Brody asks, "Will (the president) continue to dine on cheeseburgers and fried loaded with ar and calories their girth does not need?" Please help, NYT and Mr. Sifton.
16
You don't have to eat them. I enjoy them and look forward to the lamb shanks. Yum!
5
May this Pres. reap the consequences of his diet. Soon.
11
Assessing Mr. Trump’s diet I would be more concerned with the large double desserts (cake and ice cream). As for saturated fat; the fry’s are most likely made not with saturated fat but with polyunsaturated vegetable oil (likely gone rancid) that is known to increase inflammation and adverse health outcomes. The lowly hamburger will have less negative health impact than does the hamburger bun that accompanies it.
4
Weird. This test is just a way to gather more information on the state of your body. Who would ever assume that an “all clear” result is a free pass to consume mass qualities of junk food? When I get checked for skin cancers and get a pass, I don’t run straight to the tanning salon. I’m not sure what the point of this article is.
9
In 2004 Paolo Raggi reported annual Calcium Score increase of less than 15% is associated with a good prognosis regardless of high score. On the other hand, greater than 15% annual progression shows poor prognosis. The serum cholesterol which had no predictive value. In fact, the 41 heart attack patients had the same LDL cholesterol as the 450 heart-attack free patients. You might ask, "Why is calcium score a superior predictor over the LDL Cholesterol level?" The answer is: Cholesterol is measured in the blood stream, distant from the wall of the artery where the pathology is located. However, the calcium score, measures the pathology directly in the wall of the artery. Progression of calcium score indicates progression of pathological change in the wall of the artery. The cholesterol panel should have been replaced by the calcium score in 2004. It wasn't. Mainstream cardiology is still in denial, having buried and ignored Dr Raggi’s 2004 study. As Upton Sinclair once said: “You can’t get a Cardiologist to understand something if his salary depends on him not understanding it.” Reference article: Raggi, Paolo, et al. “Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy.” Arter, thromb, and vascular biol 24.7 (2004): 1272-1277.
For more see: http://jeffreydachmd.com/2018/03/calcium-score-paradigm-shift-in-cardiol...
4
"Or will he and countless other continue to dine on cheeseburgers and fries loaded with saturated fat and calories their girth suggests they do not need?"
Why do you continue to spread misinformation here? Carbs are causing more cardiovascular problems than fats, saturated or otherwise, and as the success of low carb diets shows fats are highly satiating and so in and of themselves don't make one obese; DOA figures show that the obesity epidemic is correlated with an increase in carb consumption, particularly sugar, rather than an increase in fat.
You really are doing a disservice to your readers by spreading this outdated dietary nonsense.
32
I am not sure why Ms. Brody says that the procedure is not covered by insurance. I had the procedure, and Medicare covered it along with my secondary insurance. I paid nothing. Ms. Brody needs to investigate more thoroughly before claiming something that is untrue.
8
Nope. Still not covered by insurance.
Usually means medicare won't cover it.
I had it done two weeks ago. Medicare does not cover it. But, it’s relatively inexpensive, about $100, and worth it.
My score was 136, and I have a family history, so it’s back on the lower-fat diet for me.
Now, if I can just get a pass on the wine....
I had the test to determine if I could get off my statins for awhile. Been having some slight memory problems ( can’t remember words at times...is it aging? Early onset dementia? Obscure side-effect of my statins?)
My doctor recommended this test. If my score apwas low enough, I could stop taking the stains and see if my memory improved. If not, and my 136 score is a not, stay on statins and low dose aspirin.
Although my Dad lived to 92, ans my Mom is 91, all of their siblings died of cardiac issues. Some in their 50’s. So, I’m not taking any chances at 65.
Don’t know how earljag got Medicare to pay. Neither Medicare nor my supplemental insurance covered this test.
Late 50, get a physical every year. The last few years my cholesterol had started to go up, got slightly over 200 but otherwise in good health. Doctor ordered the calcium scan, came back at zero. So he did not prescribe cholesterol lowering drugs. Thank goodness for the scan.
8
Consider correcting “It does not measure the soft plaque that can rupture and travel through the coronary circulation until it reaches a narrowing it cannot pass, leading to a heart attack or stroke.”
Plaques in the coronary circulation do not cause stroke. Stroke has many causes, including plaques along the arteries that travel to the brain, but this does not include the coronary arteries. Although a heart attack might cause a secondary stroke (ie through left ventricular thrombus) this is a rather circuitous explanation and I don’t think that is what was meant here.
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Several years ago the local hospital's radiology department team ran consenting medical staff members through CT cardiac angiography. A fellow never-smoking, thin, exercising, normotensive internist who had antecedent only moderately elevated cholesterol and a good family history found that, while his arterial calcium load was fairly low, he had significant soft plaque in his left anterior descending artery. It wouldn't have showed up on the usual non-contrast cardiac CT. He started Lipitor that day.
Granted, this case isn't the usual; the base cardiac CT does give useful information, but this test just doesn't 'rule in' or 'rule out' a disease state. It may help 'firm up' or 'firm out' (to coin a phrase) an intention/recommendation to treat or not.
The article's last paragraph is important. Adequately powered (30,000 patients) studies need to be run to ascertain if, in a population with moderate risk, performing non-contrast cardiac CT and then starting (or not) further medical intervention based on the test's outcome actually results in significantly fewer subsequent cardiac events. An expensive study, yes. But compared to the yearly cost of making cardiac CT a part of the panoply of recommended (or 'patient-expected') disease-preventation tests, completely warranted.
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I had a calcium scan three years ago, at age 67, and was found to have 'moderate' blockage. I had been resisting taking a statin for years, fearing side effects, but this convinced me to start taking one. Also, my insurance company, the wonderful CDPHP, in the Albany area, covered it--no problem.
3
the take-away I got from your comment is that you resisted the advice of your doctor about taking statins. many people seem to have this phobia about statin side effects. why not try them and see if you have the side effects, or not? I take 20 mg of simvastatin, have for a long time (family history and high cholestorol) and have never had any side effects.
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I should have clarified that I had taken a statin years ago, and felt it caused a deep depression. I stopped taking it after reading about depression as a possible side effect, and the depression lifted. Who knows if there really was a connection, but I resisted taking one for years after that, despite high cholesterol levels. The most effective way of lowering bad cholesterol and triglicerides for me was a strict low-carb diet, which put those levels smack into normal range. It was hard to maintain, though. The statin I take now is very effective.
I am fat--have been almost every minute of my life...still I have normal chol, triglyerides, no diabetes, etc. Just atrial fib. My skinny sister has four stents and COPD andno renal disease...go know. These docs have no end of tests they want to run (and get paid for--sorry, did I type that out loud?). I was hospitalized for one of those not-flu viruses in Feb and right after all those blood tests, sure enough, the primary wanted more. I said could you look up the hosp ones? This never ends. I do not consider repeated doc appts to be a desirable form of attention.
About 4 years ago, at the age of 60 my cardiologist said that he would like to put me on a statin. I have high blood pressure controlled by Lotrel which is a combination ACE inhibitor and calcium channel blocker. He said that if I had a calcium scan and the score was good it would not be necessary to start taking a statin. The calcium score came back as zero. This was good news because my father in his late 70's took between 12 and 20 "nitros" a day. I asked my cardiologist if given my calcium score of zero he would be surprised if I had a heart attack within the next 5 years. He said that yes, he would be quite surprised. I am glad I did the test and did not have to start taking a statin.
1
Every male at age 50 should get a calcium score. If positive, go on statin. In not, do't go on a statin. The "risk factors" (LDL, HDL, hypertension for coronary artery disease are just that-- not real disease. Calcium in the coronary artery represents "real" disease. A 100,000 person trial should be done. Taking statin for the rest of your life is big deal. A $100 test is worth it.
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Every MALE?
10
One half of US males die of cardiovascular disease.
As a Family Physician for 30 +years I have a general rule Not to do tests unless the answer will change something. This is the big problem with Calcium scores. If its high, take your statin, control your BP don't smoke... If its good, The same advice. So the instances where it changes management are few. Not screening test.
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Kudos to Bob. More of Bob's clear thinking/analysis needs to be applied to decisions concerning many diagnostic tests and treatments for a whole host of "diseases."
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Certainly can change management! Someone with no risk factors who has slight to moderate elevation in cholesterol but zero calcium score. Many physicians currently advise doubling down on exercise and diet and no statin. Taking a statin is not as trivial as many would like you to believe. Increased risk of diabetes, myopathy, neurologic symptoms.
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True, but let's be real -- most of us are imperfect in our health behaviors and a good scare can be a powerful motivator!
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I'm very disappointed that a calcium scan is not "a ticket to be reckless". So where can I find one?
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At a fast food drive through.
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Calcium coronary artery scans are good at detecting the problem, calcification not cholesterol. There is a calcium cap on arterial plaque that can rupture and induce a clot that blocks circulation to the heart. The reason why there is no conclusive evidence calcium scans improve outcomes because the scans are not accompanied by proper treatment. The doctors detect calcification but treat for cholesterol. In 1991 Dr. Stephen Seely wrote that phytic acid (IP6) provided in rice bran extract decalcifies arteries. (International Journal Cardiology Nov 1991) https://www.ncbi.nlm.nih.gov/pubmed/?term=seely+aorta+calcium+phytate
Sadly, doctors ignore this remedy.
3
Phytic acid is expected to act by blocking the absorption of metals in the gastrointestinal tract. Thus consuming this would hypothetically lead to lower levels of calcium, iron and zinc in the body. Although it could lead to improved health there are no medical studies that show it actually prolongs life or improves outcome in any particular illness. Thus doctors are ignoring this 'remedy' because it has not been shown to work.
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Aren't doctors still refusing to accept trials from Niacin as alternative to statin? We are at the mercy, ruled and doomed by the pharma mafia. I recall when I was shopping for life insurance, I expected to to pay high premium for all the medicine doctor was trying to pump into my body (sarcasm). Few weeks later I got a letter from the life insurance company stating I was on their "super preferred" customer. Called the company to clarify and they laughed it of .... "sir, if there is anyone who knows how long the individual is going to live is us (Life Insurance Company)". That was almost 20 years back and yep no problem ....
I think the best advice I got is from my wife, "be well informed, ask question and counter question and decide weather you need the medicine or not."
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Bill - calcification is not the problem. The calcium is there only because the plaque is there. Calcification actually stabilizes vulnerable plaque, not makes it more vulnerable. Given a particular amount of plaque, the more calcification, the better. There is even evidence that one of the main ways statins work is by promoting plaque calcification. See comments and cites elsewhere in this section. Decalcification has never been shown to be valuable; indeed it will likely lead to harm.
A Cardiac CAT scan saved my life! Ten or so years ago I had seen a cardiologist and had various tests including EKG, Stress Test and Echocardiogram. None showed anything of significance however I knew there was something wrong.
A friend gave me an article to read regarding various imaging techniques including the Cardiac CAT scan. I paid to have it done and the results were three arteries were 90% blocked. This led to an angiogram which confirmed the blockages and a week later I had triple by-pass surgery.
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Great comment. I think one need to know there body. Wish all the best.
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A "Cardiac CAT" scan? This article is about Cardiac Calcium CT scans, which is probably a different test than you are referring to. A cardiac calcium scan does not give detailed arterial blockage information-only a "calcium load" figure for total and individual cardiac arteries. Your test was probably a CT Angiogram, which provides much more specific information, but is invasive and more expensive.
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No, he probably made a spelling error.
One can exercise daily and be on a perfect diet, and yet still have high LDL. Although HDL/triglyceride ratio is much more predictive of heart disease than simple LDL, the latter almost always determines who gets drugged.
Vastly too many people do get drugged on statins, including almost half of those over 75---a group that hasn't even been studied, let alone shown to benefit from a statin.
To the degree that calcium scan keeps some people off statins for primary (not secondary) prevention, then the scan is of value. There are billions of dollars behind pushing statins, but no one pushing for a system of reporting adverse effects in the USA from drugs. Prescription drugs, meantime, are the 4th highest cause of death.
We almost always look at finding people who need a statin, but we almost never look at getting people who show no proof of benefit off statins. Meantime, it's 100% certain that 100% of those on a statin drug run risk of adverse effects. How bad? For some, death. Even if death is extremely unlikely, if there's no benefit, then why run the risk?
But death isn't the only adverse effect. Statins, in those genetically predisposed, trigger devastating neuromuscular diseases. See statinvictims.com for photo (click on guy standing on one leg).
There are enough people pushing statin drugs: it's Big Pharma's biggest "blockbuster". These same people push the denial of severe adverse effects--with great success, since our nation has no organized system for report
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"One can exercise daily and be on a perfect diet, and yet still have high LDL."
I don't think that's likely. I suppose it's possible but not likely.
French fries loaded with saturated fat? Doubtful. Vegetable oils have been routinely used for frying in restaurants for nearly 3 decades. https://uproxx.com/life/mcdonalds-fries-oil-gladwell/
If you want to blame some sort of fat for clogged arteries, I suggest arachidonic acid. Excerpt: "A number of studies have found a positive correlation between the amount of arachidonic acid (AA) in adipose tissue and the risk of ischemic heart disease (IHD)." https://academic.oup.com/jn/article/135/9/2271/4664062
What sorts of food contain arachidonic acid? Our bodies make some of it from linoleic acid but most of it is to be found in the cell membranes of meat and eggs. Chicken, turkey, and pork have way more AA than beef or mutton due to the fact that whereas cattle and sheep graze on pasture for most of their lives, chickens, turkeys, and swine are more often raised in confinement all their lives and are fed grains. Excerpt: "We now know that major changes have taken place in the food supply over the last 100 years, when food technology and modern agriculture led to enormous production of vegetable oils high in ω-6 fatty acids, and changed animal feeds from grass to grains, thus increasing the amount of ω-6 fatty acids at the level of LA (from oils) and arachidonic acid (AA) (from meat, eggs, dairy). This led to very high amounts of ω-6 fatty acids in the food supply for the first time in the history of human beings." http://openheart.bmj.com/content/3/2/e000385
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You state that cardiac calcium scans could be of great benefit to millions of older adults. But you offer no definitive evidence from research studies documenting that such benefits exist. In fact, at the end of the article, you state that research has not shown that these scans improve outcomes -- e.g., reduce the number of cardiac events. I find this a troubling inconsistency. Also, I'm troubled that you don't explain why insurance refuses to cover these scans. Could it be because the evidence supporting these scans is weak? I think readers deserve to hear more from skeptics and wish you'd taken the time to talk to those parties.
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Anything that benefits Pharma mafia will have all sort of studies reporting its benefit including cyanide. Do your own research, go to independent reputable websites.
1
Both are the exact same reason. There's no enough experimental evidence for the insurance companies to accept the risk and cost. I, for one, enjoyed hearing that a new option was available. I never knew a Calcium scan was a thing. Now that i know, if i decide to get tested for the $100 I might get added to the pool of subjects to prove or disprove efficacy of the scan.
My questions are: how to enroll in a possible trial? and why is a value of 1 considered entry into a risk group? Article such as this one have previously stated that everyone has some degree of heart disease starting from teen years. How does this tie into heart disease?
Age is a MAJOR driver of risk scores; almost all males over 70 will have a 10 year cardiac event risk greater than 7.5%. This is often used as a basis for prescribing a statininthe absence of hyperlipidemia.
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A good article. As it suggests, the cardiac calcium test cannot see the soft plaques that are often the culprits in heart attacks. Like any medical assessment, this one is incomplete and imperfect. You may gave a very high score and have clear arteries. In contrast, you may have the perfect score of zero and have seriously blocked arteries. I’m 67 and have a calcium score of 250. My doctor put me on a statin and baby aspirin. I have always been an avid exerciser, eat reasonably well, and don’t smoke. I am not sure I can do much more. Nothing in life is certain.
7
"Nothing in life is certain."
Except death and taxes.
1
And recommended medical tests....
1
Ms. Brody states: "those told they had coronary calcium were two to three times more likely than those with zero calcium to start taking a baby aspirin or a drug to lower cholesterol or reduce blood pressure and to adopt heart-saving behaviors like quitting smoking or exercising more." I don't know why she doesn't mention diet, which is at least as important as exercising, and perhaps smoking, and more effective than the meds. The more whole foods, plant based the better. Where whole foods means unprocessed, and plant based means no animal products. And a healthier diet has no adverse side effects, where meds always do.
eg: “A Mediterranean diet is better than what most people are consuming; even better may be a diet based on whole foods and plants.” (https://nutritionfacts.org/video/the-mediterranean-diet-or-a-whole-food-...
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good piece. I had it and it changed my life. I am 60, long-term serious athlete,do cross fit and can still out do some of the pretty studly athletic kids in my class, lift 1x-2x a week when in town, watch closely what I eat, have never smoked or drank, and taken a statin for 15 yrs due to heredity. my treated total cholesterol is 130, my ratios are excellent, insulin is good and ks CRP is excellent.
but I have a coronary calcium score over 400. and its all in about the worst place it could be; my LAD. my Dr had the more sensitive test and I have 0% blockage anywhere. Still, I had the further eval and my calcium is within the vessel walls and not at the surface so *somewhat* unlikely to break off and cause a heart attack. which is why I watch my hsCRP like a hawk. if I start seeing inflammation, I'll make whatever add'l changes needed.
and what hurts is this stops me from doing serious backpacking, climbing and other backcountry stuff. something happens there, its over. I was planning on doing the Zion Narrows again, a 17 miles hike in the Virgin River where some parts are hiking and some are swimming depending on water level/temp. its a hoof to do it in a day but awesome.
on subject, I've seen 12-15 in 6 months from bob harper (who also has high Lp(a) as I do, kevin smith, 31 y/o soccer player 2 bodybuilders -both in their 20's. they had other probs too, sure.
but for $60 it cost me, it was prob best thing I'd done even if it informed me of things I didnt want to know.
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Sam,
Go to Zion. Probably higher chance to die in car wreck and you haven’t given up driving. IMHO.
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Go test yourself locally, find a pool and swim in cold water for an hour or two, and then go someplace local (with cell service) and do a hard hike for several hours. If you are good with all of that, you can probably do Zion Narrows, if not, then avoid. Also what you are doing in Crossfit sounds pretty tough, suggests you'd be fine in the backcountry.
finally, do a stress test in docs office, and if your heart doesn't misbehave then, also a good predictor. Make sure they run the test hard though!
2
"There is still no definitive evidence from randomized controlled clinical trials to show that patients with elevated calcium scores who are treated to lower their risk actually experience a reduced rate of cardiac events. "
That statement implies the scans and treatments are more examples of profiteering by the medical industrial complex. The word "waste" should replace "value and limitations" in the title.
11
So uninformed and judgement filled, love the not so subtle slam to our president. Thin people have bad arteries too. But we don't talk about that, because we have to keep the judgement alive. As a person the president may be not great. As a president, he's done great things...but all we want is warm fuzzies.
1
No idea what this has to do with the actual article discussing the efficacy of Cardiac Calcium Scans.
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@Bronte saurus:
Which president are you talking about?
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Question, how much radiation are you exposed to per scan?
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From the article, "A cardiac calcium scan is a specialized type of low-dose X-ray". To me personally, this would mean that I would want to have some hope of a definite benefit before I would take the test. As the article points out, there are strong reasons to suspect that the test could be beneficial to some people. In particular, the article makes it clear that diagnostic tests like this are useful if they help your or your doctor make a decision between options that carry their own intrinsic risks or sacrifices. Do remember that this test is normally given only to older people or people at substantial risk of dying within 10 or 20 years.
1
Why does the medical profession use the scary word "disease" here? Particularly if there have been no attacks, symptoms, impairments, and the patient (me) is unusually physically active. My application for a very rare job opening I badly wanted, and at which I could have tried to do some good, was stopped short when the medical screeners saw "disease" in my profile. The statin and meds could have continued to have been delivered. The appeal was pro forma and the recruiters were not going to take on the medical staff. And this was in a program for older citizens, not many of whom I assume had no issues. Yet the brochure welcomes their "experience," and sometimes spoke of the need for "innovation." Isn't "disease" supposed to mean an illness of some type, perhaps with some debilitation? If so, why do I get put in yet another box which I don't choose to reside. I prefer to think of it as healthy with an asterisk, make my own risk-taking decisions, and not let it stop me from living my life. But my best opportunity for a difficult mid-career transition was cut short by a label. Yet we still talk about opportunities for seniors to apply what they've learned in new ways, and show smiling pictures in the brochure.
19
Disease means unhealthy tissue, cells or function.
"A calcium score of 1 to 99 is considered indicative of mild disease"
So, a measly calcium score of 1 will put you into a risk group - this seems like a convenient way to define just about everyone INTO a disease state!
How many people who get a cardiac calcium scan get a score of ZERO? That would be very useful information to include in the article.
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From the article: “The calcium score is a risk assessment tool, helpful in tailoring medical therapy, diet and exercise.”
So - no - it is not a grading mechanism.
@Steve: If you have this test done while you're still employed, do you think your company's insurer will not take note of the results?
I've gotten letters from my company's insurer over a single fasting glucose level that was ONE point "too high" - they have now labeled me as pre-diabetic! So YES, I consider it likely that this cardiac calcium test WILL be used as a mechanism to put people into risk categories.
28
I got a score of zero after my cardiologist sent me for this scan at 60. I was pre-diabetic and overweight with a bad diet and had a younger sibling who had undergone emergency bypass surgery. My result said I was one of the 20% of women my age who had zero blockage.
What I learned is that much of our trouble is genetically determined. I had done nothing to protect my health yet had no blockage and my 90 year old mother is energetic and currently up and walking around without difficulty. I had to call paramedics after she became dehyrdrated 2 years ago and they initially refused to believe she was 88. An advantage I got from the test was my cardiologist felt sure there was no immediate need for me to take a statin - which I was glad to hear.
2
Six years ago I had a heart scan resulting in a score of 1188. I assumed I was going to die any day, and got very depressed and anxious for about a half a year. Eventually, after repeatedly not dying I finally decided my lifespan was about as unknowable as it was before the scan.
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Last year's physical exam indicated a right bundle branch blockage. The Doctor's recommendation was getting the cardiac calcium scan. The nurse brought me into her office and said the results were "troubling" 1800. Not a great way to begin the weekend. I equate the CACC score to a review of an extensive plumbing system. It shows which pipes have plaque. In my case all of my coronary arteries have plaque. It does not show the thickness of the plaque. My next series of steps were a visit to a Cardiologist and 2 stress tests. My blood pressure is good. I NOW control my lipids with a statin, try to exercise, I am of decent weight and no member of my family has died or suffered from coronary disease. My chances of a coronary event jumped from 7% to 17% with a higher CACC score, but it isn't a reason to panic. I was very concerned after receiving a score of 1800, and I sympathize with all of you high CACC performers. Take care and enjoy life.
11
Did you change any of your behaviors?
That is the value of a risk assessment as opposed to a risk predictor.
5
Why do you need a test to start doing what has been shown to be cost effective, free of side effects. It is called a healthy life style. This shows people’s obsession with testing.
Similar to other degenerative diseases, atherosclerosis seems to have multi factors to cause and develop. Therefore current medical approach, namely prescribing a statin medicine or stent surgery looks more primitive, even based upon NY Times health articles.
https://www.nytimes.com/2018/01/29/health/heart-disease-mutations-stem-c... articles. https://www.nytimes.com/2015/06/23/health/heart-attack-stent-angiogram-c...
My doctor at Cleveland Clinic prescribed a statin when he found my cholesterol level high even my CRP result (inflammation test) was 0.1 in comparison with accepted "below 1.0 level". The current cholesterol tests are outdated as we know now that oxidated LDL particle , small LDL (P) or total number of LDL (P) tests are more precise to estimate the risk. He didn't even use a simplified method of trigliceride/HDL ratio to estimate the number of small LDL(P). If a Cleveland Clinic doctor does this kind of approach, imagine how many doctors do the same to millions of patients? No wonder why statins are prescribed millions.
There are other tests such as fibrinogen, LP (a), hs CRP or homocysteine.
21
Wind Surfer, you’ve hit it right on the button. Doctors who use only LDL to justify statins should be subject to malpractice actions.
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There are dozens of alternative tests available, but the clinical utility is largely unproven. It's one thing to show that an abnormal lab correlates with cardiac risk, but it's something different entirely to show that treating based on that same lab result improves outcomes. For example, there is a surprisingly large number of Heisman Trophy winners with dark colored hair. Until outcomes data is available, using coronary calcium scores or other novel biomarkers makes as much statistical sense as choosing a quarterback based on hair color.
4
Dear Wind Surfer: I used to windsurf...then had a statin drug pushed on me.
No more windsurfing, no more walking. Devastating disease replaced all these good things within months.
The statin-prescribing cardiologist ignored everything (and inaccurately denied some) of what you've said here.
Result: StatinVictims.com
8