What Your Coronary Artery Calcium Score Means
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- čas přidán 4. 07. 2022
- After graduating from a Caribbean medical school, finishing my internal medicine residency, and my cardiology fellowship I will be starting my day in the life as a non-invasive cardiologist shortly. Follow along for medical education content covering cholesterol management, echocardiography, invasive cardiology procedures, and much more.
In this video I review the basics of cholesterol management, atherosclerosis, and how it relates to coronary artery calcium scores. Coronary artery calcium scores (CACS) help cardiologists better risk stratify their patients. It can help doctors make more informed decisions with their patients on cholesterol lowering therapy like statin medications and evaluate a patient's risk of future ASCVD (atherosclerotic cardiovascular disease), or their future risk of heart attack or stroke. I review the pathophysiology of atherosclerosis, the basics of our ASCVD risk calculator, images of a few coronary artery calcium scores (CACS), explain in detail how that information can change our medical management, who does and does not benefit from this imaging study, and how much the test costs (typically ~$100 out of pocket.
*This video is purely for educational purposes and is not meant to replace medical care. So if you have follow up questions about this video drop them in the comments but I cannot provide personalized medical advise.
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I am a male 67 265 pound male, non smoker retired airline pilot who had six month check ups for most of his life. 10 years ago I had a stress test and they told me I had the heart of an 18-year-old. But recently I had some chest palpitations and I did a calcium score of 214.. I’m scheduled to do the stress test in a couple days. Personally hoping that this is a wake up call to change my diet, lose weight, exercise, and increase my chances of having a normal life without stroke or heart attack. Your video is absolutely flawless and it helps me to understand. I wish I had seen it 20 years ago. 🙏
Boy, it seems like the"risk" changes depending on the risk calculator you take. Example, I took the calculator test mentioned in this video, and my 10 year risk was 3.3% I have high LDL, my Dr imputed the same numbers including my LDL into another test that required the LDL number ( probably designed by big PHARMA), and I have a 50% 10 year risk! As far as cac score... I have a cac score of 24. They recommended high intensity statins with aspirin. I asked them what was the highest score they have seen? In the thousands... One man had a cac score of almost 6000. He was in his 80s! They said usually people with diabetes in their 80's have a high score! I don't understand? As far as statins? Research relative vs absolute risk reduction. Wow, relative risk reduction says you have a 29% reduction in heart attack wow! Well, not really. Absolute risk means you have a 1.3% risk of heart attack prevention. Simply put; 70 people will be treated with a statin to prevent 1 heart attack. Talk about deceptive marketing for a 30 some BILLION dollar per year profit... Hmmmm I think we're making a mistake thinking that stains, and cholesterol is going to do anything to stop heart disease. Just sayin...
Bravo!❤
Right on. LDL is irrelevant. I am 68, athletic and all my blood markers and pressure is in optimal territory. In fact all my health markers. 14 day average pressure 119/74. Best 14 day reading 104/63, Triglyceride/HDL ratio 0.34, no meds, no illness of any sort, no infections, no vaccinations, and not even a common cold in many years. It cracks me up all the discussion about how to control supposed markers of bad health. Why not deal with the reasons for bad health? It is simple. Eliminate all carbs from the diet, junk food, seed oils. like the car, if we put in the wrong fuel it will and do get sick.
@@murraypooley9199 Exactly.
Right 👍🏾
Statins don’t treat calcium
My calcium score at 70 yo is 450. Vigorous exercise 3 to 5 times per week for 45 years, gave up smoking 35 years ago, good diet. High cholesterol all my life same as my parents. They lived into their 90’s in perfect health. Had a cardiac stress test every year for the last 5 years. All good. No pain, no discomfort, quick recovery. Refuse statins due to terrible side effects. There’s more to it than what doctors currently know.
As I reiterate multiple times, high cholesterol means higher risk. Nothing is definitive.
@@MarcKatzMD 16:38 my MD wanted to put me on statins for high cholesterol numbers. I saw M. D. / integrative spec and he suggested I get CAC score. I request it through my family md and she ordered a “ chest calcium score”. Is this the same test as a coronary artery calcium score test?
@@sherrylewis5720f sounds like it but you should confirm with your doctor
Hi there doctor, I just had the calcium score done and came at 430.
I workout a lot and like the above I do not take statins. I am 68 and feel great and don’t any problems with my heart.
71 year old here. I just had a Nuclear Tread Mill and Echo Ultrasound on the heart after getting a score of 6,200 on my calcium scan. Cartiologist found no blockage and everything was normal. I have been freaking out for almost a month waiting to be tested. Doctor says the calcium is on the outside and not inside. Don't freak out.
I always felt fine and can run all day and it confused me. Both parents lived well into the 90's ...... mother 98. I have inherited high cholesterol so cardiologist bumped my statin up to 40mg from 20. I eat no red meat no processed food....mostly veggies and fish, no flour (Ezekiel bread only) no milk, no sugar and only egg whites, tons of fruit..... feel much better eating this way and will do this the rest of my life. I will occasionally eat something sweet but not gorge on it.
Thanks, Doc, for a clear understanding of the CAC.
Such a well rounded video on the subject !
I was seeing this ordered at my clinic by some providers and couldn't figure out when they chose to order it...until i stumbled on your video. keep it up up up upppp my dude!!
Thanks for this video - I have struggled understanding my test score - this is by far the best explanation I have found - Thank You!
thank you for the feedback! =)
This was very easy to
Understand. Thank you.
Clear explanations. A great service. Thank you.
Excellent explanation. Thank you!
Thank you so much for this explanation I just wanted to ask when can you decide to use rotapro drilling for your patient and what is the contraindications for it ?
Great video. I just took a CAC scan because my dad's cardiologist recommended it to all siblings. He died last year at 90 yrs old. Im 59 yrs old working out with weights since 1993. Take lots of supplements. I check my blood every 6 months. I have always had elevated triglycerides average between 200 and 400 and low HDL 32. My Vldl 48. My CAC was zero. I would've thought there would be some calcium due to my triglycerides. Fasting insulin 7.1. Fasting glucose 92. A1c 5.4. Also had a PAD scan on carotid and legs which showed normal. Not taking my health for granted .
Always nice to see a CACS of zero. Keep up the healthy and active lifestyle!
Your triglycerides is high, cut down carbs.
@@MarcKatzMD Tomorrow, I'll listen to your entire video:
Cannot wait to hear you (probably) Not mention Menaquinone & Matrix Gla proteins to keeps calcium out of soft tissues & arteries; and K2 to regulate Ca distribution, into bone vs randomly into organs, breast tissue
2]. Advocate for STATINS_ [NEVER should have been approved should by FDA]...
3]. Magnesium acts as a Natural statin.
4] C-Reactive Protein levels is a much better predictor for CAD.
5] NNT & NNH =re Statins, an inhibitor and enzyme poisoner, where the Risks Outweigh Any benefit.
@@starrynight3363 I’d be happy to look into the data behind your ideas but as it stands I’m unaware of any robust clinical data to support your statements
Lovaza fish oil lowers triglycerides
Thanks for the info!
Great job explaining it.
Thank you. That was very informative and clear. I just had this test done and was very confused.
Wow Great information..!! Thank You!
Very nicely done & thorough
Thank you, Dr Katz for the best explanation of this topic I've witnessed. What is out there to address someone who has discordant biomarkers as follows: total chol 218, ldl 128, hdl 78, triglycerides 41, but LDL-P of 1509 (high), low large HDL-P , APoB 88 and Lipo 10. CAC reading 6 years ago was 1 and recent carotid scan shows no evidence of hemodynamically significant carotid stenosis. I'm 102 lbs with a 18% body fat and physically fit. My diet not so good but genetically my total cholesterol has never been below 218 from my 20s. currently 61. I searched web on the discordant readings on my tests but nothing explains it. Thank you!
Excellent information, will be put into practice as a cardio PA.
Happy it helped. The guidelines document also helps for further reading
Your explanation of this topic was well presented.
Thank you!
Excellent video Doc. Here in Texas, November 2022, the CAC test cost $75.
Here in NJ in 2023 CAC test is $99.
@@marymadelynevangelista9799 even at $99, for the amount of information we are getting its a must. I am old enough to remember never having heard of CAT scanning and when it did arrive as a brand new tech you couldn’t get near that machine for anything for less than one thousand dollars.
I've been taking a statin for 6 years and my cardiologist never ordered a calcium score but I did do stress test, nuclear, yearly EKG and echo . I recently saw a new cardiologist (prior cardiologist retired) and he did an EKG which came out abnormal so he ordered a calcium score which came out to 745. He then ordered an angiogram and my results were no blocked arteries requiring a stent. However, I was diagnosed at hospital with Non Obstructive CAD. I have an artery on right side with 40% stenosis. Not sure what all this means but will try to get some answers at follow up with cardiologist.
Great video! You mention the importance of choosing a Coronary Calcium Scan ideally on those who it would change management, ie. the gray zone on the ASCVD risk calculators. But given how flawed or short sighted those are (why is literally not having a heart attack in 10 years the goal?) do you feel you’re missing key people here? PLUS, that 40yo with a score of 8 probably should consider a statin (90% percentile for age..) but very high chance he/she would have a super low Framingham risk score. Thanks!!
I sure do need all of the information . Exactly where I am now with doc giving me a risk score and asking me yo go get the calcium scan.
Yea, try to get a CACS if you are healthy. We all should be able to see where we stand.
Thanks for the info
First-year cards fellow here. Such a great way of simplifying it, definitely gonna use your approach when talking to patients.
Happy it was helpful. Trying to make the videos that I wish I had when I started fellowship. Good luck doc!
Ok, now stop using "gonna", it makes you sound unprofessional.
@@charlesanddiana comments like this gonna get you blocked
Thank you Dr. Katz! This is a very informative video and I think everything is really well explained. QQ for you; What would you recommend as a next step for a 56 yr old male who has about 1500 CACS? His BP is under control with medication, HDL 65, LDL 160, total about 250. Would you recommend nuclear stress test or something else next?
Thanks again!
Sorry for late reply. Typically we do perform stress testing of some sort with CACS >400. But requires personalized approach with an individual’s physician
How do you feel at cac scire of 1500?
Any shortness of breath or chest pain.
How long the score took to double?
Excellent description of the test and its true relevance to cardiovascular disease. The morbidity associated with CVD appears to be multi factorial. As an example my mom who had chronic hypercholesteremia (>300) had no identifiable coronary artery disease confirmed by angiogram prior to an aortic valve replacement at age 90. She lived to age 95 still active (even bowling). I am 70 and had a score of 0 but I still take a low dose statin more for its anti-inflammatory benefit. Again great video and please keep up the excellent educational content.
Thank you for the feedback 😊
I read somewhere that part of what statins do(in addition to lowering LDL) is that they actually take soft plaques and CALCIFY them which is part of their success in lowering heart attack risk. The hardened calcified plaque isn't a risk to break off and cause a heart attack the way soft plaques are. For this same reason, those taking statins can show higher and higher CAC scores as they take statins even if they improve their diet and keep the cholesterol in check...their existing soft plaques harden and slightly shrink(to the person's general net benefit). For this reason, some doctors don't recommend additional CAC scoring after patients with a positive score starts statins. It only serves to add unnecessary stress when a higher CAC score after a few years on a statin may be better than the alternative.
Perfectly stated. From my personal opinion as a cardiologist- I don’t typically recommend repeating a CACS unless the score was previously zero. But also depends on the patient as I try to balance my medical advise with the patients wishes
@@MarcKatzMD here is a general statement about vitamin K2. My dentist stated that I had high amounts of "Calculus" at the roots of my teeth or at the gum line. He prescribed daily 90 mg of vitamin K2. Four months later when I returned for my routine cleaning I had no "calculus" build/up around my teeth. It was suggested that the K2 might also be reducing the calcification of my arteries. Seems to me that annual or biannual CAC scans would be justified to evaluate the affects of K2 on existing calcified arteries. Gosh for $100 it is worth a look?
@@lkelly4337 no that is not worth radiation exposure
@@lkelly4337I take 2400mcg of K2-MK7 with 5000i.u of D3 and my teeth are superb not only that but combined with the Linus Pauling Heart Protocol my CAC has reversed by 30%.
@@MarcKatzMD radiation is minimal per Dr Agaston and he should know. (czcams.com/video/6rnGgus1hqk/video.html)
You did a good job of describing the pathophysology from inflammation to calcification. Apologies if I missed it in the video, but I didn’t here discussion of the root cause. What is causing the inflammation in the first place?
I'm 75 and have a CAC of 16.3, putting me at the 14th percentile. My latest lipid results are total 137, HDL 47, and triglycerides 65. I don't want to start statins for three reasons besides the issue of side effects. 1) The Byrne et al. and other studies, including the MESA study, show that the absolute risk reduction from taking statins is unimpressively low. 2) My lipid levels are already fairly good. It's unclear to me how much improving them further will help. 3) After playing around with the risk calculators and observing how large the variation in estimated risk can be as a function of the variation over time (weeks or months) in BP and even in lipids, it is difficult for me to put great trust in the calculators. Maybe I'm foolish, but my plan at this point is to watch my diet (including an increase in Vitamin K2 foods) and to see what happens.
You missed writing your LDL number. The main number that matters the most
@@danz4928 LDL was 77
@@gshenaut seems like the new guidelines in Europe and the US want everyone to be under 50 in the us and 45 in Europe. It’s all about the Ldl.
@@danz4928 Read Dr Malcolm Kendrick's book - The Clot Thickens.
I disliked this video.
No mention of differences between large and small LDL. No mention of dividing triglycerides by HDL and scores of less than 1 mean very low risk of heart attack, or stroke. Mediterranean diets are not healthy. Full of seed oils, and foods full of oxalates. All you did was push statins. Statins are the killer. Physicians push drugs.
My cholesterol levels have always been within the ranges but recently my doctor recommended getting a CAC and I was over 500. I followed this result up with a stress test and blood flow was good. I'm still scratching my head though on what else could have created this build up.
PS. I'm 68 years old and my doctor put on a statin to maintain that happy range of my cholesterol.
Thank you for the video.
Regarding 10:41-10:46, you mention ". . . patents who are already on a Statin mediation . . ."
Do Statins affect the results?
I'm 67 years old, healthy (5'8" 155 lbs. physically fit/active). I've been on a Statin for 15 years. Average total cholesterol +/- 170. Per family physician's recommendations, got the test. Results on the "widow maker", not good (423). Been battling low iron saturation, supplement with iron tablets, and take levothyroxine for thyroid.
No symptoms, feel great! Next stop, the cariologist, thinking a CT Angiogram may be in order.
what do you know about k2 and it's help with reducing calcium plaques?
Thanks Dr. Katz for the extremely informative video.
Excellent video. Very educational
czcams.com/video/BzTjPuikhQE/video.htmlsi=WpB_94fJf3_zZDJO
I'd also like to know about aortic stenosis in the calcium buildup there how does that happen?
Great video! Well done!
I had a CACS back in 2018 at the age of 46. My score was 17 and I have a familial history of high cholesterol and heart disease. The Dr at the time said it isn't recommended to get the test more than once, but that seems counter intuitive to me. Do you recommend getting this test done as a one time assessment or is there any harm in getting it done periodically (3-5 yrs) to see at what rate the calcification is progressing? Also, does the condition ever improve or for example, will I always have a CACS of at least a 17? Thanks.
Should there be a full sliding scale of CAC scores vs. age? For example, a score of 50 for a 75 year old is a lot less troublesome than for a 50 year old. You did touch on this for younger people. I would think the risk should be higher the older a person is before they are subjected to statins. Also, the risk calculators have been shown to overestimate risk in most cases (Johns Hopkins study) though probably in a relative sense higher is truly higher, within the same calculator. But if I'm 80, I would think a true 10 year risk of 20% is a lot less troublesome than the same assessment at 50, since there are many more "10 yearses" to get through at 50 than 80.
Yes
Triglycerides were the main risk factor for young adults. LDL was not indicative except somewhat for the highest quartile.
Association of four lipid components with mortality, myocardial infarction, and stroke in statin-naïve young adults: A nationwide cohort study
Men don't generally start calcifying their plaque until after the age of 45 or 50. So, for younger men this isn't a good test of heart disease. The best bet is to get a CIMT which is non-invasive, cheap, quick and doesn't require a fair dose of radiation like the CAC. It measures the plaque in your neck which includes the soft and more dangerous plaque. Heart disease is systemic so if you have plaque in your neck it will be in your heart as well.
Hey doc,
I had a calcium score test don't roughly 8 or 9 yrs ago age 31 CAC score was one. My diet has changed much I just started a statin this year. My question is how much do these scores change year to year
You mentioned the Mediterranean diet, do u have any thoughts on extra virgin olive oil or omega 3 supplements for someone who has an elevated ( mild/ moderate) calcium score and elevated ldl?
I don’t like over the counter O3FA. And using EVOO to cook and over salads is fine but I wouldn’t start eating it in its own just health benefits. Ask your physician to see what they think
Thank you
Thank you for this video. I had elevated score- dont know the number. If your cholesterol is fine would you still have to go on statins? Some ppl cant do statins because of muscle aches. Ive made lifestyle changes last 8-1/2 mnths- doesnt that stabile the calcium?
Lifestyle helps slow progression but statins can help even more and are known to stabilize plaque. Depends on individual person
Got two zero CAC scores long ago, but in recent years couldn't find anybody local who still performed this scan
Very well explained. Are risk charts available?
What risk charts do you mean?
I am a 46 year old male and just got a score of 255. I have literally exercised 6-7 days/week for 31 years and have never missed a week ever. I have normal blood pressure and cholesterol, have never been overweight and no family history. I have done 45 minutes of cardio every day for decades and weight training. I was shocked at my score and it makes absolutely no sense. What can someone do who has a high score but has no possible areas of improvement in terms of their lifestyle (ie: diet, exercise, blood pressure and cholesterol)? All of those things are already optimal so I don’t know what else I can possibly do. Very bizarre.
Medical therapy. Otherwise keep doing what you’re done
U r absolutely right bro. Keep going as you r.
Vitamin D3 (5000-20000 IU) combined with K2 (300 mg) take calcium out of bloodstream and puts it back in bones and organs. I’m no doctor ; I just follow dr berg. He has lots of videos. Check out lowering calcium and D3. Just had my cac done and it was 1.
Stay happy and stress free.
Continue healthy lifestyle.
Calcified plaques are better then soft ones.
Do remember your exercise has created plenty of collateral vessels in your heart by now and they are a good thing to have
I had one done and the score was 121 in the (widowmaker) Anterior descending... 63 years old. on statins but wasnt consistent at taking them ( reports on hard on liver etc) Anyway, can it be reversed? I have heard once it is hard calcium no, if it is soft plaque, that could be. Any opinion on that and how concened should i be with that score. Not that it may matter but i do run a treadmill fast slow, fast slow for 30 minutes till heart rate is 135 then it recovers in a minute back to 110. Regular heart beat is 60 ish. blood pressure is often 110 or less and 60 on the low end. so can it be reversed and if so over what period of time?
Excellent video,I had high cholesterol(inherited) on was on statins for over 25 years and have run 4 times a week for over 35 years religiously. Doc said need to go for a scan. Score was 375 and 3 blocked arteries(LAD, RCA, CircumFlex). Luckily the exercise created collateral arteries and the statins turned the soft plaque into calcified plaque which is a
good thing. I got 3 stents placed over 3 separate procedures and placed on Plavix and an aspirin. I have improved my diet removing ALL junk food and lost even more weight. My BP was always normal.
Diet will help but if you had hereditary factors that typical means that your liver is making most 80% of the cholesterol so hence need for statin and reducing simple sugars reduces inflammation which is now seen as just as important or even more important than just the cholesterol number. Hope this helps. BTW I feel really great
Reversed my CAC by 30 % without statins just 3 simple supplements.
@@SET12DSP and you're not going to tell us what those are?
@MarkHolmes Of course I will. Most people, it seems, just settle for standard medicine. Unfortunately, it just wasn't good enough. Especially seeing that it just leads to more medications and procedures.
I am on the Linus Pauling Heart Protocol, which uses high dose vitamin C with Lysine and Proline amino acids.
I take 5 grams of Vitamin C mornings and 5 grams afternoons with 15 grams evening.
Lysine 3 grams and Proline 4 grams 2x per day.
@@SET12DSP did you have to slowly ramp up to that? I take aged garlic extract (Kyolic), Konzentrated K (powerful k2 formula), nattokinase, L-Carnitine, high dose Fish Oil, tocotrienols. (CAC of 442 , 3 years ago - 385 in the LAD).
@MarkHolmes Mark I hear of people getting results on different acids, malic, citric, and absorbic , sodium ascorbate. Of these Malic, maybe the strongest. It was suggested to take breaks while on citric. These all have advantages and disadvantages. With sodium ascorbate, it is a bit easier on the stomach for some people as well as producing less diarrhea. If diarrhea is a chronic issue, then Lipo Spheric C is the best but very expensive at a $1 /gram Dr. Thomas Levy suggests it may be 5x more potent than ascorbic because it is fat soluble
Some people make their own.
So, in the end, I think the acids contribute a lot to the decalcification. But I also feel there is more to than that. And there is no substitute for C as it's needed to rebuild the artery correctly.
Personally, I have no issues tolerating ascorbic, and it's just plain cheap.
Now, how to start!
You have to find your own bowel tolerance. To do this, you'll need to take C in divided doses. I use 3, but you can use more. I'd start with 3-4 grams of ascorbic acid powder. I use morning, afternoon, and night.
If you get diarrhea, just back off a little. And maybe try a larger dose at night. I was told there is less trouble at night! And I concure as I can handle 25 grams after my evening meal easily.
It may take a while to find out where your body is at. As someone told me, your body will tell you. I didn't quite understand that, but I do now. What is meant by that is if your body can use the C, it will use it all with no bowel issues. But if it doesn't need it, it will either give you diarrhea or loose stools. The loose stools are OK, I was told. I have them often with no issues, typically, but it can happen. But the effort of finding your tolerance is well worth it.
I practice intermittent fasting, so my meals are time spaced, meaning I usually eat two meals in a 4-6 hr window. This stimulates autophagy, meaning getting rid of bad cells within your body, not to mention getting rid of multiple glucose spikes throughout the day by eating between means and its away of controlling your weight. I was formally was a 100lbs heavier. But I didn't really use intermittent fasting to lose my weight. I walked it off basically while being a vegetarian. I am no longer a vegetarian. But I am sugar and grain free.
For me I use BulkSupplemets powder for ascorbic acid. Lysine and Proline. In water.
Any issues get back to me...
Good luck 👍
16:38 Great video. My doc mentioned this test at my last visit because I have been looking at natural remedies to avoid a statin. I’ve had a stroke at age 49, I am a type 1.5 diabetic since age 40, my LDL off statins is about 111. but I went vegan or whole food plant based 5 years ago. I’m now 61. Would you recommend this test?
It's only $99. Why not? Just be aware that if it something higher than 0, you will start worrying. So consider that.
I saw that carbs are the cause of the super small particle LDL. Those particles get into the wall of the artery and cause atherosclerosis. Not the large fluffy LDL
Good video
Hi Doc...excellent vid! I am 58 and just scored a 209. My Cardio prescribed me 10mg Statin and a Bayer Aspirin a day, my cholesterol is only 137. I dont understand something...shouldn't a high risky score like mine trigger a more then just a stress test (he also scheduled that). Shouldn't a Angiogram be done to see if there is major blockage?
No statins needed, I would ignore that recommendation, get a second opinion, find a low carb doctor that can help you.
Yes get an angiogram.
Hi doctor is 485 calcium score dangerous? I'm taking 10 ml of rubestatin and baby aspirin as per the doctor. I've also lost 30 pounds and changed my diet to a healthier one. Any comments will be appreciated. Awesome video doctor.
Thanks
JC
This is very informative; thanks so much for taking the time to do this! I haven't had a CAC test, but did have a coronary CT scan. How do the scores correlate? My CT scan score was 1V (small area of spotty calcification in LAD) and a low-dose statin is recommended to stabilize soft plaque (5 mg of Rosuvastatin). I'm a 66 year-female with A1C of 5.8, BP 128/74. Cholesterol levels have always been okay, but have crept up a little (177 total, LDL 108, HDL 48, Tri 104). This is very alarming to me. Do I need to get a CAC test?
First off, I cannot give personalized medical advise on the internet. Second, ask your doctor! These are great questions to ask someone who has access to your personal medical information and [hopefully] knows you.
Generally speaking, coronary CT scans are the same thing as a CACS except a coronary CT can be done with contrast and is then called an 'angiogram'. A coronary CT angiogram provides information about blockages that cannot be seen on a CACS (or a coronary CT scan without contrast).
The side effects of statin medications are often vilified with the same veracity as vaccines on the internet. However, within the field of cardiology we know the lipid lowering class of drugs are safe and effective at decreasing the risk of atherosclerotic cardiovascular disease. In conclusion- if you have specific questions about starting a statin medication or about your specific coronary CT scan then talk to your doctor!
If taking calcium is bad for your arteries, why do pharmaceutical companies make stains with calcium in them. I won’t mention any.
Ps thank you so much for your video presentations!
@@deb73042 consuming calcium or taking calcium supplements has nothing to do with coronary artery disease
@@MarcKatzMD Not all cardiologists would agree with you on the benefits of statins and the lack of harm. You should also mention that just to be fair. Read Dr Malcolm Kendrick, Dr Aseem Malhotra, and many other researchers, scientists, etc. What about the NNT ? Not very strong evidence for statins, plus who needs increased chances of diabetes, muscle issues, etc? Why are we so beholden to pills? Stress management, wise eating choices, exercise, reducing insulin resistance - all seem to be better choices. Just my .02 worth. My cardiologist said he would have put me on a statin when I was first discovered to be a LADA diabetic 25 years ago. I guess the question is - how does he explain that at 73, I'm still alive without his pill? Total Cholesterol 200, triglycerides 64, HDL 60, LDL 111. Lp(a) - 9 mmol/L. , hs-crp .39 . Non-Smoker - walk 4 miles a day. No cardiac events so far. Good video - just maybe not showing the total picture?
Was really helpful for me. Enjoyed it!
That’s what I love to hear!
BRAVO NICE JOB DR. KATZ. THANK YOU FROM MONTREAL.
Thanks
I was 71 when I had the calcium test because all though I had great blood work I was having light headiness and out of breath occasionally when doing light yard work , was told my left coronary artery was narrowing. So now with the stain I am on jardiance
As I posted a month ago, I am a 58yo male with a CT Scan score of 209. I did a stress test today and had no issues, got the heart rate up to 140 and the tech and doctor said there where no abnormalities...so what does this mean now?
Excellent presentation doc, 2 yrs ago I got a cac and to my shock it was 1260. I work out regularly and intensely, never any discomfort or chest pain. After extensive testing by my cardiologist it was determined that my arteries were clear and the calcium had manifested itself probably on the outside or within the arterial walls. I was cleared to go back to working out without restrictions.. Doc, can you shed some light on my particular diagnosis as it is confusing to a laymen.
Certainly. The first thing to know, as you mentioned, is that the calcium can grow inside or outside the lumen of the artery. If it grows on the exterior portion of the artery it can be a sign of underlying inflammation without causing blockages. What’s quite interesting about coronary calcification is that we’ve also seen in extreme endurance athletes like triathlon participants that those individuals can have much higher coronary calcifications but be in great cardiovascular shape. We won’t know definitively for years while following those studies to know if it’s a sign of negative outcomes to come or if it’s an adaptive response. Generally though in average individuals we see it as a marker of more advanced atherosclerosis than what we can measure on contemporary calculators based on noninvasive information. Hope that helps! Lmk if any specific questions I can help answer
@@MarcKatzMD
Thnx so much doc, very informative..I workout very intensely for my age.. Now It makes sense why the technician who performed the sonogram on my heart and arteries asked if I had ever contracted a serious viral infection..
Very informative. Can you offer comments on statin side effects and the potential to increase risk of developing diabetes?
Typically benefits outweigh the risks
Dear Doc, please make video on k2 and calcium supplements. Either share the link... information that should be part of the video if I may say obediently from a layman's perspective. It should talk about the impact on people with calcification of heart artery and valves. Is it safe to take calcium or calcium carbonate + calcitrol or D3 + k2 for an arthritis patient suffering from calcification of heart.
Vitamin D supplements and calcium supplements have little to no impact on atherosclerosis
There's an abnormal inflammatory response associated with cardiovascular disease. It seems like the endothelial of certain individuals is more prone to injury. This process allows cholesterol.
to migrate to the muscular layer of the Vasculature
Yes
Is it possible to early diagnose leaks occurring from the inner wall of an abnormal vessel into the vessel with a blood test? For example, in a special blood test performed 1 month before a sudden heart attack, can the increase or decrease of some molecules in the blood be monitored until the heart attack occurs?
Hello Dr. Katz, excellent video and information. Subscribed, I really like you’re no nonsense approach. Let me tell you about my worries:
43 yr hispanic male, works out and eats healthy. Total cholesterol 180 with hdl 49, ldl 117 and trigs at 51. Had a CACS and it came back 375 in the LAD. I’m absolutely terrified and stressed about it. Having a nuclear stress test tomorrow. Docs want me to start Atorvastatin 40mg and are preaching stuff I already do. Not overweight either, maybe a few pounds and I lift weights. I really don’t want those statin side effects. Should I be as mortified ad I am? Former smoker, am I at high high risk the plaque will break the cap and form a clot? I’m informed enough to be dangerously miseducated if that makes sense. Why do I have such a high score in just the LAD? Widow maker as my doc told me.
Thank you Doctor Katz for your help.
Typically, the presence of hard calcified plaque doesn’t mean you will 100% suffer a heart attack in that artery. It does mean you are at a higher risk though and statins can help lower that risk.
As I said in the video- it’s the cards you’re dealt and how you play them. You can do everything right and still have a genetic predisposition to developing CAD. I can’t explain the distribution of the coronary calcification.
I commend you for quitting smoking and can add that it is possible your score could have been worse if you weren’t already doing the right behavioral things like exercising, eating right, and avoiding smoking.
Do you have any updates?
I'm 73 with an overall score of 440, with 380 in the LAD. Test was from 3 years ago. Still going strong and not on statins. I don't see how statins are going to reduce the risk. The Number Needed to Treat (NNT) is pretty bad for statins. If you give a 100 people a statin, 2 will be helped. 98 will not be. So a 2% chance of being helped and then if you look at the Number Needed to Harm, you'll see it's about 25 out of a 100. I don't like those chances, so I eat well, take the right supplements, walk every day and live for another day
Look into low dose third generation (stronger, less side effects) statins. Crestor 5 mg daily or 3x week is what some of the most informed docs are doing for themselves. At some point, we are going to see some better drugs than Statins on the market. You are young enough to probably see them as a future option.
Control your thoughts. Control your stress. Otherwise, you may end up having a heart attack over this issue, not from the test results but because of the stress!
55 F
Diabetic
Non-smoker
Caucasian
CKD
Fatty Liver
Diabetic Neuropathy
Diabetic Retinopathy
(Canadian...all tests and medication are covered)
My actual question is at the bottom, I don't need my actual results diagnosed. I just need a better understanding of already provided result.
Early this year i got a calcium score of 842.
After many more tests, nuclear stress tests, ECG, there was no blockage found and blood flow is ok. Heart is ok although there was limited thinning on one side.
Both cholesterol numbers were low.
After discussing with cardiologist a couple weeks ago, he says that it's my diabetes that caused that score (it was crazily out of control for many years but my last A1c was 8.2).
I've already made many changes to improve my health in that regard but I just don't understand how exactly diabetes would give that score.
Does having that calcium score mean I'm supposed to have calcium buildup somewhere already, or is it indicating a high future risk?
Thank you.
CAC score of 1346. Echo and stress test good. High LDL . Statins for over 10 years. Age 64
can you tell me about the food best for high blood pressure patient even if the blood pressure remains high at 160?
No salt,no cafeeine and no white sugar.
Exercise ,deep breathing,yoga and high fiber diet.
Get your kidneys checked too
Recently had a calcium test done after they discovered evidence of plaque from a pneumonia X-ray. They did the pneumonia x-ray because I had chest congestion from a cold that wouldn’t go away after 9 days. My score on the calcium test was 429. I was very surprised because my cholesterol has never been an issue (total about 150, LDL 85) and my blood pressure and blood sugar have always been normal. Non-smoker, non-drinker, not overweight, ok diet, and no symptoms of heart disease. If I hadn’t had the bad cold, I would never have known that I have the high calcium. Now they are prescribing 5g statin and aspirin. So I think there may be value to getting the calcium test even if you don’t have any apparent issues.
Hey Marc, great vid. As a young PCP with a great interest in lipidology, how do you rectify low 10 yr ascvd/cacs of 0 in younger patients with(despite lifestyle modifications) persistent LDL/ApoB elevations vs lifetime risk. It seems that perhaps attempting to be as preventative as possible is a reasonable goal in the context of longer term risk. Wouldn't statin/zetia use earlier on before the 10 year risk crosses the threshold be more beneficial? Perhaps the data is tbd. I think the European Recs are heading this direction. We can't of course tell the future, and I love your "stack the cards in your favor" analogy(one I use weekly). With the information provided it's of course ultimately a patient's decision but without unique extraneous factors otherwise, the benefits probably outweigh the risks... any thoughts?
Sorry for late reply. Agree with your overall train of thought. Not to mention ASCVD risk calculators are far from perfect. I think 99.9% of cardiologists agree that the lower cholesterol the better without treating things unnecessarily. But it all comes down to the patient in front of you and that personalized approach to that patient. Sounds like you’re doing a great job already and happy to discuss further if you have any specific questions!
There are major lipidologists who agree with this. It's cumulative. doesn't make sense to wait until effects of all the years of high particle count have accumulated to then lower them to change the risk calculation. Rather, lower the long term effect of particles starting early.
@@MarcKatzMD excellent thx for the reply
@@ceeweedsl excellent thx for the reply
@@Wipeout416 Low dose non-daily class 3 statins seems like the best way to go as an early intervention...so far. 5 mg or 2.5 mg Rosuva 3x week? W/Ez? w/COq10? Sooner than later, makes sense. I mean, if UV degrades, do you wait until you see degradation to begin applying a protectant?
In the pipeline are better CETP inhibitors. The newest ones in trial seem to offer real improvements over statins and offer other benefits such as lowering of BP (as opposed to early ones) as well! Too good to be true? Look for Dr. Attia's interview w John Kastelein - #255-Latest therapeutics in CVD. Info on FH is revealing but later discussion turns towards CETP inhibitors.
Wonderful video, thank you for explaining this so it's easier to understand. I am 53 yr old female, overall cholesterol 274, triglyceride 90, HDL 65, LDL 191 normal blood pressure, normal sugar, get plenty exercise since I walk for a living, don't drink, don't smoke eat pretty healthy and have never had medical issues. Am i a good candidate for this test? Doctor wants to put me on statin but I would only want as last resort
If your LDL is >190 guidelines recommend a high-intensity statin. So ideally a CACS is not indicated. Worth a conversation with your cardiologist
@@MarcKatzMD Please specify what these guidelines are and where can they be found? Thank you.
@@marciandjohn6320 (1) Full guidelines from ACC/AHA via this link: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000677
(2) Regarding specific question of LDL >190: "In patients 20 to 75 years of age with an LDL-C level of 190 mg/dL (≥4.9 mmol/L) or higher, maximally tolerated statin therapy is recommended"
Great Video Dr. My question; what happens if you change your diet, go on a statin, workout and your score goes up dramatically? I read that can be a good thing as the INFLAMED PLAQUE HAS CALCIFIED and that will cause you score to go up?
Yeah it goes up!!! But I'm not calcifying my arteries...nor my brain nor my eyes. I have able to reduce my CAC by 30%
@@SET12DSP so tell us more. you're being disingenuous.
@MarkHolmes I wrote my reply this way as to get a return reply instead of writing at length and hearing of no interest in Linus Paulings Protocol.
Now, there is what I call further enhancing of the Protocol.
I use Dr. Thomas Levy's advice from his book "Stop America's #1 Killer " Proof that the Origin of All Coronary Heart Disease is Clearly Reversible Arterial Scurvy.
Dr. Levy has many u-tube videos.
One of his enhancements is using magnesium, as when magnesium is up in the body, calcium is down.
Any questions please feel free to ask!
@MarkHolmes I can pretty much explain how it basically works if you'd like. I have been on this just about 3 years now. I have a check-up with my cardiologist on Wednesday, so it should be interesting when I ask them for a comment on my CAC Score going from 660 to 458. They didn't even have my score on their patient web portal for 5 months WTH. BTW I am 68.
So the scores started at age 60 with 299, then age 65 at 660, and that's when I started the Pauling Protocol. Then, 20 months later, it was 458. It's said by many cardiologists that it can't be done. But I say really! Your machine just measured it. And then they may say, "Oh! That's just an error, and I say a 30% error? I don't think so as I worked on medical test equipment and noway errors of this magnitude would be tolerated on test equipment going out the door.
Above all I believe in Linus Pauling as he was a 2-time Nobel Prize winner and was awarded 48 PhD's over his lifetime.
@MarkHolmes So, according to Dr Thomas Levy Cardiologist. The problem is purely a focal scurvy or a point in the artery that is depleted of Vitamin C caused by the mechanical stress of the artery next to the beating heart. When depleted, Lp-a comes to the damaged artery as a substitute for vitamin C to start the plaque build-up to shore up the artery that has cracks and holes in its walls.
A high dose of Vitamin C is used to repair the damaged Lysine and Proline exposed strands. But Lp-a has to be controlled or neutralized, and to do this, Pauling uses the supplements Lysine and Proline to bind Lp-a then vitamin C can really go to work rebuilding the artery correctly instead of using a poor patch job to shore the artery up.
A high dose C has to be used because if any toxicity in the body exists, vitamin C gets used up fighting bacteria. If one has any kind of dental issues, which can be a source for heart disease, the C gets used up so much as to short the artery of what it needs. You can have bad root canals or implants and not even feel anything, as Levy says.
This is the one thing that can stop the Pauling Protocol from being successful.
To battle oral bacteria, I use vitamin K2-MK7 with D3. I use a much higher dose than what is typically used as recommended by Dr. Kate author of "K2 and the Calcium Paradox" which is 100mcg of K2-MK7 per 1000i.u of D3. To much D3 can overrun K2-MK7 with calcium. You can take more K2-MK7 than D3 with no issues.
That's about it other than I take 4 grams of Omega3 per day with 1600mg of CoQ10.
So it's working for me with no blood thinners or statins.
At age 69 I was diagnosed with a CAC of 29.9 in LAD. It's 3 years later should I get an other one? I do have elevated cholesterol but triglycerides are low and HDL is 80. Not on statin (have refused them since my 40s when I was diagnosed with high cholesterol. I have low blood pressure, physically active (ex ballet dancer who keeps on training hard), strong heart. Thank you for sharing your opinion.
The decision to get a repeat CACS should be made between you and your physician and unfortunately I can’t give personalized medical advice online. What I can share is two things- first is that different medical societies have studied your specific question and most guidelines recommend repeat scanning for patients with CACS >0 in about 3-5 years. Second is that the reason we estimate a patient’s ASCVD risk over a 10 year period is that the benefit of statin medications is longitudinal. It takes time for atherosclerosis to develop and likewise for statins to show a benefit in stable patients not actively having a heart attack.
Some opponents of statins say that doctors ‘push’ these meds. I acknowledge statins are the most profitable drug for big pharma ever to come to market. But they are safe and effective. Additionally, I acknowledge that with any test or therapy there is always a risk that must be weighed with its benefit. So if your CACS were to increase I would strongly consider starting one. Frankly if you were my family member I would want you on one to decrease your risk of heart attack or stroke! But that conversation needs to be had between you and your physician. Hope that helps!
Reference: Golub, Ilana S., et al. “Major Global Coronary Artery Calcium Guidelines.” JACC: Cardiovascular Imaging, 2022, doi.org/10.1016/j.jcmg.2022.06.018.
@@MarcKatzMD it seems I have read that you will normally see a 10-15% progression per year on a CAC, regardless. I'm a bit puzzled why you are not giving more credence to the actual risks / harms. They are real you know. It still comes down to the patient deciding if the benefit outweighs the risk. The NNT still bothers me. Sure 2% helped of millions is helping some, but then there is no discussion of how many millions are harmed and it doesn't take much to find those people.
@@MarkHolmes I always asses risks and benefits of every medication and therapy
I'm 52, and my score was 0 except for my right coronary artery. It was 33. My percentile was 50%-75%. I've been treated for hypertension for 11 years now. I'm wondering why the calcium deposits only show up in one specific area and are not distributed in a greater area. Is this from an injury possibly
My test results said it was maybe a “3, but may not even be that high. it may have been caused by the machine was making noise.” Do you know that that means?
Great video and all makes clear sense. Very little though is said about how exercise can be effective CACS and cholesterol numbers. Can you comment on that?
Excessive exercise (e.g. people who do marathon/triathalons) can show higher coronary calcification. But not sure if that’s protective or evidence of the fact that anything in excess can be harmful. Overall, exercise is good for you and can help your cholesterol. But you can never ‘out run’ genetics or your diet.
Wonder if that has to do with the excessive exerciser refueling with bad carbohydrates rather than a balance of meat protein and fat? Anyway thank you for the reply.
Hi doc , would you recommend ASA 81 mg for someone with high score ? If yes what’s the cut off number ? Ex : 44 yo female with high CRP, Apo B on crestor 5 mg , significant FH of premature CAD . Do you recommend ASA ? Thank you
I cannot give personalized medical advise online. You should talk to your physician
Just an update, back in late August 2023 I had a full angiogram done and found that 209 score added up to 90% blockage in LAD and others. Double bypass surgery was performed 5 days later. IMO...any calcium score over zero means you have plaque in your arteries, how much and how dangerous can only be determined by a doctor going in and up there.
👍👍-Thanks.
Indeed very well explained. Thanks a lot. Have you ever seen or heard of someone reversing their CAC-score? Does the risk-level of a heart attack depends on how the calcification is distributed along the coronary arteries (e.g. highly concentrated at one place or spread over several places)? Thank you!
Check out vitamin K2.
Mine has from 660 to 458
@@SET12DSPcould you offer more information. Did you make lifestyle changes?
@myfairyblueworld I'm on a Keto diet, which is low carb high fat. I am also grain and sugar-free. I accomplished my reversal with the Linus Pauling Heart Protocol, which is a high dose ascorbic acid powder in divided doses 3-4 grams 3-4x per day with 2-3 grams of Lysine and Proline each 2x per day. I walk 4-6000 steps per day. I am 68 years old.
@@SET12DSP thank you. I wish you continued health.
I have a question. My lipoproteins (A) come back 105. Dad history of heart disease and stroke, maternal grandfather died of heart attack. Sister died in early 40's from fluid building around her and lungs. Mom had cancer then ended up with kidney disease. Dad had stage 3a kidney disease. I already have mitral valve regurgitation I believe it is. Where the valve does not close all the way. Cholesterol levels are very high. My sons cholesterol is not good. I don't understand good and bad so I wish I had the numbers to show you. Just had the CCS TEST today. I believe it said 1-10 but not sure bc down below that it had other things. Been having kidney problems or bladder issues also, lot of pain. I also have pain in chest shortness of breath especially going up stairs hill etc..I'm 56 in june.. our family does not live out of there 60's . My dad with heart disease and kidney disease did make it to 72. Thanks. Barbara.
as a Cardio guy, I see that you're pushing the statin's for those with high cholesterol. However meta research on statins with a large sample of 15K people, peer reviewed sat statins only increase life span by 4 days and the side effects in most cases are not worth the risk and side effects such as muscle wasting away. Maybe you need to look at nutrition and how vitamin K2 can reverse calcium and takes it from the arteries and put's it back into the bones and teeth where it belongs. Just like a typical American Dr, your treating the symptoms and not the underlying causes.
Even the talk about cholesterol is wrong. There are 11 markers for cholesterol and some of the things used to predict hearts issues Apolipoprotein B, and maybe take a NMR LipoProfile to see actual particle size. Your a young guy, you should be up on this.
" how vitamin K2 can reverse calcium and takes it from the arteries"
I have yet to see anyone provide a well done study showing that "reversal" of calcium.
I keep looking, keep hearing, but NO well done studies showing actual reversal.
NOT simply a CAC score which can vary from test to test.
Top doctors, including the inventor of the CAC test all say no real reversal, not even with K2.... but what seems to be a myth, continues to appear over and over on the Wild West internet.
Show us how to find reliable truth. I doubt it exists for now.
Sixty-eight year old male on a statin for many years, exercising every day, recently completed a nuclear stress test with good results, no chest pains, basically clean diet, non smoker, low body weight takes CAC test scoring 1300. Would an angiogram be recommended, especially if that patient can't stop worrying that he has a ticking bomb in his chest.
Why does plaque built up in the same location over time? If the body is healing itself in the first sign of damage and responds by repair then what causes additional plaque built up?
Inflammation
But what about the small particle ldl blood test, size and amount? Wouldn't that be a better test ? That's the stuff that causes atherosclerosis right?
That’s another blood test that we can use in a similar manner to CACS to better risk stratify patients
I’ve never had high cholesterol, nor smoker, nor diabetic, but my cac was 913. I’m willing to adjust my diet to more Mediterranean foods, but I’m not willing to take a statin as recommended by my cardiologist. Should I take a statin?
Yes
very good info. very clear, concise. Thanks! BTW, where do you practice? Sounds it is not in US.
Thank you. I currently practice in New Jersey
FYI.. I just had a screening & Medicare covers the standard 80% of the cost. I believe it's covered every 5 years.
Hi Dr Katz. My scan shows a score of 132 (moderate) with a percentile ranking of 25-50%. What does that last bit mean? I don’t understand the percentile part… does it mean that I am like 25-50% of the population my age? That’s a wide range it seems… would appreciate your help understanding…
It means that 25% of people in your age range have scores better/lower than yours, and 50% of people have scores worse/higher than yours.
It is a wide range. It 's essentially saying you're in the 2nd quartile.
You should be able to find a calculator online that will take in your age and score and give you a precise percentile.
Why would we NOT want to know our own CAC scores? It was only after I ordered CAC test for family member that Docs were aghast of 1150 score and put him on statins and BP...3 years later, CAc score went up another 100 pts. Are statins helping? He has stress tests every year and never an issue, no chest pain...he is in excellent physical condition at 73 and we eat healthy and exercise. Since going on statins, his A1C went up a lot!!! So we are revamping diets again...never get any info from docs about diets and supplements, so we are on our own. Very disappointing and frustrating.
Statin therapy can increase calcium score but I view that as a good thing- you’re turning vulnerable soft plaque into something unlikely to rupture and cause a heart attack. I know physician communication can be irritating and frustrating and I’m sorry you seem to be experiencing that first hand. Overall, the I usually explain to my patients that the benefit of reducing risk of atherosclerotic cardiovascular disease (e.g. stroke, heart attack) outweighs the negligible impact that statin therapy has on A1C. Of course, every patient an individual is different and can be impacted by medications differently and that’s where having that discussion with your physician comes in. Always important to remember that we treat the patient and not just their numbers! I hope your family is doing well
Great video! So clear and informative. I am 43 and got a score of 3 last Dec after full work up for chest pains. I also have EOE and do often have varied chest pain and occasional (1 or 2 per year) significant impaction but really only take tums from time to time. I was prescribed a low dose statin and baby aspirin. Followed up with cardiologist and said no aspin but does want me on the low dose statin. Have not started taking it but certainly will if needed and helpful but there was so much conflicting information when I looked further into it. Since I also have EOE I thought it could be related to the calcification as opposed to cholesterol which has for years been flagged out of range but around 216 or so but never medication. Other than this, thankfully healthy. The dx was of course scarry and worries me a lot but I was also worried to be on that forever especially if it could make it worse. I will certainly do it if that's what's provides best protection and risk mitigation. I am married and have a 9 year old daughter and would love to do a cool, healthy 86 or so. Good decade 😄. Anyway, Kudos again on this helpful video. Thanks! ✊
Statins are safe and effective medications that have been well studied. Unfortunately there are many non-medical individuals online who promote misinformation concerning statins. On top of that, there are an extremely small number of physicians who view statins negatively. The simple fact is that the medical professionals who truly believe statins are dangerous are in the exceedingly small minority. I have never met a single physician who would not agree that in the right clinical context, like a CACS that is not zero in a 43 year old, a statin could help decrease future risk of atherosclerotic cardiovascular disease.
I would definitely have this same conversation with your physician to hear what they have to say! Hope I helped answer your question
@@MarcKatzMD Thank you so much for the reply Dr. Katz. I appreciate the comments and you taking the time to reply. It certainly does make me more confident and comfortable with taking them and I will certainly follow up. Thank you again! Best, Jason W.
@@MarcKatzMD Have you watched Dr. David Diamond or Dr. Paul Mason talking about statins? And have you reviewed the studies Dr. Diamond refers to? It does not bode well that Lipitor is the most profitable drug in history. By the sound of it, a low-carb/high fat diet will do more good for people than any statin ever could, unless of course, you've already had a coronary event, or you are a smoker. Here's a link to Dr. David Diamond on statins if you're interested: czcams.com/video/YaEmiUfL7ts/video.html
@@DARKLYLIT I agree that I do not enjoy or like big Pharma. It is true that statin medication’s are one of the most profitable drugs ever made. However, for specific patients that are at high risk of atherosclerotic cardiovascular disease, statin medicatios, along with a healthy diet as you have pointed out, can decrease risk of heart attack and stroke. In particular patients who have already had one heart attack to prevent future heart attacks. Additionally, a healthy diet in combination with a statin may be beneficial in certain patients. Some patients may be able to benefit from diet alone. It all depends on the patient and the conversation you have with your physician. Overall however I believe lower the LDL the better
@@MarcKatzMD Dr Nadir Ali is a cardiologist at Univ of Houston Hospital has done considerable research on HDH/LDL, Statins, diets & interactions etc himself and other research associates. He has a large presence on CZcams lectures and Research Seminars. I bring this up bcz I think it may add value to the discussion on the subject here.
Isn't the CIMT test much better since it can pick up both soft and hard plaque without the use of radiation?
If by 'CIMT' you mean a vascular ultrasound then yes and no. I often use vascular ultrasounds to detect underlying peripheral vascular disease (PVD). So I will sometimes use vascular ultrasounds to detect PVD, like an ankle-brachial index, as a surrogate marker for CAD. Unfortunately sometimes the tests are inconclusive or a patient's anatomy doesn't allow us to properly visualize the vessel. As I'm sure you are aware, a lot of these decisions require a thorough discussion between the patient and their physician. Hope that helps answer your question!
What I don’t understand is how I had a heart attack 11 years ago and my cardiac cath showed a small blocked artery around the back of my heart with absolutely no build up in my other arteries and ten years later, when I got a calcium score done, it was zero. How does this fit into the current model of cardiovascular disease?
There are a few things that I am confused about in your statement. First, based on current guidelines it is not advised to get a coronary artery calcium score in patients who have had prior coronary artery bypass surgery or those with prior coronary stents. Part of the reasoning of obtaining a coronary artery calcium score is to guide medical therapy. If someone has had prior coronary stents or coronary bypass then by definition they already have a manifestation of atherosclerotic cardiovascular disease and should be on cholesterol lowering therapy like a statin.
Second, it’s important to note that heart attacks occur in coronary arteries where deposits of atherosclerotic plaques with thin fibrous caps covering them rupture causing a thrombus, or clot, to form. These areas that are prone to plaque rupture don’t necessarily have to be in areas of coronary arteries that have significant blockages. Meaning, the degree of narrowing of an artery is not predictive of future heart attack.
But to be frank, something doesn’t add up as I’m not sure how a CACS of zero is possible in an individual with a known history of coronary artery disease with prior stenting 🤷🏻♂️
@@MarcKatzMD ah, I see your confusion. My heart attack was in a small artery around the back of the heart that was too small to stent. It was totally blocked. The surgeon woke me up during the procedure to show me just how “clean” the rest of my arteries were, though. They were all wide and clear. I had no surgical intervention done. I was put on 5 medications, including Simvastatin. Three months later, I could no longer hold my laptop computer with one hand, could barely lift the nursing home charts with two hands, and could no longer push myself up from being seated in a chair. We stopped the statin.
My husband had a calcium score test done ten years later, which made me wonder what one would show on me, given that my surgeon was so excited about how clear my other arteries had been when I had a heart attack. I asked my PCP if we could do one, and since they are all patient-pay here, there was no one to say no if she wrote the order. So I had one done that showed zero calcium build up. I have never had an answer that made sense to me for the question of what could have caused the heart attack. My cardiologist (who I still see for POTS) said something about some plaque broken off from elsewhere, but if I have none in my heart, would I have any elsewhere? What model of heart disease explains what I have experienced? My HgA1c is 5.2, I have insulin resistance, I have Ehlers- Danlos Syndrome -Hypermobile type, Hashimoto’s thyroiditis, Lymphedema caused by the little-known lymphatic and fat disorder called Lipedema (which researchers now believe may be a connective tissue disorder of the lymph system) and weigh 355 lbs as a result. My cholesterol levels were not yet high when I had a heart attack in 2011. My blood pressure is usually low-ish and I now have to measure it before taking my beta blocker for POTS because it can be 90/55.
The cac can be wrong … my husbands was over 800!
He had a Doppler text he had multiple ct scans he had stress tests ekgs ultra sounds and every other test and no plaque.. he is clean
Calcifications are present or they aren’t. It does not mean that there is flow limiting stenosis of the coronary arteries
Very helpful video. I could hear you fine, and cadence was great, by the way:)
Thank you for the feedback!
As a retired Electrical Engineer, I like your approach. I just had a CT Angiogram done at a local hospital. It is covered under insurance. My score was 1455. I did a lot of research and most say that the size and density of the LDL, Stress , Sugar, Carbohydrates, and Insulin Resistance is much more important than Cholesterol Levels.
What is your opinion of this? Also Niacin vs. Statins.
Thank you very much.
Go pay a visit to doctor.
@@oscarcollier5141 Keep your opinion to yourself.
I retired from the electronics industry myself, Their likely to want you on a Statin period!
It's in the name of stabilization.
What is working for me is Dr. Linus Paulings Heart Protocol he was a 2-time Nobel Prize winner awarded 48 PhD's over his lifetime. Using his Protocol I have reversed my CAC from 660 to 458 in 20 months.
How about a CT angiogram with contrast?
Thanks for your excellent presentation. It may be too early to know, but I was wondering if you have heard of COVID affecting this calcification. My score jumped from 77 to 264 in about a year and a half. I was under extreme stress during that time and getting very minimal sleep due to being the sole caregiver to my mom who was almost completely paralyzed. I don’t know whether stress and lack of sleep could create such an increase but I also got COVID during that time. Secondly, I saw some people commenting on taking vitamin K and possibly reversing their score. So far I have read that nothing can decrease your score, only slow the progression. Have you heard of any studies involving vitamin K and reduction of calcium scores? Thank you!
Haven’t heard of COVID causing calcification specifically. Same with vitamin K- it’s all nonsense
Hi my husband had Covid as well and he just got diagnosed with hight calcium score when he was zero. 😢
I had my test done, and my score total was 3071. 579 in the LAD. My primary thought that maybe the score was wrong. Non smoker, not overweight, no diabetes, work out often. Needless to say I was very surprised, and now very worried. No symptoms(angina, etc). Stress test was ordered but not for a few weeks. I feel like I need some
More aggressive testing like a Lexi Scan, etc. Advice? Thanks.
Lexiscan is a form of stress testing (I have a full video on stress tests). Would definitely want you to see a cardiologist or lipid specialist if I was your PCP
May I ask your age?
What is the upper limit of cac score in asymptomatic person?
Any further news? Your circumstances sound so similar to mine … curious
Both cardiologists that I saw offered no hope … just take statins and aspirin 😩 and wait for a cardiac event
@@ronniekirby5406 May I know your score and details?