Coronary Calcium Score Test, Statins and the Risk of Heart Attack (When to use and How to interpret)
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- čas přidán 2. 06. 2024
- Discover the critical role of the Coronary Artery Calcium Score (CAC score) in heart health with our in-depth video. The CAC score has become an essential tool in predicting future heart attack risks. It offers valuable insights - a high score indicates elevated risk, while a score of zero can be reassuring, depending on the individual's overall health profile.
But there's more to this test than meets the eye. Misinterpretation or incorrect ordering of the CAC score can lead to unnecessary worry or even harm. This video navigates the complexities of the CAC score:
Learn when it's appropriate to order a coronary calcium score.
Understand how to interpret a positive result and what it means for your heart health.
Explore the need (or lack thereof) for repeating the CAC score.
Decision-making process around whether a coronary angiogram is needed following a high CAC score.
I address these critical questions and more through a real case study, providing practical insights and expert analysis. Whether you're a healthcare professional, a patient concerned about heart health, or just someone interested in preventive cardiology, this video is for you.
Watch now to empower yourself with knowledge about coronary calcium scores and make informed decisions for heart health. Don't forget to like, share, and subscribe for more insightful content. Your feedback is valuable - drop your questions and thoughts in the comments section below!
Learn more at: heartcare.sydney/what-is-coro...
#coronaryarterydisease
#cholesterol
#statins
0:00 Case study
02:08 ASCVD calculator
05:07 Problems with repeat calcium score scan while on statin therapy
09:13 Calcium score scan and invasive angiogram
10:40 Statins and vascular calcification promotion
13:33 Summary - Věda a technologie
Further infor at: heartcare.sydney/what-is-coronary-artery-calcium-score-and-when-is-it-indicated/
I’ve probably watched 100 videos on you tube on this topic within last two days after I found my score was 248 and every video was disappointing. And here I find this wonderful doctor with this perfect explanation using example of his own patients. Thank you. All questions your patients asked you were my questions as well.
I'm pleased to hear that you found the video informative and helpful in understanding the concept of the Coronary Calcium Score.
Having a score of 248 certainly requires attention, but remember, it's just a number. The key lies in understanding what it represents and how to manage it.
Thankyou Dr. I’m a 75 yo Oral Surgeon, still working, office outpatients only. Ca score 650. No chest pain. T2 DM. Doing keto. Lost about 90 lbs over last 18 mo. I have been struggling with/idea of d/c ing Rosuvastatin. So thankful I viewed your video. Thankyou!
Glad you found it useful
Excellent video. As someone who's just had my second scan (which I realise now was probably not necessary) and my score has gone from 330 - 430 over 5 years this video certainly helps with anxiety. Statins doing their job.
Thank you. Glad it was helpful.
Excellent breakdown of CAC - the best explaining of the true purpose and risks I have seen so far! Thank you very much and keep up the good work!
Glad it was helpful!
I'm cardiologist from Iran .
It was so useful for me .
You're an excellent teacher.
🌺🌺
Thank you, Yeganeh. Glad it was useful.
I was on statins for 25 plus years due to inherited high cholesterol. I ran every week for all those 25 years and took statins. My Doc felt a Coronary score should be done, came back as 385 with 3 blockages >75%. I had no symptoms at all even while running hard 5K's. Anyway got RCA, LAD and Circumflex done with stents. I am so very grateful to the cardiologist. Back running again. I guess the Statins did a good job of calcification of the soft plaque over decades..
Did you ever have a nuclear stress test?
Thank you for sharing your story. It emphasizes the importance of regular health check-ups, even if we feel healthy. Treatment decisions like cardiac stents (angioplasty) are complex (especially in patients with no symptoms) and based on many factors specific to each patient and situation. It's great that your doctor was proactive. Keep up with your running, and best wishes for continued health!
Next Level Cardiologist and his explanation was tailored perfectly to an every day guy like me. God Bless you and your family for the work you do for the betterment of society ❤
@@michaelmcw111 Thank you, Michael!
This is an excellent Video. Made complicated things, much simpler. Thanks Doctor.
Thank you. Glad it was helpful.
Thank you. This is the best explanation I found regarding calcium score.👍
Thank you🙂
This was very succinct and direct information. This is a very helpful and valuable video presentation about CAC tests and scores! Thank you!!!
Thank you, Patricia 🙂
I just did calcium score and angiogram.. score was 405 ,angiogram was good as I had 3 stents put in two years ago .. I also had fatty liver ..so I stopped sugary drinks processed foods and went on low carb diet incorporated intermittent fasting.... I’v heard statin increase calcium score so don’t think I’ll start taking them.. I lost 18 kg over last two years and my angiogram shows no more worsening stenosis.. ie still same as two years ago ..I’m worried statins will increase calcium score.. iv managed to keep cholesterol at normal levels.. ldl 2 ,, triglycerides at 0.8 and hdl 1.4 .. so triglycerides to hdl ratio is great
Hi, you have done a fantastic job losing 18 kg by following a healthy lifestyle.
Coronary calcium scores are recommended in occasional, ambiguous cases to assess "future heart disease risk". For individuals with a history of cardiac events, like heart attacks, stent placement, or bypass surgeries, this test is not helpful, as their high-risk status is already established.
For high-risk individuals, such as yourself, with a history of stent placement, statins are highly recommended. This is regardless of an LDL within the normal range. Your current LDL is within normal bounds, but an ideal target for someone in your situation is below 1.4 mmol/L.
Ultimately, your treatment choice is personal. However, based on current evidence, statins are highly recommended in your scenario. While they may increase coronary calcification, overall, they reduce the risk of future events.
Thanks.. but I don’t understand why it has to be 1.4 .. ldl .. my cardiologist is angry with me for not taking statins too .. I lowered my cholesterol naturally with exercise and diet.. I don’t understand what statins will do that is more beneficial.. I totally reversed fatty liver as my enzymes were high alt and ast were 87,90 .. I reversed it with fasting and diet no more sugars and high carbs.. so I feel I eliminated the risk factors that caused my condition..also taking bit k2 d3 to try eliminating calcium from arteries
@@cpchris2 I truly commend the efforts you've made. Lowering your cholesterol naturally, reversing fatty liver, and lifestyle changes are incredible achievements that have undoubtedly reduced many risk factors.
However, it's important to recognize that still a residual risk remains. Statins are recommended because they can further reduce this residual risk. The LDL-C target of 1.4 and below is not arbitrary; it is based on extensive research from large-scale trials conducted on hundreds of thousands over the past three decades. The evidence for its benefit is strong. To put it in perspective, if I had three stents, I'd aim for an LDL-C even below 1 mmol/L.
I understand your reservations, and as always, the final decision is yours to make. The best choices are informed ones. Stay well.
Great clear presentation and informative
Glad it was helpful!
excellent presentation for any type of knowledge base!
Thank you
Great discussion, thank you.
Thank you
Interesting video, thanks for sharing. 👍
Thank you
Clear explanation, thank you very much
I had no idea that I was a high risk patient UNTIL I took the CAC test. I recently received a CAC score of 1202. I’m 61, 6’@145lb, don’t smoke, pretty active with ranch work and I exercise intermittently. I’m very concerned as my pcp has essentially given no advice. Btw, total cholesterol was 229, trig-109, hdl-72, ldl-135 with no breakdown of types of ldl. I don’t know what to do next, as in which tests I should have done, or where to turn. Please give any advice you can, PLEASE!
I hope you’ve found a good cardiologist by now.
Definitely, find another doctor. Statins help reduce soft plaque, which is more dangerous than calcified plaques. I hope you found a better PCP or cardiologist.
Better safe than Sorry. Had Cath angiogram , no problem 40 minutes , awake but sedated to dont care. All good. My Calcium Score came in at 1571. Of that 509 LDA and 1024 Right , Thought I was toast. Cath angeogram showed only mild 10% or less stenosis. 41 years of statins thank you. Calcium was in the outer wall .. stable . Very fortunate . Dad 5 bypasses early 50's. All 6 uncles heart attacts 40's 50's.
Excellent explanation..easy to understand. Thank you
Thank you Doris
Excellent Video. Thank You Doctor !
Glad it was helpful.🙂
Fantastic presentation 👏 👌
Thanks, Akash 🙂
Thank you doctor. Very informative presentation.
Glad it was helpful!
Great lecture. If the video explain why ca test is to be done for low and medium risk patient, it would have been very helpful
heartcare.sydney/severe-coronary-disease-despite-a-calcium-score-of-zero/
I don't use statins. Age:early 60s. D2M ~22 yrs. A1c-6.2 for 22+ yrs. Total Cholestrol~175-185mg/dL all along. BP:120/80. Vegetarian. What may be my cal score? 2900 with no chest pain even if I climb mountains or 1000 steps. Yes, all of my arteries are calcified from 500 to 800. NO one in my family have HEART DISEASE. This means, I assume that most of my plaques are NOT SOFT PLAQUES but mostly hard & stable ones. I have a plan of what to do next.
Excellent video. I have a question:
A patient has been experiencing localized chest pain in the the left chest area for 2 years. The pain comes and goes and is ONLY aggravated during sleep time. Sleeping on either side and or on the back initiates the pain when it decides to come. The patient Usually wakes up with shortness of breath and squeezing chest pain in the same area (Lower left chest). The squeezing pain lessens after an undetermined while then remains in the background during the day and lasts for a couple of days.
The pain is NOT aggravated by effort. The patient jogs and perform sports activities without problem.
ECG was done 3 times throughout the 2 years and is normal. Echocardiogram done twice and also normal. Stress ECG also normal.
Can these symptoms be a sign of coronary artery disease? Or Could this be a suspected case of variant angina (coronary spasm), which comes only during sleep time? Or a myocardial Ischemia case, where blood flow is interrupted for some reason?
The patient refuses to conduct any invasive examinations such as coronary angiography because it’s invasive, or ct angiography because of radiation and contrast risks. The patient would like to conduct a cardiac MRI instead. Most doctors assured him that a cardiac MRI will not show blockage in the coronary arteries. Is this true? Can a cardiac MRI reveal any stenosis, occlusion or blockage in the arteries? Or it will be useless.
How can we rule out CAD OR VARIANT ANGINA ? Can this be a none cardiac related ?
The only known risk the patient has is high cholesterol. He is 46 years old and a non smoker. He also refuses to give up on modifying cholesterol level through diet and exercise and is postponing taking statin for know.
KINDLY ADVISE!
Thanks Khaled.
Unfortunately I can’t provide medical advice here but from what you explained, unlikely his symptoms are cardiac. Best to follow his cardiologist advise.
Simplest way, if he is so anxious, is to proceed with a cardiac CT scan. Risk of radiation is minimal.
MRI is currently not used to diagnose coronary artery disease.
HOW is it a valuable tool? when zero scores may indicate a soft vulnerable plaque and a calcified artery may indicate a stable one
Every test in Medicine is valuable if used according to the indications. Any test has pros and cons and the doctor who orders the test
must be familiar with the limitations and strengths. How to interpret the results of a test, whether negative or positive, is an art which needs to be mastered. Otherwise, we could put humans in a machine, do a test and finished.
A zero calcium score is extremely valuable if done in a person above 40 years old with no or low baseline risk factors for heart disease. However, if that person has many other risk factors for heart attack like smoking, diabetes, hypertension or high cholesterol, then there is no point checking the calcium score. You can read more here.
www.heartcare.sydney/what-is-coronary-artery-calcium-score-and-when-is-it-indicated/
While I can accept the initial increase in CAC score is due to the statin stabilizing the plaque, how can you be sure the increase in the score is NOT the further development of more plaque? If the score continues to climb, it suggests the intervention is not working. Do we not need to know that?
Hi, the short answer is NO.
As mentioned in my blog (heartcare.sydney/what-is-coronary-artery-calcium-score-and-when-is-it-indicated/), we should not repeat the CAC score if elevated. Remember that the role of the CAC score is "stratifying the risk of ischemic heart disease in an individual with low to intermediate risk based on ASCVD calculators". If someone has a high CAC score and we decide they are high risk, the job of CAC scoring is DONE, and there is no need to repeat the test. The repeat measurement will not change anything. A high-risk patient will not change to "higher"-risk, and if they have no symptoms, they should continue the medical therapy and pursue a healthy lifestyle. In this video, CT calcium scores were repeated by different care providers or after a presentation to ER (ED). Repeating the test can cause confusion and unneeded concern for the patients when they see the score climbing. Unfortunately, in some instances, this can also lead to unnecessary angioplasty.
@@heartcaresydney Thank you for taking time to respond to my query. Really appreciate it.
Are you saying, changes in the CAC score have no relevance as a marker for the progression of the disease? If it continues to climb (or even reduces) we should ignore it? How do we know we are on the right track in addressing the issue?
I paid $50 for the CAC scoring, and got a ver high score (1703). But I’m 72 and have taken statins for at least ten years, so according to this I probably wasted $50.
While statins can contribute to an increase in calcium score by stabilizing plaques, a score of 1703 is notably elevated. This suggests a significant pre-existing atherosclerotic plaque burden even before starting statins. It’s quite possible that your commitment to taking statins over the past ten years has played a protective role, by stabilizing these plaques. This score signifies the importance of continuing your statin therapy, and it’s a testament to the potential benefits you’ve gained from the medication over the past decade. While you might feel the $50 was unnecessary, having such data might provide a clearer perspective on the journey and decisions you’ve made for your heart health, over the past decade.
My Calcium Score came in at 1571. Of that 509 LDA and 1024 Right , Thought I was toast. Cath angeogram showed only mild 10% or less stenosis. 41 years of statins thank you. Calcium was in the outer wall .. stable . Very fortunate . Dad 5 bypasses early 50's. All 6 uncles heart attacts 40's 50's.
CAC Does NOt measure the deadly soft plaque statins raise CAC. …only CIMT measures soft plaque. One can have zero CAC but lots of killer soft plaque
Dear Dr, from last 10 years i was diognised as stable anjina after walking for 15 mts there was pressure in arms, thereafter after resting for 5 mts i become normal with no symptoms. 1 yr back i did CT anjiography and score was 3000, subsequently nuclear test don and was normal , from last 1 yr i am taking beta blocker and statin suggested by my cardiologist,as regards calcium score he said forget about it, as my age is 75 yrs, i am worried what to do, my condition is same as described above, kindly advise
Very helpful video. I'm a 71 year old woman with no risk factors other than cholesterol 276 and Lp(a) 150. I have an Agatston score of 1 which I thought was very good but the cardiologist still said I should take statins. After watching this video perhaps you would recommend statins as well because there may be unstable soft plaque?
Thanks for the comment Joline. My recommendation is always to follow your doctor's advice as they most probably know your history much better than I do.
Hi
Anyone knows the highest number of a CT calcium score?
I have a total calcium score of 93, 34 on the widow maker. Im 58 years old. What does it mean ?
It means in the past you had soft angry plaque that has since calcified and is now inert. It poses no danger unless a piece of it breaks off…
@@greco37 CAC Does NOt measure the deadly soft plaque statins raise CAC. CAC test is useless and used by money hungry drs to get business…only CIMT measures soft plaque. One can have zero CAC but lots of killer soft plaque
MINE 2.1.2023 was 980. Should I be very concerned?
Hi Chris
I would follow with the doctor who ordered the test. They must have a plan in mind for high scores like yours. If not, I recommend seeing a Cardiologist.
@heartcaresydney Thank you much. God bless you
Thanku for the valuable information. I hope this gets way more views.
P
very informative very good video very useful
Porque no está traducido en castellano?? Somos una colonia inglesa?? Es una falta de respeto para el CZcamsr.
Gracias por señalar esto. El video ahora tiene subtítulos, por lo que debería poder traducirlo.
Enjoyed it very much! Thanks for doing this.
Glad it was useful yashar
@@heartcaresydney de
À la gare
@@madi-moussadiarra1611 je suis a la gare aussi