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.
Amazing. From USA. I canceled my angiogram yesterday because I have no pain. The cardiologist said I could get one but i don’t have any pain. I had a week long cruise and was going to cancel. I had a cac score of 800. I am on statins, plus eztimibe, plus aspirin.this makes me feel better. Thank you most heart fully.
Unfortunately the misuse of calcium score is common. The calcium score is NOT a test to decide whether someone angiogram or stent. It is just a RISK ASSESSMENT TOOL. If Zero --> can be reassuring in "low-risk" people. If high --> means high risk and the patient needs INTENSIVE MEDICAL THERAPY to lower the risk Any decision to proceed with an angiogram or further invasive procedures should ONLY be guided by symptoms or the presence of a significant abnormality on a functional test like stress echocardiogram. A calcium score should never lead directly to an invasive angiogram.
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.
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!
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..
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 ❤
Most people had a heart attack while their cholesterol are within normal range for whatever reasons. The main culprit for heart attack is the “inflammation”!! Infant’s diet are notoriously “fat loaded” breast milk yet few infants develop heart attack because their inflammation level is very low!!
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/
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.
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.
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!
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.
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.
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.
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.
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?
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.
Great Video Doc! I have a cac of 944 (700) on the LAD. They found blockages in 4 arteries mild-moderate/moderate but flow ok LAD was 0.81 so no stent. I’m on high dose atorvastatin. If this increases my CAC by 20% a year I’ll be on over 2000 in 5 years. 4000 in 10 years. I’m only 56. Does the increase in CAC down at any stage or is the an accurate picture of the future. Thank You Dr 🙏
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.
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
@@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
