The Calcium Scan Score: A Wakeup Call That Low Cholesterol Is No Indicator For Avoiding Heart Attacks

                General results - showing relative level of calcium plaque in each artery

Graph showing score between 50th and 75th percentile for men over 74.

 The sheer shock of getting the results of my recent Calcium CT scan is hard to exaggerate. Here I was cruising with just believing I had prostate cancer and bronchiectasis e.g. 

Brane Space: After CAT Scan: A Medical Reprieve - Of Sorts

to contend with and now I learn (even with total cholesterol at 144) I have to worry about a heart attack too. This revelation would never have occurred had I not gone in (with Janice to get her own) "Calcium score" last week, i.e.

Coronary calcium scan - Mayo Clinic

My primary care doctor's office on receiving the result noted:

You have a pretty significant amount of calcium in your arteries. The goal for LDL would depend on whether or not you had a heart attack in the past. If you had not been probably having an LDL below 70 is reasonable, given that you are 79 I think doing what you are doing right now makes sense, 1 could argue we use a more potent and well-tolerated statin like Crestor but frankly what you are doing right now seems to be reasonable

Results: CT Calcium Score

Impression

1. The patient's raw score correlates to between the 51st and the 75th percentile. For patients in this percentile range, this indicates a moderate atherosclerotic burden and a moderate risk of significant coronary artery disease compared to the age- and gender-matched standards. 2. Please see risk and recommendations below Total Calcium Score 0. Negative test. No specific recommendations at this time. 1-10. Minimal calcific atherosclerosis is present. No specific recommendations at this time. 11-100. Mild calcific atherosclerosis is present. Recommend discussion with the patient's physician and/or cardiology about the test results, and whether more testing or medical therapy is appropriate. 101-400. Moderate calcific atherosclerosis is present. Recommend discussion with the patient's physician and/or cardiology about the test results, and whether more testing or medical therapy is appropriate. >400. Severe calcific atherosclerosis is present. Recommend discussion with the patient's physician and/or cardiology about the test results, and whether more testing or medical therapy is appropriate. Note: Clinical discussion should also be considered based on patient age, risk percentile, and whether or not the patient has multivessel or left main disease (both considered higher risk). GENERAL INFORMATION REGARDING CORONARY ARTERY CALCIUM SCORING: 

Recent medical research has shown that the amount of calcium present in the coronary arteries correlates with the extent of atherosclerosis. The CT scanner calculates a calcium score for each of the coronary arteries based on the size and density of the calcium deposits. The total calcium score correlates with the severity of the underlying coronary atherosclerosis but does not correspond directly to the percentage of narrowing in the arteries. Calcium deposits in the coronary arteries may appear years before the development of symptomatic heart disease. 

Coronary calcium scoring is a screening test, but it may direct a patient to lifestyle modification or to further medical therapy or other diagnostic examinations. Some reports indicate it may have a role, with serial examinations, in measuring the progression of disease and the effectiveness of any treatment. A calcium score of zero means no coronary artery calcification is present. This implies a low likelihood of significant narrowing of the coronary arteries. It does not rule out the presence of noncalcified atherosclerotic (soft) plaque. Soft plaque is not detectable by the calcium-scoring test. If there is family history of coronary artery disease or other risk factors such as high blood pressure, high cholesterol, diabetes, sedentary lifestyle or obesity, other diagnostic modalities may be necessary to determine the risk of coronary artery disease. The raw calcium score is compared to known age-matched standards, to the scores of other people who are in the same age and gender group, to generate a percentile score. This percentile relates only to the amount of calcified plaque in the coronary arteries, and does not represent a percentage narrowing of the arteries. Significant stenosis of a coronary artery can only be evaluated with further diagnostic tests, such as cardiac stress testing or coronary arteriography.

 

My plan now is to try to avoid the cardiac 'day of reckoning' by lowering my saturated fat intake - no more Omaha Steaks 'Meat Lover's Lasagna', few giant pizzas and no more giant fatty breakfasts, e.g. 

such as took my youngest brother Mike down. One good aspect is that it justifies my refusal to take the additional ADT of abiraterone - which has multiple cardiac co-morbidities.

See Also:

The Heart Test You May Need—but Likely Haven’t Heard Of | Johns Hopkins Medicine

Excerpt:

How's your coronary artery calcium? What's that, you ask? Like the more familiar tests used to assess your risk of future heart problems—cholesterol, blood pressure and blood sugar tests, for example—coronary artery calcium (CAC) testing helps reveal your risk of heart disease, often before other warning signs appear.

And:

Mayo Clinic Minute - How a coronary calcium scan assesses heart attack risk