Coronary Artery Calcium Score (CAC) - Can It Predict A Heart Attack?

welcome to another episode of talking with docs I'm Dr Paul I'm Dr Brad weaning I'm Mike heffernuto Mike Heffernan Dr Mike Hefner is a cardiologist who's joined us we're going to do some talks about Cardiology we've had some in the past and for those of you that are new to the channel we like to incorporate a little bit of humor because everybody knows that laughter is the best medicine what about antibiotics we wouldn't even be alive most of us have done antibiotics fine fine antibiotics are an important medicine everybody knows that laughter is the second best medicine what about anti-hypertensives what's that preventing stroke heart attack and death okay okay antibiotics everybody knows that laughter is a close third best medicine suffered there Paul what about viagra that is actually very smart medicine how does it even know what body parts work on yeah like why didn't your arms stick straight up in the air after you take it okay fine laughter is not even medicine but laughter is important you know that we know that and that's what we incorporate it into some of our videos so if you don't like laughter and you don't like jokes go watch another video okay what are we talking with today coronary artery calcium scoring coronary artery calcium scoring also known as Zac don't sound that out not CAC okay no and this is something that a lot of people have wrote in the comments saying well my calcium score is zero I don't need any treatment I don't need any medication or my calcium score is really high we're going to give the skinny on kind of its role and how it can be helpful in potential treatment of your coronary artery disease so take it away doctor after that okay um what is it so actually let's go back okay why are you even interested in it um so we have lots of us I think none of us here have had a heart attack fortunately right but we're all wondering you know are we at risk of having a heart attack and so there are lots of people out there who are worried about having a heart attack appropriately so you might have a family history or other risk factors and wouldn't it be nice to know if you're at increased risk because if you were then might you'd be able to do something about it to reduce your risk so it's all about in you know in in the field of Cardiology there's a lot of gaming of risk stratification who's high risk who's medium risk who's low risk and then we know how best to treat you to reduce your risk so we've got scoring systems okay um most of the scoring systems that we have are actually just based on clinical factors how old are you what's your gender what's your blood pressure what your what are your cholesterol numbers those are kind of typical things that we would enter into an algorithm to say oh okay well here's your risk it works really well on a population basis if you take like thousands of people you are probably doing a good job at preventing heart attack stroke and death but on the individual basis there's an argument to be made say luck doc you know I think I I realized that you just did my Framingham risk score um and yes I might be at medium risk for instance but how do I know I am at risk and that's where coronary artery calcium scoring comes into play and we talk about this with with surgery and infection because I tell you all the risk is one percent but if you get infected you get 100 infected you don't get one percent effect so you might be someone that falls out of that average and you might have unique characteristics that that make this test potentially more useful for you right okay find this important because I have this battle with my family doctor all the time because my cholesterol is a little bit high and he's just obsessed with getting it down below a number and leave it's good enough it's close enough right but I mean something that's more personalized like this I think I would really appreciate it and I think there's an appeal to that and we know that the risk scores are not perfect and there are a whole variety of different risk scores I mentioned the Framingham risk score and it's confusing like have you ever try and tease through it it is really confusing for sure and we know that you know it it categorizes a lot of people fairly well but we know it underestimates risk and it overestimates risk in particular individuals so that leads to coronary artery calcium scoring this is not a new thing okay so this has been around for more than 20 years there were some good data that came out of the United States Germany the Netherlands and said look if you do a CAT scan of the heart and just look at the coronary arteries in a kind of rather crude way and score how much calcium is sitting on the coronary arteries that can predict risk okay so individual so a CT scan is when you go inside that tube and it takes pictures slices of your body and what it can see in your vessels and in your heart is how white they are and that's abnormal so a normal vessel you should not be able to see white in your vessels and as that calcium is deposited you can see that in those pictures right okay and and the technique's gotten a lot better as time has gone on and so you can grade that calcium scoring okay and so you might have a score of zero okay and we'll talk about zero in a little bit but zero zero is good zero means you're at low risk it doesn't mean you're at zero risk right not on a test but in this case it's not bad right a score of more than a hundred now these are artificial numbers I understand Radiologists are familiar with these numbers um so score more than 100 means you're at higher risk right risk is of about maybe two to three percent um per year of having a hard event heart attack stroke for instance okay um for us that's high risk sure and then a score of more than like 350 400 is very high risk okay so so we can do these tests people worry about the radiation a little bit sometimes right um and so if you think about all the radiation that you might get just walking around outside over the course of a year that's three millisieverts um and a typical CAT scan for coronary artery calcium scoring is 0.8 okay still low yeah okay okay so uh plus of this sort of technologies that it can give you another indication of risk of a coronary event which is good we're always talking about prevention right preventative medicine is always better than reacting to a disease once you've already got it if you can prevent it that's better so that's great what are some of the downsides that you perceive some of the some of the negative sort of things associated with this test any problems that you can imagine no real problems other than you know just availability so you know I know the issue you've got you've got viewers all around the world right yeah I think in the United States should be probably pretty readily available in other countries Canada for instance availability is less less easy and probably elsewhere in the world that that holds true as well radiation exposure is low okay um and not not a lot of downsides and you get your personalized results so you get an idea then so let's say you're abnormal okay so wow yeah wow it's not a stretch no it's going to be a long day for me today um so your abnormal Brad okay and so what's the downside well I tell Brad you know your score is 100 right um and you know what I do now I worry now I might worry right and you know it's a sort of Damocles hanging over your over your head and so it's like okay your score is 100 let's reduce your risk right and what am I going to do I'm going to prescribe a cholesterol pill okay so even so what if I have though what if I have a score of 100 yeah my cholesterol is normal uh unlikely okay so so okay so these all kind of go together they all go together okay so yeah so Sam a little bit unfit thankfully I'm not a smoker but if I was obviously you tell me to quit smoking yeah if I'm an active you tell me to exercise right and if I have high cholesterol that's one of our modifiable risk factors you're gonna skipping on some medication to try to get me if you have a family history change your family change your family okay control your blood pressure okay exercise you mentioned exercise regularly if you have diabetes make sure it's well controlled okay here is the million dollar question is it reversible so Brad came in at 100 because he's been eating hot dogs and smoking darts all day he fixes up his lifestyle heavy into kale gets out the chicken wings can he bring that score down are those calcium deposits there for the life so that's a fantastic question um that that leads to a bit of a rabbit rabbit hole okay number one jump in maybe number one no indication to do repeat calcium scoring yeah once you get the answer you know where your risk is so and in fact if you have a score I your number might go up um so you have a score of a hundred there's a lot of soft plaque in there right that the cat scan is never going to find I treat you and now the soft plaque gets stabilized and it becomes calcified and ironically the score might go up but your risk goes down right um so to answer your question so I wouldn't do repeat calcium scoring but we know that if we can get I'm going to use Canadian units here no millimoles per liter if you can get the LDL down around 1.4 1.3 I think in SI units it might be for American viewers maybe around 60 or 70. okay if you get down into that range then we know there's plaque regression right regression regression so it can go away um and we know that because we've done a number of studies where we actually put angiograms and tubes right into the catheters reading the coronary arteries and uh and check 18 months later after good treatment it's like oh look at that there's less plaque wow okay okay it's hard to get down that low in the LDL you know what I mean not now really with medication not now yeah our viewers not gonna like this no no and that's okay so a quick question about the score is it more useful for people that have no symptoms and set you really low risk as like a hey where am I sitting or is it more like I think I read that if you have disease or if you have a high family history you've maybe even had an event right it really plays not much of a role at all right once you have established disease it's not useful correct okay so get treated anyways right correct and people ask for that right and you know somebody who's had a previous bypass they say hey Doc can you do my coronary artery calcium score it's like no that's a waste of time yeah because you're on this already right so it's it's just useless for high risk right people under the age of 40 with no risk and no symptoms also not useful also generally not useful um unless and and then it's the intermediate risk so it's a people over the age of 40 maybe with some other risk factors that's probably where the real sweet spot is for this okay um in the United States you have access to pay for it so often I estimated on the internet that the cost ranges between 100 and 700 so it's not a cheap test so this is the access is going to be a problem for people and it's not coverable in insurance plans and that's what makes it a complicated test to know when to order so is the average cardiologist going to order this test if you're 50 and you come in and say have one or two recipes is this is this where they're going to go or is it more when they're like I'm not really sure what your risk is I want one more piece of information yeah so it's it's the I'm not really sure yeah you know ultimately is do I need to prescribe a medication to reduce your risk or not usually it's a Statin or a non-statin and it's like you know what you're sitting in in the mid-range we just need that little extra piece of information um let's get that okay two million dollar question yeah you probably already have done your own blood work and checked your own risk would you have the cardiologist would you have the test done to yourself yep so if I'm intermediate risk I don't know it's a decision between between being on medication or not on medication I think it's a fairly simple test to do there you go okay you heard it that's a good answer and then lasting that I'm going to ask is if my cholesterol is off the charts and my calcium score is zero I've had a lot of people comment in the comments to say that hey I have no risk I'm not taking cholesterol medication I got perfectly clean arteries my score is zero why would I possibly take this medication that has something because it's not a common scenario to be in right situation in the comments but yes I think you're right it does happen actually I have a CAT scan thing on my desk uh virtually that somebody did a week ago okay already calcium score is zero middle aged man yep um but the radiologist commented about hey there's a fair amount of soft plaque here her in the left main coronary artery the Widowmaker and the LED okay collecting your descending artery so the coronary calcium score is zero but this fellow has got plaque in in particularly a significant artery there's going to be an argument when I have this discussion with them you need to be on therapy to reduce this risk eventually that soft plaque is going to be hard plaque and that's what our bodies do to stabilize like why that's why we put calcium into these plaques it's like a response to the inflammation in the plaque deposition to stabilize it right okay it's funny that they don't grade the soft plaque probably just more difficult to visualize using x-rays or yeah wow wow there you go we learned a bunch of things today one I'm abnormal two we learned about the calcium score and that it is a useful test but not in isolation and this is not going to be the only test it's going to determine your treatment so have an open discussion with your doctor and please listen to them and proceed with Kasha and if you like this video please like it subscribe to our Channel Dr Heffron thank you so much my pleasure as always guys and remember you are in charge of your own health we'll see you next time

Channel: Talking With Docs

Views: 138,404

Keywords: cholesterol, high cholesterol, ldl cholesterol, how to lower cholesterol, hdl cholesterol, bad cholesterol, good cholesterol, lower cholesterol, causes of high cholesterol, foods that lower cholesterol, cholesterol levels, high cholesterol diet, how to reduce cholesterol, high cholesterol causes, cholesterol lowering foods, what causes high cholesterol, low cholesterol diet, how to lower cholesterol naturally, low cholesterol foods, cholesterol symptoms

Id: v5rtIorqwlM

Length: 12min 52sec (772 seconds)

Published: Sun Apr 02 2023