The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment

[Vince]

The 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of blood cholesterol endorsed the coronary artery calcium score as a tiebreaker in the decision to withhold, postpone, or initiate statin therapy for adults at intermediate or borderline risk of atherosclerotic cardiovascular disease (ASCVD).1 We disagree and will make a case against the use of coronary artery calcium scoring for any reason.

The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment

 

[Another Great Day]

The 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of blood cholesterol endorsed the coronary artery calcium score as a tiebreaker in the decision to withhold, postpone, or initiate statin therapy for adults at intermediate or borderline risk of atherosclerotic cardiovascular disease (ASCVD).1 We disagree and will make a case against the use of coronary artery calcium scoring for any reason.

The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment

Great article, very interesting!

 

[DragonBits]

The 2018 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on the management of blood cholesterol endorsed the coronary artery calcium score as a tiebreaker in the decision to withhold, postpone, or initiate statin therapy for adults at intermediate or borderline risk of atherosclerotic cardiovascular disease (ASCVD).1 We disagree and will make a case against the use of coronary artery calcium scoring for any reason.

The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment

When I looked at the ASCVD calculator, if I put in my age of 70, male, I have to take a statin. Basically, end of story.

Meaning, it doesn't matter what my blood pressure is, it doesn't matter what my Total cholesterol is, it doesn't matter what my HDL is. Sure, if I put in more negative numbers my risk goes up, but virtually every number will require a statin.

Even if everything is perfect, my risk will still be at least 7.7% and require a statin. That is with 100 Systolic blood pressure, HDL of 70, total cholesterol of 110. NOTE these are not my number, I was just playing around.

I suspect this is basically because the leading cause of death all around the world for males over 40 is heart disease. By far.

They make these calculators, but it's configured to basically say 99% of all men age 70 should take a statin. I guess if you are younger and your number are a lot worse, then it's more useful, but males at age 65+ they should say just say we don't care what your test results are, just take a statin

 

[Vince]

Potential harms from coronary artery calcium testing is radiation exposure. Which contributes to cancer. The new machines use much less radiation than the older ones.

 

[Guided_by_Voices]

The stress and potentially harmful interventions (e.g. statins, high-carb diets) that could come from a calcium score could be considered harms as well.

 

[FunkOdyssey]

I disagree with the article, which seems to assume the only value of a coronary calcium score is deciding whether to begin a statin. They're basically arguing that patients can't handle the truth and are better served not knowing whether they have evidence of atherosclerosis or what its severity might be. That's somewhat understandable from the medical provider's perspective, but as a patient, who would favor burying their head in the sand?

I'd rather find out. I used the positive results of a coronary calcium scan to overrule concerns about moderately elevated cholesterol and justify continuing my mainstream-horrifying 90% red meat diet. This represents the flip side of @Guided_by_Voices concern that a bad calcium score could lead to ineffective interventions -- a good score can help keep you on a path that is working.

I elected to get a colonoscopy early at age 40 for the same reason. I would like to live a long healthy life, so I want maximum vigilance around the most common causes of death. Give me all of the information and then let me handle it like an adult.

 

[DragonBits]

I disagree with the article, which seems to assume the only value of a coronary calcium score is deciding whether to begin a statin. They're basically arguing that patients can't handle the truth and are better served not knowing whether they have evidence of atherosclerosis or what its severity might be. That's somewhat understandable from the medical provider's perspective, but as a patient, who would favor burying their head in the sand?

I'd rather find out. I used the positive results of a coronary calcium scan to overrule concerns about moderately elevated cholesterol and justify continuing my mainstream-horrifying 90% red meat diet. This represents the flip side of @Guided_by_Voices concern that a bad calcium score could lead to ineffective interventions -- a good score can help keep you on a path that is working.

I elected to get a colonoscopy early at age 40 for the same reason. I would like to live a long healthy life, so I want maximum vigilance around the most common causes of death. Give me all of the information and then let me handle it like an adult

At age 42 you should have had a zero CAC score. My CAC was 65 at age 65, which is considered good at that age. Just saying, I wouldn't bet anything on a zero CAC test at your age. It appears to take time to build up calcium in arteries.

Here is an article about the subject.

The Diagnostic Value of CAC Score Varies With Age - Physician's Weekly

In younger patients, diagnostic value is less than in older patients A study by Danish researchers suggests that a coronary artery calcium (CAC) score of 0 may not be a reliable marker for diagnosing obstructive coronary artery disease (CAD) in symptomatic individuals age 40 or younger...

www.physiciansweekly.com

 

[Guided_by_Voices]

I disagree with the article, which seems to assume the only value of a coronary calcium score is deciding whether to begin a statin. They're basically arguing that patients can't handle the truth and are better served not knowing whether they have evidence of atherosclerosis or what its severity might be. That's somewhat understandable from the medical provider's perspective, but as a patient, who would favor burying their head in the sand?

I'd rather find out. I used the positive results of a coronary calcium scan to overrule concerns about moderately elevated cholesterol and justify continuing my mainstream-horrifying 90% red meat diet. This represents the flip side of @Guided_by_Voices concern that a bad calcium score could lead to ineffective interventions -- a good score can help keep you on a path that is working.

I elected to get a colonoscopy early at age 40 for the same reason. I would like to live a long healthy life, so I want maximum vigilance around the most common causes of death. Give me all of the information and then let me handle it like an adult.

I agree with colonoscopies and they illustrate the problem with CAC scores in that colonoscopies are immediately actionable, while CAC scores for people who are already doing most heart-healthy things ( as in truly heart-healthy, not what mainstream heath authorities call heart-healthy) are rarely actionable. They are a late-stage indicator and it is hard to tell the impact of an intervention under realistic conditions. Dr Davis was apparently able to do so and showed that Vitamin D supps were a very positive factor, but that is an exception. The action from almost any CAC score is to do everything you can to preserve your CV functioning, no matter he score.

 

[JayD]

An old family doctor and surgeon friend of my fathers blamed statins on destroying his kidneys. He died of kidney failure.

I would watch this before taking statins.

He also has interesting videos on high fat low carb diets

 

[Nelson Vergel]

This is worrisome. Data linking high volume exercise with increased calcium score.

Potential mechanisms linking high-volume exercise with coronary artery calcification

Angelica Zambrano 1, Yin Tintut 2 3, Linda L Demer 2 3, Jeffrey J Hsu 4 3
Review Heart . 2023 Jan 26;heartjnl-2022-321986. doi: 10.1136/heartjnl-2022-321986. Online ahead of print.

Abstract
Recent studies have found an association between high volumes of physical activity and increased levels of coronary artery calcification (CAC) among older male endurance athletes, yet the underlying mechanisms have remained largely elusive. Potential mechanisms include greater exposure to inflammatory cytokines, reactive oxygen species and oxidized low-density lipoproteins, as acute strenuous physical activity has been found to enhance their systemic release. Other possibilities include post-exercise elevations in circulating parathyroid hormone, which can modify the amount and morphology of calcific plaque, and long-term exposure to non-laminar blood flow within the coronary arteries during vigorous physical activity, particularly in individuals with pre-existing atherosclerosis. Further, although the association has only been identified in men, the role of testosterone in this process remains unclear. This brief review discusses the association between high-volume endurance exercise and CAC in older men, elaborates on the potential mechanisms underlying the increased calcification, and provides clinical implications and recommendations for those at risk.

Keywords: Atherosclerosis; Computed Tomography Angiography; Coronary Artery Disease.

 

[Golfboy307]

This has been known for quite a while in the running community, especially among folks who do ultras. Not sure the same reasoning applies to weightlifting and resistance type exercises.

 

[DragonBits]

This is worrisome. Data linking high volume exercise with increased calcium score.

Potential mechanisms linking high-volume exercise with coronary artery calcification

Angelica Zambrano 1, Yin Tintut 2 3, Linda L Demer 2 3, Jeffrey J Hsu 4 3
Review Heart . 2023 Jan 26;heartjnl-2022-321986. doi: 10.1136/heartjnl-2022-321986. Online ahead of print.

Abstract
Recent studies have found an association between high volumes of physical activity and increased levels of coronary artery calcification (CAC) among older male endurance athletes, yet the underlying mechanisms have remained largely elusive. Potential mechanisms include greater exposure to inflammatory cytokines, reactive oxygen species and oxidized low-density lipoproteins, as acute strenuous physical activity has been found to enhance their systemic release. Other possibilities include post-exercise elevations in circulating parathyroid hormone, which can modify the amount and morphology of calcific plaque, and long-term exposure to non-laminar blood flow within the coronary arteries during vigorous physical activity, particularly in individuals with pre-existing atherosclerosis. Further, although the association has only been identified in men, the role of testosterone in this process remains unclear. This brief review discusses the association between high-volume endurance exercise and CAC in older men, elaborates on the potential mechanisms underlying the increased calcification, and provides clinical implications and recommendations for those at risk.

Keywords: Atherosclerosis; Computed Tomography Angiography; Coronary Artery Disease.

Aged black garlic has been shown to slow the progression of CAC.

Black Garlic and Its Bioactive Compounds on Human Health Diseases: A Review - PMC

Black garlic (BG) is a form of aged garlic obtained from raw garlic (Allium sativum) via Millard reaction under high temperature (60–90 °C) and humidity (70–90%) for a period of time. Several studies reported higher contents of water-soluble ...

www.ncbi.nlm.nih.gov