Healthcast 621 - The Coronary Artery Calcium Scan (CACS) and Heart Disease

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One of the new tests available to doctors and patients without a prescription is a test that tells you if you currently have arterial plaque and gives you reassurance for 12 years that you will avoid a heart attack from blockage of the coronary arteries. The CACS looks for calcium buildup that shows white on the CT scan. Where there is calcium in the arteries there is plaque. To me this is a wonderful preventive medicine adjunct to the care I give my patients. I no longer have to look at high cholesterol numbers and worry that my patient is going to have a heart attack, because I have found that high cholesterol is not always associated with development of arterial plaque!

Let me back up and explain to you what heart disease really is. Your heart is a muscle that never stops beating until you die. It is fed by arteries that cross over and around the heart and the arteries feed the heart with oxygen, nutrients, and proteins to feed and repair the heart. Heart Disease is really disease of the heart's arteries. It occurs when cholesterol sticks to the arteries of the heart, which narrow the pipeline that feeds the heart. As the plaque grows the arteries narrow more and more until the vessels clog and a part of the heart is deprived of oxygen and nutrition. That part of the heart muscle dies…that is a heart attack.

Cholesterol in the blood does not mean the development of heart disease. Yes, there is cholesterol in the plaque, but it takes inflammation which is the glue that sticks cholesterol to the arteries. Some people have high cholesterol their whole lives and never have arterial plaque or a heart attack. Cholesterol is not a bad lipid, it is necessary to our whole body, and our brain is mostly cholesterol, every cell wall in our body has cholesterol as the main component, so lowering cholesterol too low can harm you! Statin dose that makes your cholesterol too low is damaging to your brain and all your cells. There is a new kind of dementia called Statin Dementia! This is why I think you should not take a statin unless you have arterial plaque, or your habits increase the inflammation and the formation of arterial plaque.

My own experience is key to my belief in this test. In 2002 one of my friends who was a surgeon died at the age of 47 of a heart attack. He had no sign of this ahead of time and it came as a surprise to everyone who knew him. I always have had high cholesterol and my husband has had it too, he was even placed on a statin at age 40, so I set us up for the NEW TEST the CACS. At that time the test was brand new, and the research wasn't back however seeing is believing and we have used ultrasound for diagnostic purposes for years in OBGYN, so we both had the tests. Now the test is $99 at most radiology departments and at that time it was $1000/test! I didn't care because it was worth knowing whether we would have a heart attack in the near future. It turns out that we both had a score of zero (0) and there was no plaque! Yea, I felt better and stopped worrying about my cholesterol. I was 47 and my husband was 51.

I never recommended this test to my patients because the stats weren't totally back yet, and it was very expensive, until years after I began my BioBalance hormone replacement and preventive medicine practice. I began to read about the test and that it was reliable and a good way to tell if someone needed a statin or not. I began to recommend the test to anyone including anyone at risk or on statins.

Over the next 20 years I ordered tests on my at-risk patients (those who had family histories of heart disease but normal cholesterol and those who had high lipids that didn't come down with bioidentical hormones. I was surprised when over the 20 years, at least half of the patients who had high cholesterol had no arterial plaque (no risk for heart disease and MI) and about half the patients who had positive family history, but normal cholesterol had no plaque! So lipids and family history didn't mean anything! These are the 2 reasons that patients take statins! Patients are given statins blindly for positive family history and high cholesterol not knowing whether they are at risk or not, and one test for $99 can tell if you need statins or not!

By the way, when I was 63 and John was 67 we had another CACS and I was still 0 and John who had been on statins for 27 years did have plaque! His score was 141! The statin didn't work to prevent narrowing of his cardiac arteries. His new cardiologist was on board and put him on a different kind of cholesterol lowering agent and I put him on Celebrex to prevent inflammation that stimulates plaque formation. Without this test he would have been on a drug that was not working— a statin!

What is the test like?

The test is a 2 picture CT scan. It takes 5 minutes and can tell your doctor a lot! It is recommended after 40 in men with a family history or who are on statins, and women after 45 who have the same risks or who are just anxious over having a vascular disease like an MI. It also tells us about your other arteries, and those leading to your brain and pelvis without taking a picture of them. If you have plaque in the arteries of your heart you surely have plaque in your other arteries all over your body!

The pictures are taken when your heart is contracting and also when it is in diastole or relaxing.

Your doctor will tell you what the test says and means for you, however if you are a 0 amount of plaque you can breathe a sigh of relief that your heart arteries are not blocked with plaque.