Hello all, I only joined the BHF forum a few months ago to make enquiries on behalf of my dad who’d had a bypass. However, following his experience and the fact I’m nearly 50 and haven’t always looked after my health, I decided to go for a full medical check up including a newish technology where a CT scan takes 64 images inside your heart.
I have no idea how to get such a test back home in the U.K. I’m overseas right now and took advantage of the cheaper prices here. The CT scan cost the equivalent of £450.
I was injected with contrasting fluid so my arteries would show up nicely on camera. Next I was passed through a CT scan a total of four times holding my breath when directed.
A few hours later came the photos and a chat with the cardiologist. Not too bad, but my left anterior descending artery is about 20% clogged with soft plaque. The consultant wasn’t overly concerned but advised me to lower my LDL cholesterol from an already within range 3.2 mmol/L to 2.6 by eating less red meat, more oily fish and more vegetables.
I don’t think any other test can make such an early diagnosis so I’m well pleased. I’m aware that soft plaque is the one that can rupture and cause blockages, but if I try to maintain the 20% blockage as best as I can by fairly large diet changes (I’m already extremely active), I can’t do anymore.
That’s it. Not much else to add. Hopefully this technology will become more accessible in future as tests such as ECG or ECG stress tests won’t pick up such lower levels of blockage. If anyone can find such a scan, called 64 slice CT heart scan or similar, I really really recommend it.
Happy new year all and take it easy,
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Kev12564
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Excellent post, you raise some really interesting points.
I had my bypass done by the NHS and I've nothing but praise for their work, however for many years before that I had an annual check up done by BUPA, including a really major one shortly before I retired.
BUPA's work I'm less impressed with!
Basically they used the crude and basic risk assessment tests that I now know can be traced right back to the Framingham study, which began shortly after the second world war. I sailed through these, plus the stress ECG, with flying colours. In fairness the NHS also uses something similar, but they're both no better than very rough approximations of your true risk. However, the message given to myself and many others didn't emphasise how crude these risk factors are. My take out was I was in pretty good shape as far as heart risks were concerned. How wrong was I.
If someone at BUPA had pointed out, many decades ago, that if I was willing to spend no more than £1000 I could have had a far more accurate picture of my heart risks, then I'd have spent the money and my life may have taken a different path, one that didn't include a triple bypass!
First, the standard risk assessment question about relatives dying from heart problems is hugely flawed. Think about it. You may not know how your relatives died, they could have been misdiagnosed, they may have had heart disease symptoms much earlier but didn't actually die from the disease, or a different disease took them earlier. In other words there are myriad ways of getting the green light with this critical question when it should have raised a red flag.
For about £600 you could have a comprehensive DNA test that's structured towards heart problem genes. That way there's no guessing based on shaky family histories, you get straight to the accurate genetic data that's specific to you. It may sound expensive, but DNA testing is falling in price all the time, furthermore you only ever need it done once (your genes never change!) and it's valuable information for your children, grandchildren, brothers, sisters, nephews and nieces, etc.
And if that shows up any problems you could then have had a £250-300 CT scan every five or six years starting from your 20's. Again, no more guess work or approximations or inferences from shaky risk factors or flow tests, with a CT scan you're at last dealing with the hard facts. Either you do or you do not have atherosclerosis, and if you do then precisely how advanced its it?
This knowledge also raises another invaluable option that you personally now have. You quite rightly raised the point about soft plaque versus older, stable plaque. One thing you may not know though is that, now that you have a base line reference CT scan, you can go back in a few years for another scan to see if your medication regime and life style changes are making a difference.
Crucially, if your plaque score has increased by under 15% then you have a small (under 3%) chance of a "cardiac event" (ie a heart attack) over the next six years. But if your next scan shows an increase in plaque above 15% then your risk rockets to 15-20% within the next 3.5 years. This means that a CT scan gives you the tools to quantifiably and scientifically evaluate the steps you're taking to manage your heart disease. Furthermore it underlines the somewhat paradoxical reality that a person with a sky high but STABLE calcium score, is actually at far less risk than a person with a much lower but fast GROWING calcium score. As calcium in your arteries ages it tends to stabilise and is therefore far less likely to become "hot" and rupture leading to the blood clots that cause a heart attack or stroke. This is the key that explains why so many people have devastating strokes and heart attacks when they only have quite low levels of arterial blockage, certainly far less than can ever be detected by ECG's, stress tests, echo tests, or even angiograms. The bottom line is you need a medication/lifestyle regime that minimises new plaque being laid down. It's actually more practical and beneficial to think in those terms rather than chasing a unicorn like hoping to remove plaque from your arteries.
Unfortunately, here in the UK, NICE haven't approved CT scans for these purposes, some health authorities dabble with them, but most do not. Consequently I've decided to pay for regular CT scans to be done privately. It comes as a bit of a jolt in this country as we tend to assume that the NHS will take care of everything. But given that you can spend the equivalent of a CT scan on just a couple of family trips to the cinema, then I've decided this is a critical medical insight that I'm not prepared to do without.
In fairness, this check I had today is fairly new technology. The cardiologist advised it didn’t exist a decade ago. There are downsides such as the cost (although £450 to get such a huge kick up the behind seems a good deal) and I’d imagine the radiation from so many X-rays is a concern. Saying that, you’re right to say I have a baseline to work with. The 20% stenosis figure is no doubt arbitrary, but I have all the images on a CD for a trained eye to compare with future tests in, say, three years’ time.
In the meantime, I can certainly lower my LDL which is far easier to monitor.
I’m obviously concerned about having the less stable soft plaque, but I can’t undo what’s already there. Hopefully the 80% remaining pathway will allow any clots to pass through.
I just googled “64 slice heart scan U.K.”. It’s available privately, but I can’t see any costs listed. I’d guess upwards of £1000.
A private CT scan is about £250 in the UK. Some clinics may insist on an initial consultation with a cardiologist which will drive up the price, but the test itself is only about £250.
There's an interesting documentary available on YouTube called "The Widowmaker" which investigates the history of how CT scans were developed.
You're right that radiation is a key factor that influenced NICE, however the radiation doses required are dropping all the time as the machines become more sophisticated. On the latest generation of scanners they're now no more than a couple of weeks of normal background radiation.
Another big issue in the NICE decision was that much of the research validating CT scans was conducted on too narrow an ethnic range. In particular there weren't enough far east asian and south asian respondents to guarantee statistical validity. As the NHS is duty bound to provide a service for all ethnicities this is a common objection raised by NICE.
One final point. You have atherosclerosis, surely you were also put on medication rather than just relying on lifestyle changes?
To be honest, I didn’t ask about medication, but it was a private hospital and keen to make extra cash so I’m surprised this wasn’t mentioned.
I just wikied atherosclerosis, and it says this starts at an early age and generally gets worse. I’m guessing mine is at the stage where medicine wouldn’t help.
Do you have any recommendations? Obviously I’d ask my doctor, but it’d be good to have a heads up before then. Thanks.
You yourself identified the blood clot risk leading to heart attacks and strokes, most people on this forum are prescribed a small daily dose (about 75mg) of soluble aspirin because of its anti platelet properties. This means any hot plaque rupture would form much smaller and less damaging clots.
After that is a statin. There's a lot of mixed reviews about statins, but even the anti-statin proponents acknowledge the benefit of moderate statin doses for genuinely high risk individuals. You're not just high risk, you actually have atherosclerosis! Personally I'm in the pro-statin camp, chiefly because statins deliver some important benefits besides cholesterol lowering, for example they're pretty efficient at moderating inflammation, which is one of the root causes of heart disease.
Then you might want to consider an ACE Inhibitor such as Ramipril. I noticed my blood pressure drop significantly within days of first taking Ramipril.
Finally there's a beta blocker such as Bisoprolol Fumarate, which also helps lower blood pressure and reduces the workload of the heart.
The BHF (the sponsors of this forum) publish an excellent booklet on heart medications that you can download here,
It's useful to bypass Cardiologists, who aren't interested in early diagnosis.
Have you thought about getting Calcium CT/intimal carotid test (or whatever they are officially called?) as well? Has anybody taken these tests, privately?
There are basically two tests. An X-Ray based heart scan, which is the CT scan that CocoNutWater is talking about. And then there is an ultra sound scan of the carotid arteries in the neck. This is slightly cheaper than the CT scan, and also has the advantage that there's zero radiation involved.
However, it's not directly measuring the calcium in your heart, it's using the carotid arteries as proxies for your heart. So it assumes a problem here will also mean other arterial problems.
But that's a risky assumption, different people have different outcomes from atherosclerosis and everyone's arteries react differently. Some people's hearts are most affected. For some men it's first seen in erectile disfunction as the arteries to the penis are primarily affected. Or for other people it might be the arteries to the brain that suffer, causing vascular dementia.
My consultant says (he's not a Cardiologist, "so that's good"), you/anybody can have the whole body PET if you were found to have some vascular/coronary issues, especially in some critical areas. Radiation is always the major concern but I notice in the USA, people have this more often and it is highly sensitive.
I have had some vascular tests. Unfortunately, these need to be repeated to be certain, the last one, being three years old.
I was quite staggered by the discovery that my "mild" and "moderate" problems are simply swept under the carpet.
These cardiac private tests should be more available at a low cost. I don't particularly need any dismissive cardiologists who "tell" me things as if I was a child in his clinic, not in my life stage and after what my previous reports had said.
I did ask the cardiologist re. carotid intimal test (to check the thickness of your artery). He wasn't interested. I wasn't even sure if carotid intimal doppler is the same ultrasound as standard carotid doppler ultrasound, which could check any abnormality in artery walls, but not sure as to what extent.
I had an ordinary carotid doppler before. I assumed that these were different. At least, I know roughly what I had from my previous report. I can empathise totally with you, as to why you wish to consider leading your own private monitoring at intervals. Health is precious, especially heart health.
"I had an ordinary carotid doppler before. I assumed that these were different."
That's correct, a carotid doppler test is a straightforward flow test, it measures the flow of blood through the carotid arteries and is normally done when you've either had a stroke or your doctor feels you're at risk of a stroke. It doesn't measure the build up of plaque/calcium in the arteries.
The problem to me at least is that none of this would stop with private test. In my limited experience with thyroid I have found GP’s etc to be extremely unwilling to support me by either accepting the results or helping to address issues raised - in fact I’d go so far as to say I’ve been ridiculed for even attempting to help myself. The NHS system can be extremely good but it is slow to pick up on the innovation out there or supporting people to monitor their progress independently, increasingly easy to do given the rapid progress of technology. I don’t know which is more frustrating - not knowing or knowing/suspecting and being powerless to get treatment 😕 Please don’t think this is negative but I’m afraid I don’t feel I’m encouraged to be overly proactive rather more of a nuisance at times.
I appreciate that here in the UK it feels a bit alien and slightly inappropriate to pay for private health care, but what's surprising me is that the sums of money involved are actually relatively trivial in the scheme of things.
Lifting my heart health care to something approaching global best in class, by augmenting the NHS with a few private extras, will probably cost about the same each year as I spend getting my car serviced! Looked at that way it becomes a pretty simple decision.
It depends on your personal situation. Everyone has different situations.
If you do not need anything other than what NHS can provide, you are in a very lucky situation. It would be less stressful (leaving all the decisions by NHS) and after all, it's free! If you are happy, then why change?
You may well have been taken care of. This happens, as well.
Oh absolutely I can understand that, the point I was trying to make was that too often our best endeavours are viewed somewhat reluctantly if sourced independently. My examples is admittedly a little low key but my private blood tests for thyroid were just pushed back across the table. I think that any attempt we can make to improve or maintain our level of health is worthy of exploration and discussion it’s just that I don’t always think it gets the best reception from within the system. Totally support your efforts to maintain your health 🙂
I am kind of interested in finding out if 64 slice CT is used in any NHS hospitals. It's not a "brand new" imaging system. (?) It looks like it's been around for some time. I wouldn't ever hear of this if I did not see this thread.
I take it some "leading" research centres/hospitals do use them. NHS consultants/hospitals use some private imaging contractor that can provide the up to date machine and operators that NHS themselves haven't managed.
I mean, I wouldn't be surprised if these types of equipment become "vintage" in 3-5 years time given the new technology that keeps developing. In one study, this "technology" area was highlighted that it shows numerous years of under-investment on NHS.
Something like this could catch early or mid-stages of the disease and you could well be spared from the same old diagnostic tests that are virtually 'Pre-operative' tests. Soon enough, you get catapulted into cardiac procedures. Not an ideal situation to my mind. That's what I fear most.
You would normally expect to stay well (as much as one can be) and their focus is SOLELY on late-stage disease except for some cholesterol tests given by GPs. Some people's professional life (if you are a commercial driver) /quality of life (if you have a hard to diagnosed condition) has been ruined due to this single-track approach.
Maybe, NHS Cardiologists are expected of the minimum number of patients to send them to the theatre in their annual contract. If the contract does not stipulate a more inclusive approach, it shows in the consultant's attitude when patients see them.
CocoNutWater. Well done to you. Thank you for sharing.
There are 128 or even 256 slice variants available now, so maybe 64 is already old hat. However, it’s certainly made me think. For the past year, I’ve been hitting the gym with my heart rate reaching 150 or even 160 for minutes at a time. You’d think any rupture would’ve occurred by now, but who knows?
Unfortunately, my post-64 slice test meeting with the consultant was a bit rushed and I was unprepared. Once back in the U.K., I’ll take the results to a private, e.g. Nuffield, cardiologist to see what to do next if anything, apart from lowering my LDL.
"For the past year, I’ve been hitting the gym with my heart rate reaching 150 or even 160 for minutes at a time. You’d think any rupture would’ve occurred by now, but who knows?"
I'm not sure it works like that, the plaque status (and in particular the "hot" plaque status) is dynamic and changing all the time. So clearing the hurdle of 160 bpm on one day is no guarantee of the same happy outcome on another day.
It's also the case that physical exertion is just one possible trigger for a rupture; stress, lack of sleep, the shock of a cold shower, and a thousand other things are all possibilities.
But it would wrong to sound alarmist, I'm sure a cardiologist will assure you that your actual risk of an imminent cardiac event is actually very low. Instead I offer you my congratulations, you've lucked upon the very early diagnosis that many of us on this forum would have given our eye teeth to have received.
Armed with that early warning, and the precise monitoring tool of an occasional CT scan (or if you wish to avoid the radiation and also save a few quid, a carotid intima media-thickness test, or CIMT) you're now in the enviable position to arrest the development of your atherosclerosis via medication and life style changes, while leisurely evaluating what in your individual case might have been the underlying root cause of your heart disease. I think you should reflect on what I said earlier about high but stable plaque being significantly less dangerous than low but growing plaque. Because of your early diagnosis you'll hit the sweet spot of both low and stable plaque. That makes you a very lucky guy!
my husband has been bothered with occasional chest pain fir the last few weeks.. GP referred him for a stress exercise test at the local hospital up here in Scotland.. after the test the cardiac practitioner nurse went along to see the Cardiologist who was holding a clinic..
he has benn prescribed aspirin, simvastatin 40mg and bisoprolol AND is awaiting a heart CT scan..this will be on the NHS.. maybe we’re just lucky to have that facility here in Scotland
"he has benn prescribed aspirin, simvastatin 40mg and bisoprolol AND is awaiting a heart CT scan..this will be on the NHS.. maybe we’re just lucky to have that facility here in Scotland"
Unfortunately it's all rather random.
I live in a small market town on the south coast, a few miles away is a large city. My town has a tiny but well equipped NHS hospital that was built and funded by a wealthy private benefactor, amongst its many facilities is a CT scanner.
The hospital in the nearby large city is a regional centre for cardiac care, and is where I had my bypass operation. Despite a reputation for surgical excellence they unfortunately do not have a CT scanner.
That's pretty much the reality right across the UK. You may get today's cutting edge cardiac care, or you may get yesterday's version. It's a post code lottery.
Actually I believe the real picture is even more confused than that, your husband's CT scan may be the most comprehensive version which includes a read out of the precise degree of calcium deposits. Alternatively he may receive a quicker and less precise scan without any quantified results, or (and this is especially likely if he's an ex smoker presenting with chest pain) the CT scan may be more focussed on his lungs to chiefly look for any signs that may indicate cancer, and the actual heart data will be pretty cursory. You won't actually know until your husband's had his scan. Even then they may or may not share the results with you, although if the results are not volunteered you are entitled to request a copy.
Actually that's an interesting point which may be relevant to the original poster. I have duel nationality, I'm both Canadian and British, so there's the possibility of receiving medical care in different countries as well as the possibility of a blend of NHS and private care in this country. Consequently I've made it my business to hold and maintain a full set of every test I've had with the NHS. That's been interesting because on some occasions there was some reluctance to provide these copies, and it was necessary to politely remind the relevant doctors that they mustn't obstruct this entirely legitimate request.
he’s never smoked and i believe they’re more interested in having a look at the arteries.. the hospital is fairly new plus they took ownership of 2 new CT scanners last year
I had a CT scan ( Calcium Score test) a couple of years ago - as I had had VERY high levels of cholesterol for 30 years and had refused statins for that time because I had no other risk factors and no symptoms of anything, I was somewhat "shocked" to see that I had a moderately high level of hardening/calcification of my heart arteries - which is apparently indicative of a high level of soft plaque. I passed EKG test with flying colours ( am a fit runner) . I could not reduce my chol levels to the numbers that my cardiologist wanted to see with exercise or diet, so decided to take statins (20 mg CRESTOR) and have got the number down now to what he wants. I believe that the BEST thing about these scans is the psychological impact the results have on people - what they can now see with their own eyes overcomes whatever they may have been thinking. As someone famous once said , imminent death helps to focus the mind!!!!
Indeed. I had been overweight from age 30 to 48 before starting a much fitter lifestyle a year ago and losing over 20kg, During my overweight years, my cholesterol was fine (LDL was 3.2 which I thought was considered normal but I’m now advised to get this to 2.6) but I did drink a fair amount of booze.
I had no idea what to expect from this 64 slice scan. The results showed just the LAD artery contains soft plaque, the others are clear. I’ve no idea why this is, and it’s on my question list for whichever cardiologist I’ll see. I should point out again the cardiologist who viewed the scan results wasn’t overly concerned, and his main advice was to lower my LDL.
I’d already taken big steps to improve my health, but this scan shows I can do a lot more. A lot more fibre and veg and less meat and eggs, and we’ll see. I might consult a dietitian, and I’ll get my LDL measured again in six months.
I understand that focussing on LDL isn't current best practise for lipids/cholesterol management. Probably the most important individual metric is the ratio of HDL to total cholesterol, I've seen pretty persuasive research showing that the ability of LDL scores to predict cardiac events really isn't great, but using HDL gives solid, actionable data.
i have seen 2 types of articles ONE STATING LDL < 70 mg/dl promotes deplaquing and another saying Tot chol:HDL ratio 2.4 to 2.8 does the plaque regression .. I follow both whichever works i shall get the benefit.. I did not do CT scan but angiogram was done in Feb17 100% block after LAD diagonal1 LAD Distal is fed from RCA/PDA retrograde collateral,Diagonal 2 Proximal 50%,LCX Distal 90%,OM1 mid 90% ,RCA PLV proximal 90% and RCA PDA diffuse 90% blocked ... I am thinking to do CCTA scan to see plaque position now . If it is regressing then prognosis is correct and therapy will continue
Interesting post. I had a MI due to total blockage of LAD. One stent placed. I did not get any of the information you have. I expect I will need to request access to my records to see what data is held.
I had a rubidium ct scan and stress test some weeks after. So apart from angiogram derived data should have some detail from the ct scan
My ldl level is about 71 due to meds and diet.
As it was previously very high would be interesting if any improvement is possible.
HDL has improved but could still be better
Lipids improved
So I am hoping this large reduction in LDL and increase in HDL will have some positive effects.
Still too high regards BMI however this is reducing slowly but surely. Hardest risk factor for me is stress reduction.
As my cholesterol isn’t considered high (total 5.03 mmol/l, HDL 1.66 mmol/l and LDL 3.2 mmol/l), is it doable to improve these figures, e.g. LDL < 2.6 mmol/l, by just lifestyle changes?
I’m already very active and not overweight, but I do drink a bit too much alcohol and should eat more greens. Whilst these will both change ASAP, I can’t help thinking that’s not enough to change my figures although I’ll give it 3 to 6 months before I get my blood checked again.
Is medication such as statins an option here? Would a doc prescribe these for such figures as mine?
I can now follow this up and close the story as far as my heart health goes.
I’d never had any sort of heart scan before. After having this check overseas, I flew back the next day and realised I had a load of unanswered questions about my results, their significance and what if any lifestyle changes I could make.
To recap, all was OK, calcium score zero and “20%” stenosis due to soft plaque on my mid left anterior descending artery.
So what I did was pay to see a private cardiologist in the UK to review the results and answer my questions.
Before I go on, here’s a few caveats. I’m nearly 50 but very fit and active, normal weight, no family history of heart disease, non smoker and no diabetes.
The UK consultant had no concerns whatsoever about my results. The 20% stenosis was in his opinion an overestimate used to indicate the presence of some plaque. He was more interested in my calcium score of zero.
He said I could lower my LDL (currently 3.2 mmol/L) by diet if I wanted to, but any medication was totally unnecessary right now, although a statin might be an idea if my cholesterol was the same in five to ten years’ time.
He did speak at length about diet and exercise and recommended cardio-type activities for an hour or so four times a week - and not quick bursts of ten minutes a day here and there. He eats butter in moderation and wouldn’t touch Benecol or these other products.
A few other points, but the main point is I’m doing OK thankfully but need to maintain a healthy lifestyle like anyone else. He didn’t even think it necessary to have another scan ever unless I become overweight or sedentary in the future. I think I’ll still opt for a recheck in five years.
He didn’t harp on about the importance of CT scans, but I will. Look at Bill Clinton who passed numerous ECG stress tests but then needed bypass surgery. A CT/MRI scan ain’t cheap unfortunately, but it’s pretty much the only way I can see of knowing your heart health. Cheers all.
I paid for this scan in UK three weeks ago, it cost £822 plus the consultants fee. I don’t have exact results but had letter saying ‘as we all do there is some slight calcification and some minor narrowing. No treatment of either balloon or stents is necessary”. Advise is to take 75 mg aspirin and statin daily. I was under the Consultant who saved my husbands life six weeks ago, which was the reason for my deciding to have the heart scan.
A lot of money, but that sounds like £822 very well spent. Obviously I’m no expert, but from what you wrote it sounds fairly healthy with only a few minor lifestyle tweaks needed.
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