Coronary Calcification

For so many years the message has been that high cholesterol (specifically high LDL) is the predictor of heart disease. However, increasingly it seems that the best predictor is not high cholesterol, but calcification of the arteries. And the take home appears to be that if you have a zero or low calcium score you risk of a heart attack is negligible.

This taken from Doc’s Opinion:

An individual without coronary artery calcification is very unlikely to have a severe narrowing of a coronary artery.

docsopinion.com/2014/08/19/...

Now, with the diet/heart hypothesis, and of course cholesterol levels coming under increasing scrutiny and the science leading up to the conclusions failing to prove causation, then maybe it’s time to put the spotlight on the alternatives.

So, having said that, are you one of the 500 who has been diagnosed with the commonest form of FH? If so, what are your options? Currently, if we to accept the current paradigm, it’s a lifetime of statins (a huge consideration, especially if your child has the condition).

But hold on! If you have FH and have a calcium score of zero, then your risk of heart disease is negligible. So how does that stack up against the known, sometimes appalling side effects of statins and the likely diminished quality of life (mild to rhabdomyolysis) taking them?

Again from Doc’s Opinion:

One randomized placebo-controlled trial did not find any significant benefit with atorvastatin (cholesterol lowering drug), vitamin C and vitamin E in patients with high coronary artery calcium score.

i.e. Statins will not lower your calcium score.

There is a whole lot of information from the following link, including a 2008 study from the Simon Broome FH Registry UK which is linked to Heart UK: heartuk.org.uk/files/upload...

jeffreydachmd.com/2013/07/f...

If then we believe that the risk of a heart attack is greatest in the early to middle years and those over 60 with FH are at the same risk as the population, then why would anyone of that age still be taking statins, especially if they got there without taking them? From this we can conclude that having FH is not an automatic death sentence when you neglect to take statins.

You might say:

’Ah yes, but would you take a chance that your child, or indeed you, might not fall into the lucky category and make it to 60 without statins?’

I’d probably agree with your very real concerns - unless of course I possessed the knowledge that coronary calcification is the primary indicator for predicting a heart attack, and that would be the same for anyone whether you have FH or not.

Statins undoubtably have a part to play in the management of FH but what I guess I’m saying is that there is an argument that anyone diagnosed with the commonest form of FH might just avoid taking a powerful medicine if a coronary calcium scan indicates a zero or low score.

ncbi.nlm.nih.gov/pubmed/256...

24 Replies

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  • How would I find out my calcium score? I'm 33 and have been on 20mg of atorvastatin for a couple of months. Dr suspects a genetic cause for high cholesterol and high LDL, but I haven't been gene tested

  • You may be able to find some information on this link:

    bhf.org.uk/heart-matters-ma...

    CT coronary angiogram

    What is it?

    A CT coronary angiogram is used to measure the blood flow through the coronary arteries. Similar to a conventional coronary angiogram, a CT coronary angiogram involves injecting an iodine-based dye into your bloodstream to highlight your blood vessels.

    However, unlike the traditional angiogram, which is a sophisticated x-ray of the arteries, the dye is injected into a small vein in your arm rather than an artery in your groin. You may also be given some medication to slow down your heartbeat, making it easier to take images.

    Discover what to expect in a cath lab (( A cath lab is where tests and procedures including ablation, angiogram, angioplasty and implantation of pacemakers / ICDs are carried out. Usually you'll be awake for these procedures. A cath lab is staffed by a team of different specialists, usually led by a cardiologist. A cath lab shouldn't be confused with an operating theatre, where you would have surgery such as a heart bypass operation, under a general anaesthetic.)), where angiograms are carried out.

    Any risks?

    Because of the radiation, it should be carried out only when really necessary.

  • Some years ago I was a participant in a heart study and I remember I was given an ultrasound scan on the ankle and carotid artery.

    mesa-nhlbi.org/ParticipantW...

  • Private screening do angle and neck scans. doing it on an individual basis can be expensive. At times private screening can be done as a package, value for money.

    Four years ago I had angle and neck ultra sound scan done, it was normal.

    I will not be spending any more money on private scans.

    Food intake control, regular exercise and once in a while taking a holiday and eat what I want for healthy living, and enjoy one life.

  • My philosophy as well.

  • Thanks for the Info I will read it in detail as I have been on Atorvastatin since 1999 and the Cardiologist commented two years ago when doing an angiogram "there's a lot of Calcium" Reading the abstract here ncbi.nlm.nih.gov/pubmed/256... could be the reason!

  • Thank you.

    Did you have any stent after the angiogram ?

    Statin medication and any other medication to control your heart problem?

    Did find more on calcium.

    Coronary calcium scoring

    In this test, which does not use X-ray contrast, pictures are taken of the heart to look for the presence of calcium deposits in the blood vessels of the heart or coronary arteries. Calcium deposits are a very specific sign of coronary artery disease, as is cholesterol and scar tissue build up in the arteries. While the amount of calcium in the arteries increases with age, patients who have significantly elevated amounts of calcium deposits are at increased risk to have heart attacks or heart complications. This is true for patients of all age groups, for both men and women, and across ethnic groups. In patients who have a strong family history of premature heart disease or in patients at intermediate risk of heart disease based on their age and risk factors, calcium scoring can help better assess their risk of heart disease and can help tailor medical therapy.

  • In 1999 I had a stent and in 2015 I had a double CABG which included bypassing the stent. The comment on the calcification was raised in 2013 after 14 years of Atorvastatin, one of the articles sited by mike suggests that atorvastatin may cause inhibition of vitamin K2 which is used by the body to put the calcium where it belongs!

  • If I had a high calcium score I would definitely be taking a keen interest in K2, along with a LCHF lifestyle:

    wholehealthsource.blogspot....

  • Mike I think it is the abstract in this link you posted that says it all! tandfonline.com/doi/full/10...

  • Hi Mike

    The issue is one in 500 people has not been diagnosed with FH, it's nothing like that number. Why? Well my guess is that the ones who haven't been diagnosed don't have a relative with early heart disease!

  • I think the thing about coronary artery calcification is that it's like everything else, a predictor of risk. It can't say that you will definitely have a heart attack or when you will have one.

    This is my issue with the whole idea of preventive medication. You are basically betting with your health - that you will be the one statins help and not the one they harm. It's all very well saying that the benefits outweigh the risks - what that means is that if you look at a group of people more will have a heart attack prevented than will get diabetes - but that doesn't help you if you are the one who gets diabetes, or derives no benefit from the statin.

  • But isn't that what you are doing with most preventative medicine? (not only medication)

    There is always an element of playing the averages unless you have lots of tests and some tests are known to be harmful, so unless you start to suspect you don't follow the averages in some aspect, why would you have certain tests?

  • Yes, that's why I have issues with any kind of preventive medication.

  • "unless you start to suspect you don't follow the averages in some aspect, why would you have certain tests?"

    I didn't voluntarily have a cholesterol test. My doctor took a complete blood test because I had a skin infection. A trainee doctor picked up the cholesterol and raised the issue even though it was completely irrelevant to the skin infection.

    I have refused cholesterol tests since I started doing more research and decided cholesterol levels are irrelevant to risk anyway. I want a genetic test simply to settle the uncertainty over whether I have FH or not, which has already been raised in a process I didn't properly consent to.

  • I also won't have mammograms or cervical smears because of the risk of overtreatment.

    My experiences have made me anti preventive medicine overall, I think it does much much more harm than good.

  • Basically what I've found out from all the reading I've done is that risk varies hugely in FH.

    Here's another study on the subject:

    onlinelibrary.wiley.com/doi...

    "The CVD burden from FH differs considerably from patient to patient. This was already recognized in 1966 when Harlan et al. reported normal survival in a large FH pedigree [28]. Recently, this was confirmed by three different mortality studies, carried out in the UK and the Netherlands [2, 3, 29]. In addition to patients with serious excess CVD mortality, many patients were observed having a normal lifespan"

    Yet I can't get a single one of the medics I've seen to even discuss this - the shutters come down if you even mention it and these are all legitimate clinical studies. They seem frightened of even admitting FH may not be a death sentence.

  • "So, having said that, are you one of the 500 who has been diagnosed with the commonest form of FH? If so, what are your options? Currently, if we to accept the current paradigm, it’s a lifetime of statins"

    There may be some bad doctors who won't handle patients who don't take statins, but there are plenty that do. Please don't engage in such scaremongering.

  • I've met 3 and they were all bad.

  • I'm sorry to hear that. Please at least tell your local PALS that you're not happy with their care and better luck in future.

  • As usual Dak the best you can do is an ad hominem attack which brings nothing to the discussion!

  • My comment wasn't an ad hominem attack - unlike your reply!

  • Re statins and calcification, Malcolm Kendrick wrote about this.

    drmalcolmkendrick.org/2012/...

  • I'm so confused. I've done much research on statins and on cholesterol and FH. I've just turned 33 and have been on atorvastatin for about 7 weeks. GP thinks it's possibly FH because lifestyle changes didn't lower my levels at all (infact they increased) The only reason I am taking the statins is because of the 'possible FH' Almost all of the research I've done says that statins only have a place with people who have FH. If it was just higher than average cholesterol then I'd ditch the pills because I'm already feeling the effects of muscle and joint pain. My tc/hdl ratio was not good, nor was my tri/hdl ratio. The statins have improved these ratios, although my hdl hasn't budged yet. I'm planning on going sugar free soon and am hoping that will help.

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