5 Myths about the Coronary Calcium Score (CAC) | Tom Dayspring, MD

Publicado 2022-11-28
The Coronary Calcium Score can be useful, but several myths surround it. We cover 5 misconceptions regarding the calcium score and how to interpret a calcium score to lower our heart disease risk.

Let’s talk calcium scan or calcium score. The calcium scan shows calcification in coronary arteries

myth: “CAC score of 0 means no plaque”
a CAC score of 0 doesnt mean no plaque
CAC doesnt measure plaque. Measures calcification. Calcification happens late in plaque formation process.

you can have a CAC of 0 and have soft plaque. Non calcified.

study: people with lots of plaque, 14% had CAC of zero. most young people with obstructive CAD had a CAC of zero

“diagnostic value of a CAC score of 0 small in the young"

advanced coronary disease: ~30% of heart attacks or death in people with CAC of zero

if CAC is zero odds are low you have obstructive CAD. but doesnt rule it out

even with a lot of plaque, calcification may not have developed
CAC =0 is good news, it’s a marker of lower risk, but it doesn´t mean immunity

we can have plaque in other places besides coronaries
CAC=0: 54% had plaque in the legs or the carotids

CAC of zero is desirable, but far from perfect

CAC=marker of advanced disease. CAC=0 may mean no plaque. or maybe there is. CAC doesnt rule that out

CAC=0 doesnt mean zero calcification. just detectable calcification
scan picks up calcification above certain size, not small calcium spots. ~4% with CAC=0 had calcification

myth: CAC=0 means zero risk
"LDLc or apoB is high but CAC=0 so I´m safe"

“score of zero does not imply risk is zero (heart attack, stroke etc) or zero atherosclerosis (plaque)”

“CAC of zero may provide false sense of security”

CAC of zero indicates low 5-10y risk
value of CAC score depends on age

CAC=0 is the norm in young
“CAC of zero in the young is normal, more power at older age. value of a CAC of zero increases with age”

myth: "if CAC goes up, i´ll make changes"
calcification=advanced plaque
real power is in preventing plaque

“Plaque calcification is a late event, not for pre-plaque detection (goal = prevent plaque)”

some methods measure soft plaque. angiography.

calcium not the cause of risk. marker of risk
The more plaque, the more likely there’s calcification. calcification isn’t the problem. Calcification is part of the scarring of the artery, can make artery less likely to rupture

“plaque disruption and thrombosis not in calcified segments; calcium not the cause”

in general more calcium means higher risk, it´s a marker of more plaque and more advanced plaque, but something could increase calcium and not raise risk

statins can increase CAC but risk goes down. statins stabilize plaque, including calcification

CAC can refine risk. young with CAC that is NOT zero; older with a score of zero; borderline case with some risk factors but not clear if statin is appropriate, CAC can help decide

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Facebook: www.facebook.com/DrGilCarvalho/
Twitter: twitter.com/NutritionMadeS3
Animations: Even Topland @toplandmedia

References:
1-One page primer: jamanetwork.com/journals/jamacardiology/fullarticl…
2-obstructive CAD: jamanetwork.com/journals/jamacardiology/fullarticl…
3-plaque in other territories even with CAC=0
www.ahajournals.org/doi/full/10.1161/CIRCULATIONAH…
4-calcification even with CAC=0
europepmc.org/articles/pmc9612790/bin/jeab135_supp…
www.atherosclerosis-journal.com/article/S0021-9150…
5-CAC=0 desirable but imperfect
www.ahajournals.org/doi/epub/10.1161/CIRCULATIONAH…
6-low 10y risk with CAC=0
www.sciencedirect.com/science/article/pii/S2666667…
7-prevalence of CAC=0
jamanetwork.com/journals/jamacardiology/fullarticl…
8-calcium is not the cause: www.jacc.org/doi/10.1016/j.jacc.2021.12.018
9-Statins & calcium

Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!.

#NutritionMadeSimple #GilCarvalho

0:00 What is the calcium score?
0:53 Plaque with CAC=0
3:53 Calcification with CAC=0
4:32 CAC=0 and Risk
8:01 Calcium score and Age
9:33 Window of opportunity
10:47 More sensitive tests
12:17 Calcium is not the cause
13:32 Statins and Calcium
15:25 Take-aways and strategy
16:50 Additional Resources

Todos los comentarios (21)
  • @user-ly6iv8nq4j
    Family history of heart disease. Calcium score and my father (5 stents) asking me to get checked out led to a calcium score test recommendation from my primary care (Dr. Adam is awesome btw) and it likely saved my life. I had no symptoms and had the truck packed for a camping trip. CACS score was 1,441 (! Yes out of 0-400), stress test mild blockage, heart cath showed 3 blockages (100/80/50), and now I am in cardiac rehab from a triple bypass and I’m doing well thanks to the love and support of so many people. Several colleagues have gone for calcium tests and all have come back good - God bless. Please do this test if you have a family history, high cholesterol, high blood pressure, or any concerns about your heart health - I had no symptoms (age 53).
  • @thomashugus5686
    I had CAC score of 0 thru my 50’s. Went up to 150 by early 70’s. Passed a nuclear stress test and got an all clear. Then suffered major MI while on treadmills at the gym. Always in good cardio/ resistance training shape. I had a ruptured plaque in a major cardiac artery. Being a retired firefighter/paramedic I got my ass into the ER within 10 minutes. Only thing that saved my life
  • @henrypham-gq8xi
    This is the best explanation of calcium score I’ve ever heard. Thank you so much for your service to humanity. Keep up the good work:)
  • I doubt if many docs explain this as thoroughly to their patients as you guys have done.
  • @Hanover-ek4jy
    This is absolutely the best lucid explanation I have seen on YouTube!
  • @gabymalembe
    I had a score of 1188, mostly in the widowmaker artery, and was sure I was going to die any minute. That was 11 years ago and so far I’m still alive and no “events” but the day’s not over yet.
  • @TomDOLAN-cb9th
    Can t say enough about your excellent content, well-explained with important guests and giving the most important information to viewers. I really admire your work and the person you are. All the best Gil...
  • @SimplerKitchen
    My health has greatly improved since switching to less (unhealthy) carbs, more ( healthy ) fats and (least toxic) fruits , but this video is a home run that we all needed when it comes to knowledge of cardiovascular health. Bottom line is, health is all about balancing your diet that is based on organic and least toxic whole foods and exercise. Like they say, " you don't stop moving when you get old, you get old because you stop moving".
  • Excellent video with very important/relevant- information for people worried(or interested) about cardiac health and how to gauge it correctly! 👍👍👍 So many "youtube doctors" are spreading mis-information on this topic, that it makes me sad....glad to see you don't seem to fall into that group of people! 😉👍
  • @joethomas909
    Awesome video as always.. Great work doc!! 👌👌
  • @user-dq3eb4yp9s
    What an extraordinary presentation & service you provided to those of us laypersons who want to better understand the distinction between obstructive & non obstructive CAD, the role statins play as well as their overall understanding of risk assessment of adverse events over time. Keep up the effort because you should be seeing an increase to hundreds of thousands of subscribers. I’m certainly one. Thank you.
  • @RealJonzuk
    i dont know anything about this so i like that im learning high quality information for my first understanding of the topic of calcium scores Thanks Gil
  • @StushPothong
    How this man doesn't have millions of subscribers is beyond me...
  • @harshjain3801
    Thanks Gil - for a wonderful explanation. I have a friend who is on a keto diet (long term) , heavy smoker but also exercises regularly - at 57 years - has a CAC of 0. On the other hand, I , also 57, a vegetarian, with normal TRGs and lipid profile, but overweight and don't exercise regularly, have a CAC of 10. I guess, both of us have to make lifestyle changes and not rely exclusively on the CAC. Thank you very much - I really like your channel and explanations. I am a neurosurgeon and deal a lot with brain haemorrhages and similar conditions - the most common underlying theme I find amongst affected patients is a combination of obesity, diabetes, hypertension and lack of exercise....and, increasingly encountering patients in their early 40s with brain strokes...
  • @SpontaneityJD
    You are doing a great service with your videos. Keep it up :)
  • @hepgeoff
    Great info, thanks! Always enjoy your videos.
  • @Ontario100
    I feel much better after watching this video. I am a 65 year old male and have been on a statin for 20 years. I had a CT scan last week and my score is 1350. I am headed to the cardiologist in July. I would prefer a lower score of course, but it is good to know that this could be a good thing in my case. Hard stable plaque. Thanks.
  • Great information on value of calcium score ...lots of thanks from Chennai India