A Voodoo Coronary Calcium Scan Could Save Your Life

The skeptical cardiologist received this reader comment recently:

So I went and got a Cardiac Calcium Score on my own since my cardiologist wouldn’t order one because he says they are basically voodoo.. Family History is awful for me.. I got my score of 320 and I’m 48 years old.. Doc looked at it and basically did the oh well.. so I switched docs and the other doc basically did the same thing.. I try so very hard to live a good lifestyle..I just don’t understand why docs wait so long to actually take a look at your heart.. I would have thought a score of 320 would have brought on more testing.. It did not..

I was shocked that a cardiologist practicing in 2019 would term a coronary artery calcium (CAC) scan (aka, heart scan or calcium score) “voodoo.”

I’m a strong advocate of what I wrote in a recent post with the ridiculously long title, “Prevention of Heart Attack and Stroke-Early Detection Of Risk Using Coronary Artery Calcium Scans In The Youngish“:

It’s never too early to start thinking about your risk of cardiovascular disease. If heart disease runs in your family or you have any of the “risk-enhancing” factors listed above, consider a CAC, nontraditional lipid/biomarkers, or vascular screening to better determine where you stand and what you can do about it.

Here’s what I told this young man:

If your cardiologist tells you coronary calcium scores are voodoo I would strongly consider changing cardiologists.

A score of 320 at age 48 puts you in a very high risk category for stroke and heart attack over the next 10 years.

You need to find a physician who understands how to incorporate coronary calcium into his practice and will help you with lifestyle changes and medications to reduce that risk


Let’s analyze my points in detail and see if these off the cuff remarks are really justified

1,  Changing cardiologists.

Recent studies and recent guideline recommendations (see here) all support utilization of CAC in this kind of patient. If you have a strong family history of premature heart disease or sudden death you want a cardiologist who is actively keeping up on the published literature in preventive cardiology,  Such cardiologists are not dismissing CAC as “voodoo” they are incorporating it into their assessment of patient’s risk on a daily basis.

2. High risk of CAC score 320  at age 48

I plugged normal numbers for cholesterol and BP into the MESA risk calculator (see my discussion on how to use this here) for a 48 year old white male.

As you can see the high CAC score puts this patient at almost triple the 10 year risk of heart attack and stroke.

Immediate action is warranted to adjust lifestyle to reduce this risk! This high score will provide great motivation to the patient to stop smoking, exercise, lose excess weight, and modify diet.

Hidden risk factors such as lipoprotein(a),  hs-CRP and LDL-P need to be assessed.

Drug treatment should be considered.

3. Find physician who will be more proactive in preventing heart disease

This may be the hardest part of all my recommendations. On your own you can get a CAC performed and advanced lipoprotein analysis.

However, finding progressive, enlightened, up-to-date preventive cardiologists can be a challenge.

We need a network of such cardiologists.

I frequently receive requests from readers or patients leaving St. Louis for recommendations on cardiologists.

If you are aware of such preventive cardiologists in your area email me or post in comments and I will keep a log and post on the website for reference.

Voodoophobically Yours,

-ACP

14 thoughts on “A Voodoo Coronary Calcium Scan Could Save Your Life”

  1. My problem is basically the same with a coronary calcium score however my cardiologist recommended a heart. Are because of a 70 % blockage in my LAD . Insurance said no . Need a stress test . I had to have a chemical because of my back . Stress test was ok they said . I have bigeminy and trigeminy quite often . Where to go from here?

  2. I too had to do my own 64 Slice back in 2009 since my cardiologist was hung-ho on a ‘look see’ cath lab visit after abnormal stress and nuclear stress tests (currently 59 years old). They couldn’t tell me how bad it was before hand. 64 slice came back with ~30% blockage in LAD toward the top. The CT doc wasn’t busy and showed me the scans right after the CT. Fascinating. I didn’t do the cath lab and have been on statins and high BP drugs since then. I can tell you that my blood pressure is crazy high when seeing a cardiologist (not with other docs). So no real change in 10 years and haven’t really lost the weight or modified diet. And I have tons of work stress. But retirement is soon and we moved to France. Hope I can correct the life style without missing the excellent french food and wine 🙂

  3. I am 54 and I had no idea that I had coronary heart disease until my mom badgered me into having the CAC testing (which takes all of 10 minutes) because of our family history. A high score, some blockage found, a stent, and medication later- I am so glad I had that done! I now have the opportunity to make the lifestyle changes that are needed to change my course. Knowledge is power, just sprinkle on the common sense.

  4. It is time to take to take stock, when an Engineer knows more about detecting coronary heart disease…. then those two CARDIOLOGISTS.

    – The ‘Engineering’ viewpoint is to See and Measure the problem, then to Track it. (subsequent CAC’s)
    That way, you stand a better chance of defining – not guessing – the extent and growth-rate of the disease

    https://www.youtube.com/watch?v=bWcgT4BYwo0

    However, there is the aspect that ‘soft plaque’ may be more of risk for sudden events, as the hardened stuff grows relatively slowly, giving the body time to build ‘collateral circulation’. That was the opinion of one GP, GP who talked-down the benefit of CAC…. Comment ?

  5. I recently was caught by the title “skeptical cardiologist” and thought i would check you out. You see, I myself am a skeptical cardiologist. So I have perused a few postings. Not especially impressive. Now this one on calcium scores and you are so off base, you’re not on the playing field. You appear to be practicing “populist” medicine, encouraging lay people’s distrust of physicians for, what?, your own amusement?

  6. I’d say from too many doctors *Earning* their Patient’s distrust…

    From General Practitioners who feed ‘high-carb / low ‘fats’ diets to their T2D and overweight patients, ensuring a ‘Patient for Life’, – through to “Specialists” in various fields who steadfastly resist learning their ‘trades’, especially when it comes to new & better procedures, yet being ignorant of some basics…
    For example a ‘cardiologist’ vehemently declaring that “12 months of intense, constant, emotional stress” had NO bearing on my “Immediate” need for CABG x5, with no alternative therapy(s) presented.
    – Yet took 5+ weeks to arrange a surgeon/surgical date at a convenient hospital !
    And this from the top Cardiological Group Practice in my State.

    This same ‘cardiologist’ made no case for post-op Cardiac Rehab, and later sabotaged my (then)successful joining of a combined University-Hospital Rehab Trial.
    The good news is… my current Cardio immediately signed me up for Rehab, though now at +2 years post-op, assured me was not wasted as it would now benefit my mental/emotional health, in his view, equally vital.

    I believe the Doctorate of Philosophy hanging on his wall gives him an edge over his Fellows…

  7. So this particular article was written about me. I am on a statin and blood pressure meds. I will go back and get another test around October which will be around the 2 year mark of my first scan. I’ll drop the numbers in here when I get that so you can see what percent I have progressed. I am taking magnesium, K2, D3 Cq10 and fish oil supplements.. My morning routine is egg whites with a bit of cheddar and one coffee. Lunch.. 30g of mixed nuts.. Dinner is some type of protein.. I stick to that most days. Saturday I give myself a break for dinner..

    1. Robert,
      It is unclear what the value of repeating the CAC test is for those with nonzero scans. I hope to write on this soon. Perhaps your repeat scan will stimulate me to write that post.
      It’s unclear if any of those supplements will benefit you. I’ve written about fish oil supplements a lot on this site.
      I’ve written a lot also about eggs and specifically I’ve written on here questioning why anyone would eat egg whites. Check it out.
      Thanks for the voodoo quote!
      Dr p

      1. Dr P ordered a calcium score on me after my results of the echocardiogram and stress test came back normal. My score was 1798. Saved my life because he believed in covering every corner.
        If you are not getting results you want from your cardiologist then find one that covers all bases like Dr. P.

  8. My 70something mother has an amazing cardiologist that she lucked into when her more staid one retired. He has been wonderful and proactive. My 40something husband was sure he was dying, everyday, despite symptoms, but with family history. He was refusing to see a doctor, but I convinced him to see Mom’s doc, who said “get a calcium score, then we’ll begin to know how you really are” I liked that he wasn’t using the calcium score as the only test and a stress test was also planned. However, after a calcium score of 800something, my husband went off for a cardiac cath, instead of stress test. Three arteries were blocked at 90, 80, and 70 percent. Bypass surgery was scheduled for a few days later. I’m team calcium score. Husband’s cholesterol was never really bad, only slightly elevated. A good friend, with horrible cholesterol, had a calcium score of zero. It’s not an exact science, which is why I’m glad our doctor uses multiple diagnostic tools.

    1. I’m glad things worked out for your husband.
      However, I’m not an advocate of performing cardiac catheterization just because of a high CAC score. See my post on should stress testing be performed on high CAC. Too much risk associated with catheterization and too many unnecessary stents placed if there is no documentation that the plaque is highly obstructive.
      An alternative to cath without the risks is coronary CT angiography. Especially now that we can measure FFR with the CCTA.

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