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.