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CARDIAC CT CALCIUM SCORE CONTROVERSY FOR PREVENTING A HEART ATTACK!
By Steve Blechman
It was most recently reported in the European Journal of Sports Science April 2022 that, “coronary plaques of mature athletes appear to be more calcified compared to sedentary individuals and thus may be stable and less likely to be associated with an acute coronary event.”
We all know that exercise is good for our health and our heart. A surprising study published in the journal Heart on September 20th, 2021, reported that exercise enhanced the progression of coronary artery calcified plaque. The more exercise, the greater the amount of calcium plaque in coronary arteries!
This was determined by measuring coronary artery calcium (CAC) scores. “This study aimed to evaluate the prospective association between physical activity and CAC scores in apparently healthy adults,” the researchers said.
It was a five-year study that analyzed 25,485 participants. The conclusion of the study “found a positive, graded association between physical activity and the prevalence and the progression of CAC, regardless of baseline CAC scores.”
Today, many physicians and cardiologists believe that CAC score measurements taken by cardiac imaging CT scans are an effective way to diagnose cardiovascular risk assessment in healthy individuals, and future risk of having a myocardial infarction (heart attack).
According to the Cleveland Clinic, “A calcium-score screening heart test (coronary calcium scan) uses computerized tomography (CT) to detect calcium deposits in the coronary arteries of heart. A higher coronary calcium-score suggests you have a higher chance of significant narrowing in the coronary arteries and a higher risk of future heart attack.”
Recently, calcium-score screening heart tests have become controversial by some experts. Why? “Because there are certain forms of coronary disease such as “soft plaque” atherosclerosis that escape detection during this CT scan, it is important to remember that this test is not an absolute in predicting your risk for a life-threatening event, such as a heart attack,” as per my.clevelandclinic.org.
According to a recent article in JAMA Internal Medicine, March 15, 2021, entitled “Should I Get a Coronary CT Scan?” by Michael A. Inze, MD, “Plaque and coronary calcium occur in many healthy people who will never have a heart attack. Discovering that you have plaque or calcium has been associated with increased worry, and more treatments without proven benefit.”
It was most recently reported in the Journal of Cardiology May 2022 that “the clinical significance of the coronary artery calcium score (CACS) has been discussed since Agatson et al. first reported its utility in 1990” and that the “benefit of moderate values of CACS predict prognosis with subsequent treatment and noninvasive cardiac imaging is still controversial.”
In a recent cardiovascular study published in JAMA Cardiology on January 1st, 2022 involving 23,759 symptomatic patients, 12,771 (54%) had a calcium score of 0. The conclusion of the study reported that for symptomatic patients younger than 60 years of age, those without coronary calcium, “was associated with an increased risk of myocardial infarction and all-cause death.”
Another recent study published in JAMA Cardiology in March 2022 reported how race and ethnicity between Black and white individuals showed differences in coronary plaque measurement using coronary CT angiography. The result of the study found that coronary calcium was lower in Black persons than white persons.
A most recent study published in the journal Circulation: Cardiovascular Imaging on March 15th, 2022 performed a study on 196 adult twins without known cardiovascular disease, to see if “genetics have a strong influence on calcified atherosclerotic plaque.” Coronary CT angiography was used to determine coronary artery calcified plaque and non-calcium plaque. The conclusion of this study was that non-calcified plaque volume is mainly influenced by shared environmental factors, where coronary artery calcification score and calcified plaque volume are more determined by genetics.
A new study was reported by January 19th, 2022 by Medical Xpress.com found that “among patients with no detectable coronary artery calcium, those who smoke, have diabetes or have hypertension nonetheless have the highest risk of cardiovascular disease events, according to a study published in the Journal Circulation.” The report goes on to say that “the findings demonstrate that even in patients with no coronary calcium, the traditional risk factors affect risk of heart attack and stroke, according to Phillip Greenland MD, the Harry W Dingman Professor of Cardiology and Co-author of the study.” Dr. Greenland said “these findings demonstrate the importance of considering all facets of cardiovascular disease risk instead of relying on CAC measurements alone.”
If you have a family history of coronary heart disease, see your physician or cardiologist and get all the proper blood work (measuring your c-reactive protein, blood glucose, hemoglobin A1C, LDL and HDL cholesterol, apolipoprotein B and triglycerides). It was reported most recently in JAMA Cardiology that the longer a person has elevated LDL cholesterol, the greater the risk of suffering a heart attack.
It has most recently been reported by ScienceDaily April 12, 2022 that, “the diameter of the thoracic aorta is a biomarker for heart attacks and other cardiovascular events in women and men, according to a new study published in the journal Radiology.”
It has been also reported by Science Daily (ScienceDaily.com November 29, 2017) that “former National Football League (NFL) players are more likely to have enlarged aortas, a condition that may put them at higher risk of aneurysms,” according to the National Radiology Radiological Society of North America.
Also, a study by Cleveland Clinic researchers that was published in the journal of Circulation, November 9th 2017, found that NFL players have larger aortas than the average person.
“The surprising result of all of this was the actual overall average size of the aortas in the NFL group, which was really much bigger than we had anticipated going into the study,” said Dermot Phelan, MD, Ph.D. of the Cleveland Clinic, who authored the study.
“Cleveland Clinic researchers studied 206 retired NFL players with an average age of 56.”
“Heart scans of the former players were compared to heart scans of a group of non-athletes.”
“Results show NFL players in this study had a twofold risk of having enlarged aorta, when compared to the non-athletes.”
“Dr. Phelan said that this may be due to intense weightlifting that causes short bursts of high blood pressure and stresses the aorta.”
“Typically, an enlarged aorta in an average person is a risk factor for developing a tear in the vessel wall, which can be life threatening – but more research is needed to know if the same is true for elite athletes.”
“Until we know more about what this means, we should be cautious and continue to monitor these folks more closely than we would normally,” said Dr. Phelan. “People with enlarged aortas tend to be at increased risk for an aortic aneurysm formation.”
CT CORONARY ANGIOGRAM & MRI/MRA MAGNETIC RESONANCE ANGIOGRAPHY
CT coronary angiogram (computerized tomography) is an imaging test that looks at the arteries that supply blood to your heart. CT coronary angiogram is used to diagnose a variety of heart conditions, but mainly used to diagnose narrowed or blocked arteries to the heart and coronary vascular disease. A CT coronary angiogram uses a powerful X-ray machine using contrast, a special dye, that provides images of your blood vessels and heart. The risk of developing cancer from a CT angiogram isn't known, but it's small.
MRI/MRA magnetic resonance angiography is often referred to as MRI/MRA magnetic resonance angiogram. It is considered the new “gold standard” for looking at both the structure and functioning of the heart as well as focusing on blood vessels and blocked coronary arteries. MRI and MRA are usually done in conjunction with each other. MRI utilizes a magnetic field along with radio waves to produce heart imaging while MRA involves a contrast agent injected into your vein for enhanced images of blood vessels. MRA takes more detailed images of your blood vessels than CT scans without the use of X-rays and therefore, radiation free! MRI/MRA is preferable over CT scans for people that require follow-up scans without radiation exposure such as yearly monitoring of an existing aortic aneurysm, and also, for detecting COVID-19 related inflammatory myocarditis of the heart.
Lack of exercise and being sedentary can increase your risk of heart disease caused by hypertension, obesity, and diabetes!
A new study published in the journal Nature on February 10, 2022 found that “heart-disease risk soars after COVID, even after a mild case”!
Take action now, especially if you have a family history of heart disease! Consult your primary care physician and lower your LDL cholesterol, triglycerides, blood pressure, blood glucose, hemoglobin A1C, c-reactive protein (CRP) a measure of systemic inflammation, control your bodyweight, and have proper blood work by your physician. Also, ask your primary care physician and cardiologist about coronary image tests such as the echocardiogram, CT coronary angiogram, or advanced MRI/MRA magnetic resonance angiogram.
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