Calcium Heart CT Scoring Can Improve your Statin Decision MakingOctober 12, 2015
Heart Calcium Scoring and Statin Use
Reference: New York Times, Journal of the American College of Cardiology
The use of statins for the reduction of risk in coronary artery disease is controversial, in part because of the appearance of commercial conflict of interest. It is BIG business in BIG medicine. And lots of folks have pretty horrible side effects. And you have to treat 1000 people to prevent 7 heart attacks a year, for which you have one death. Hmmm. Math seems to be a bit dubious at times. And your doctor is graded and paid “quality assurance” bonuses based on the percentage of patients in his or her practice that are taking statins when they meet guidelines.
It is all well-intentioned, as a method of promoting quality, but it results in a certain intensity of persuasion and coercion when you say you don’t like the side effects. With all that emotion and coercion, is there a better tool that might refine the ability to make a decision? What would happen if you could get an additional risk scoring procedure done for $ 99 that showed you didn’t need to be on a statin? Wouldn’t that be handy?
That’s what this study asked. The MESA study is 6,814 multiethnic folks between 45 and 84 without evidence of coronary artery disease who were whittled down to a pure group of 4,758 folks without confounding items like missing data, or complete lack of lousy LDLs, etc. They were followed for 10.3 years and observed for the development of coronary artery disease events. The new cholesterol/statin guidelines were applied to this group, of whom 2,377 qualified to be on them. The majority of them (77%)qualified because according to the ACC risk calculation tables, they had a greater than 7.5% risk of having a heart attack/event over 10 years.
Was that really their risk? From that group who were supposedly meant to be on statins, 41% had a calcium score on CT scan of “0”. That was ZERO. No calcium in their arteries. They did have heart attacks. Yes, they did. At a rate of 1.5% per 1,000 years. Pretty small. More than lightning, or shark attacks. But not enough to take on the risk of statins. And not at the 7.5% rate that is the acknowledged rate for being enough risk for taking a statin. What are the risks of taking statins? Well, Mayo’s opinion is measured and valid. At the other end is Dr. Mercola, who would be less measured, but possibly more honest because he’s not in the system and thereby maybe speaks a bit more honestly, albeit off the walls.
Or just read the FDA’s concerns. What does the CT scan find? Well, it can add up the calcium in plaque in your arteries and actually find calcium that is in the wall of the arteries rather than just bulging out. It takes years for calcium to build up, so it is old plaque. Recent new, raw dangerous plaque is not seen on calcium scanning. It gets missed. And the CT does find all sorts of other tidbits, like lung nodules that you don’t know what to do with. But on balance, it’s information.
WWW. What will work for me? I’m dancing a jig. I’m thrilled. I’ve been doing this for four years and I now have literature support that what I’m doing makes sense. Now, if you have risk, you want to know how to turn it off. That’s were it gets really interesting. The fine art of getting rid of LDL’s actually isn’t that hard. I can show you how in about a month. And then there is TNF-α, CRP, sdLDL, HDLs and other blood cytokine and risk factors that can show you how to improve your score and get out of risk, without the statins. If you are interested, start by not eating sugar and white flour, and come let me show you how. I’ve been on vacation for a week here in Italy. The gelato has been wonderful. I’m going to measure my HDLs when I get home. I think I just accumulated a bit of risk. Stay tuned. I’m back in the saddle.
- You can measure your risk of heart attack by an inexpensive CT scan of your heart that measures your calcium load? T or F Answer: That’s it.
- If your score is zero you have a greater than 10 % risk of having a heart attack in 10 years. T or F Answer: Are you kidding? You didn’t read the column. Go back. Read it again. Score of zero means you have a 1.5% chance in 1,000 years. That’s low.
- Current ACC guidelines say it is worthwhile to treat you is your risk is greater than 7.5% chance in 1,000 years. Answer: Yup
- About 50% of people who currently meet the current guidelines for statins have a calcium score of zero. T or F Answer: True. (Makes you feel pretty confident in those guidelines, doesn’t it)
- You get some radiation from a CT scan of your chest. Answer: Also true. But in the world of risk-benefit, I’ll take that risk overtaking statins for 1,000 years.