What Your Coronary Artery Calcium Score Means

[@bugsy1254]

My calcium score at 70 yo is 450. Vigorous exercise 3 to 5 times per week for 45 years, gave up smoking 35 years ago, good diet. High cholesterol all my life same as my parents. They lived into their 90’s in perfect health. Had a cardiac stress test every year for the last 5 years. All good. No pain, no discomfort, quick recovery. Refuse statins due to terrible side effects. There’s more to it than what doctors currently know.

[@MarcKatzMD]

As I reiterate multiple times, high cholesterol means higher risk. Nothing is definitive.

[@sherrylewis5720f]

@@MarcKatzMD 16:38 my MD wanted to put me on statins for high cholesterol numbers. I saw M. D. / integrative spec and he suggested I get CAC score. I request it through my family md and she ordered a “ chest calcium score”. Is this the same test as a coronary artery calcium score test?

[@MarcKatzMD]

@@sherrylewis5720f sounds like it but you should confirm with your doctor

[@ra78100]

Hi there doctor, I just had the calcium score done and came at 430. I workout a lot and like the above I do not take statins. I am 68 and feel great and don’t any problems with my heart.

[@bbhoustontx]

71 year old here. I just had a Nuclear Tread Mill and Echo Ultrasound on the heart after getting a score of 6,200 on my calcium scan. Cartiologist found no blockage and everything was normal. I have been freaking out for almost a month waiting to be tested. Doctor says the calcium is on the outside and not inside. Don't freak out. I always felt fine and can run all day and it confused me. Both parents lived well into the 90's ...... mother 98. I have inherited high cholesterol so cardiologist bumped my statin up to 40mg from 20. I eat no red meat no processed food....mostly veggies and fish, no flour (Ezekiel bread only) no milk, no sugar and only egg whites, tons of fruit..... feel much better eating this way and will do this the rest of my life. I will occasionally eat something sweet but not gorge on it.

[@VerissimusAurelius]

I am a male 67 265 pound male, non smoker retired airline pilot who had six month check ups for most of his life. 10 years ago I had a stress test and they told me I had the heart of an 18-year-old. But recently I had some chest palpitations and I did a calcium score of 214.. I’m scheduled to do the stress test in a couple days. Personally hoping that this is a wake up call to change my diet, lose weight, exercise, and increase my chances of having a normal life without stroke or heart attack. Your video is absolutely flawless and it helps me to understand. I wish I had seen it 20 years ago. 🙏

[@keto4life458]

what do you know about k2 and it's help with reducing calcium plaques?

[@acer4462]

I was seeing this ordered at my clinic by some providers and couldn't figure out when they chose to order it...until i stumbled on your video. keep it up up up upppp my dude!!

[@joses5356]

Great video. I just took a CAC scan because my dad's cardiologist recommended it to all siblings. He died last year at 90 yrs old. Im 59 yrs old working out with weights since 1993. Take lots of supplements. I check my blood every 6 months. I have always had elevated triglycerides average between 200 and 400 and low HDL 32. My Vldl 48. My CAC was zero. I would've thought there would be some calcium due to my triglycerides. Fasting insulin 7.1. Fasting glucose 92. A1c 5.4. Also had a PAD scan on carotid and legs which showed normal. Not taking my health for granted .

[@MarcKatzMD]

Always nice to see a CACS of zero. Keep up the healthy and active lifestyle!

[@bettywhill]

Your triglycerides is high, cut down carbs.

[@starrynight3363]

@@MarcKatzMD Tomorrow, I'll listen to your entire video: Cannot wait to hear you (probably) Not mention Menaquinone & Matrix Gla proteins to keeps calcium out of soft tissues & arteries; and K2 to regulate Ca distribution, into bone vs randomly into organs, breast tissue 2]. Advocate for STATINS_ [NEVER should have been approved should by FDA]... 3]. Magnesium acts as a Natural statin. 4] C-Reactive Protein levels is a much better predictor for CAD. 5] NNT & NNH =re Statins, an inhibitor and enzyme poisoner, where the Risks Outweigh Any benefit.

[@MarcKatzMD]

@@starrynight3363 I’d be happy to look into the data behind your ideas but as it stands I’m unaware of any robust clinical data to support your statements

[@ElreyRayo]

Lovaza fish oil lowers triglycerides

[@higuysrealtalkwithtracy4543]

I appreciated the way you explain this. Genetically I got it. Build up in 6 arteries. My score was 370. I am 61 and going for an updated c t next week. I love the way you are explaining this. Thank you❤❤❤❤❤❤

[@PrettyPink7]

Excellent video. I’ve been told I need to get this done by my cardiologist. I’m diabetic with lvh and a leaky heart valve. I’m on a statin. I have a very strong family history of high cholesterol and heart attack. I guess I better get it done then. Thanks for the info doctor.

[@cmlopez1982]

Best video explanation. I just had one done and Im at 97 percentile. Doctor prescribed cholesterol meds

[@andreaadams8517]

Same. I'm in 90th percentile and stating were prescribed.

[@robynmann33]

Excellent explanation. Thank you!

[@russbrown6453]

Boy, it seems like the"risk" changes depending on the risk calculator you take. Example, I took the calculator test mentioned in this video, and my 10 year risk was 3.3% I have high LDL, my Dr imputed the same numbers including my LDL into another test that required the LDL number ( probably designed by big PHARMA), and I have a 50% 10 year risk! As far as cac score... I have a cac score of 24. They recommended high intensity statins with aspirin. I asked them what was the highest score they have seen? In the thousands... One man had a cac score of almost 6000. He was in his 80s! They said usually people with diabetes in their 80's have a high score! I don't understand? As far as statins? Research relative vs absolute risk reduction. Wow, relative risk reduction says you have a 29% reduction in heart attack wow! Well, not really. Absolute risk means you have a 1.3% risk of heart attack prevention. Simply put; 70 people will be treated with a statin to prevent 1 heart attack. Talk about deceptive marketing for a 30 some BILLION dollar per year profit... Hmmmm I think we're making a mistake thinking that stains, and cholesterol is going to do anything to stop heart disease. Just sayin...

[@SongbirdRanch2005]

Bravo!❤

[@murraypooley9199]

Right on. LDL is irrelevant. I am 68, athletic and all my blood markers and pressure is in optimal territory. In fact all my health markers. 14 day average pressure 119/74. Best 14 day reading 104/63, Triglyceride/HDL ratio 0.34, no meds, no illness of any sort, no infections, no vaccinations, and not even a common cold in many years. It cracks me up all the discussion about how to control supposed markers of bad health. Why not deal with the reasons for bad health? It is simple. Eliminate all carbs from the diet, junk food, seed oils. like the car, if we put in the wrong fuel it will and do get sick.

[@joseabboud-2607]

@@murraypooley9199 Exactly.

[@conniesnutritionandnuggets277]

Right 👍🏾

[@lilleypops1868]

Statins don’t treat calcium

[@timothyharris6927]

I read somewhere that part of what statins do(in addition to lowering LDL) is that they actually take soft plaques and CALCIFY them which is part of their success in lowering heart attack risk. The hardened calcified plaque isn't a risk to break off and cause a heart attack the way soft plaques are. For this same reason, those taking statins can show higher and higher CAC scores as they take statins even if they improve their diet and keep the cholesterol in check...their existing soft plaques harden and slightly shrink(to the person's general net benefit). For this reason, some doctors don't recommend additional CAC scoring after patients with a positive score starts statins. It only serves to add unnecessary stress when a higher CAC score after a few years on a statin may be better than the alternative.

[@MarcKatzMD]

Perfectly stated. From my personal opinion as a cardiologist- I don’t typically recommend repeating a CACS unless the score was previously zero. But also depends on the patient as I try to balance my medical advise with the patients wishes

[@lkelly4337]

@@MarcKatzMD here is a general statement about vitamin K2. My dentist stated that I had high amounts of "Calculus" at the roots of my teeth or at the gum line. He prescribed daily 90 mg of vitamin K2. Four months later when I returned for my routine cleaning I had no "calculus" build/up around my teeth. It was suggested that the K2 might also be reducing the calcification of my arteries. Seems to me that annual or biannual CAC scans would be justified to evaluate the affects of K2 on existing calcified arteries. Gosh for $100 it is worth a look?

[@MarcKatzMD]

@@lkelly4337 no that is not worth radiation exposure

[@SET12DSP]

​@@lkelly4337I take 2400mcg of K2-MK7 with 5000i.u of D3 and my teeth are superb not only that but combined with the Linus Pauling Heart Protocol my CAC has reversed by 30%.

[@MarkHolmes]

@@MarcKatzMD radiation is minimal per Dr Agaston and he should know. (kzbin.info/www/bejne/bKPReJqrqJabp80)

[@lucyb7608]

This was very easy to Understand. Thank you.

[@gshenaut]

I'm 75 and have a CAC of 16.3, putting me at the 14th percentile. My latest lipid results are total 137, HDL 47, and triglycerides 65. I don't want to start statins for three reasons besides the issue of side effects. 1) The Byrne et al. and other studies, including the MESA study, show that the absolute risk reduction from taking statins is unimpressively low. 2) My lipid levels are already fairly good. It's unclear to me how much improving them further will help. 3) After playing around with the risk calculators and observing how large the variation in estimated risk can be as a function of the variation over time (weeks or months) in BP and even in lipids, it is difficult for me to put great trust in the calculators. Maybe I'm foolish, but my plan at this point is to watch my diet (including an increase in Vitamin K2 foods) and to see what happens.

[@danz4928]

You missed writing your LDL number. The main number that matters the most

[@gshenaut]

@@danz4928 LDL was 77

[@danz4928]

@@gshenaut seems like the new guidelines in Europe and the US want everyone to be under 50 in the us and 45 in Europe. It’s all about the Ldl.

[@MarkHolmes]

@@danz4928 Read Dr Malcolm Kendrick's book - The Clot Thickens.

[@dminarsch]

I disliked this video. No mention of differences between large and small LDL. No mention of dividing triglycerides by HDL and scores of less than 1 mean very low risk of heart attack, or stroke. Mediterranean diets are not healthy. Full of seed oils, and foods full of oxalates. All you did was push statins. Statins are the killer. Physicians push drugs.

[@tomalexander3971]

Great job explaining it.

[@kevinsandridge5638]

Thanks for this video - I have struggled understanding my test score - this is by far the best explanation I have found - Thank You!

[@MarcKatzMD]

thank you for the feedback! =)

[@cutabove9046]

Men don't generally start calcifying their plaque until after the age of 45 or 50. So, for younger men this isn't a good test of heart disease. The best bet is to get a CIMT which is non-invasive, cheap, quick and doesn't require a fair dose of radiation like the CAC. It measures the plaque in your neck which includes the soft and more dangerous plaque. Heart disease is systemic so if you have plaque in your neck it will be in your heart as well.

[@jamesboyce9921]

Yea, try to get a CACS if you are healthy. We all should be able to see where we stand.

[@LK-bz9sk]

Excellent video Doc. Here in Texas, November 2022, the CAC test cost $75.

[@marymadelynevangelista9799]

Here in NJ in 2023 CAC test is $99.

[@LK-bz9sk]

@@marymadelynevangelista9799 even at $99, for the amount of information we are getting its a must. I am old enough to remember never having heard of CAT scanning and when it did arrive as a brand new tech you couldn’t get near that machine for anything for less than one thousand dollars.

[@robertharrison8372]

$150 today October 2024

[@brianjohnson1788]

$100 in Naples, FL last week.

[@brianf761]

At 50, and refusing a statin prescription for ldl at 120,with 59 Hdl and 70 triglycerides had a CAC of 0, pcp finally relented and said just keep doing what you're doing.

[@MarcKatzMD]

@@brianf761 That’s great! CACS of zero is one of the every few times we can confidently say “you don’t need meds!” (Assuming LDL not >190 mg/dL)

[@brianlane9534]

​@@MarcKatzMDI went to a cardiologist to follow up on test from 2 years ago because of very high pvcs. Low regurgitation rate etc. In the mean time I had a cac score 18 months prior. It was zero. I'm 65 years old. My latest lipid panel LDL 137 I think, tri in 80s, HDL 63. Total cholesterol 210. He didn't want to discuss anything but putting me on statins if I don't lower my cholesterol in 90 days. I'm gonna find a new doctor.

[@brianlane9534]

Plus my heart perfomance was greatly improved, pvcs went from 15000 in one day to almost gone after 2 years of lifestyle change. Stress was off the charts.

[@gerardlunow567]

Great video. At 70 I have a 9. I did a stress test and they stopped it, not me, I was not done yet. The explanations were great. Was happy to pay $100 to have peace of mind. I always think about risk factors. It is being aware of risk, any risk, that allows you to properly manage risk. Now I need to find out how to lower my bp. One day ok, the next 40 points up. Makes no sense to me.

[@sheddkkhan6758]

You can reverse it

[@edgaracevedo9658]

I've been taking a statin for 6 years and my cardiologist never ordered a calcium score but I did do stress test, nuclear, yearly EKG and echo . I recently saw a new cardiologist (prior cardiologist retired) and he did an EKG which came out abnormal so he ordered a calcium score which came out to 745. He then ordered an angiogram and my results were no blocked arteries requiring a stent. However, I was diagnosed at hospital with Non Obstructive CAD. I have an artery on right side with 40% stenosis. Not sure what all this means but will try to get some answers at follow up with cardiologist.

[@twinb1954]

I am a 70 year old female. My coronary calcium score last year was 441. The cardiologist (physician assistant) isn’t suggesting that I do anything. My Total cholesterol and LDL is normal. I am taking Atorvastatin. I go to the gym at least 3 to 4 days per week. I don’t smoke or drink alcohol. I also have moderate Aortic Stenosis

[@SET12DSP]

By the time you're 75, that score is likely to be 900, especially while taking a statin. Reversing mine on the Linus Pauling Heart Protocol verified by CAC 660 to 458 in 20 months.

[@Theresaburg]

Wow Great information..!! Thank You!

[@jacdragan8918]

As a retired Electrical Engineer, I like your approach. I just had a CT Angiogram done at a local hospital. It is covered under insurance. My score was 1455. I did a lot of research and most say that the size and density of the LDL, Stress , Sugar, Carbohydrates, and Insulin Resistance is much more important than Cholesterol Levels. What is your opinion of this? Also Niacin vs. Statins. Thank you very much.

[@oscarcollier5141]

Go pay a visit to doctor.

[@tellmestraight]

@@oscarcollier5141 Keep your opinion to yourself.

[@SET12DSP]

I retired from the electronics industry myself, Their likely to want you on a Statin period! It's in the name of stabilization. What is working for me is Dr. Linus Paulings Heart Protocol he was a 2-time Nobel Prize winner awarded 48 PhD's over his lifetime. Using his Protocol I have reversed my CAC from 660 to 458 in 20 months.

[@nomorenews]

How about a CT angiogram with contrast?

[@jaymart7314]

Did you get a CT scan with contrast? Hope all is well. I'm going for one at the end of this month and am concern of the dye.

[@jeffj318]

Thanks, Doc, for a clear understanding of the CAC.

[@rorydoremus3255]

Excellent information, will be put into practice as a cardio PA.

[@MarcKatzMD]

Happy it helped. The guidelines document also helps for further reading

[@greysonmuotka6103]

Such a well rounded video on the subject !

[@deanP60]

Your explanation of this topic was well presented.

[@MarcKatzMD]

Thank you!

[@thomasryan5681]

My cholesterol levels have always been within the ranges but recently my doctor recommended getting a CAC and I was over 500. I followed this result up with a stress test and blood flow was good. I'm still scratching my head though on what else could have created this build up. PS. I'm 68 years old and my doctor put on a statin to maintain that happy range of my cholesterol.

[@jaymart7314]

Mine was 472. I'm 79 and cholesterol is187.hdl 53 , LDL 97, triglycerides 244.. risk ratio 1.8. my cardiologist is sending me for an ct angiogram to determine if he can put me on repatha.. I was taken off atrovastatin because of muscle pain. I'm concerned about the dye for the angiogram.

[@sheddkkhan6758]

@@jaymart7314did you done angiogram

[@PaulaDeRosaHensley]

This is a great explanation. Thank you!

[@kathiparshall8094]

Thank you. That was very informative and clear. I just had this test done and was very confused.

[@MoMagnets]

Thanks Dr. Katz for the extremely informative video.

[@Jeffs60]

Isn't the CIMT test much better since it can pick up both soft and hard plaque without the use of radiation?

[@MarcKatzMD]

If by 'CIMT' you mean a vascular ultrasound then yes and no. I often use vascular ultrasounds to detect underlying peripheral vascular disease (PVD). So I will sometimes use vascular ultrasounds to detect PVD, like an ankle-brachial index, as a surrogate marker for CAD. Unfortunately sometimes the tests are inconclusive or a patient's anatomy doesn't allow us to properly visualize the vessel. As I'm sure you are aware, a lot of these decisions require a thorough discussion between the patient and their physician. Hope that helps answer your question!

[@MyGen-tl5pz]

Thank you Dr. Katz! This is a very informative video and I think everything is really well explained. QQ for you; What would you recommend as a next step for a 56 yr old male who has about 1500 CACS? His BP is under control with medication, HDL 65, LDL 160, total about 250. Would you recommend nuclear stress test or something else next? Thanks again!

[@MarcKatzMD]

Sorry for late reply. Typically we do perform stress testing of some sort with CACS >400. But requires personalized approach with an individual’s physician

[@nomorenews]

How do you feel at cac scire of 1500? Any shortness of breath or chest pain. How long the score took to double?

[@debbiea106]

Thank you, Dr Katz for the best explanation of this topic I've witnessed. What is out there to address someone who has discordant biomarkers as follows: total chol 218, ldl 128, hdl 78, triglycerides 41, but LDL-P of 1509 (high), low large HDL-P , APoB 88 and Lipo 10. CAC reading 6 years ago was 1 and recent carotid scan shows no evidence of hemodynamically significant carotid stenosis. I'm 102 lbs with a 18% body fat and physically fit. My diet not so good but genetically my total cholesterol has never been below 218 from my 20s. currently 61. I searched web on the discordant readings on my tests but nothing explains it. Thank you!

[@Dig-Toxic]

First-year cards fellow here. Such a great way of simplifying it, definitely gonna use your approach when talking to patients.

[@MarcKatzMD]

Happy it was helpful. Trying to make the videos that I wish I had when I started fellowship. Good luck doc!

[@charlesanddiana]

Ok, now stop using "gonna", it makes you sound unprofessional.

[@MarcKatzMD]

@@charlesanddiana comments like this gonna get you blocked

[@grainiac7824]

@@MarcKatzMD They were just saying that many of us lose confidence in someone who doesn't present in a professional manner. I didn't see it as a cut-down but as a courtesy. But you block who you want, it's your gig.

[@MarcKatzMD]

@@grainiac7824I hear yah- that’s fair. But also this is how I speak naturally. Overall I do try to be professional in my overall presentation but need to make it a little less cerebral at times

[@JeannetteAbrahamson]

Very nicely done & thorough

[@GOLFSTPETE]

Just had heart cath done on 3/16/23..no heart disease! My cac was 661? I am on no meds except copd inhalers. Blood work normal...could they have made a mistake or what?

[@MarcKatzMD]

I can’t give personalized medical advise so you should talk to your physicians about your specific treatment plan

[@carriewilkin679]

CAC score of 1346. Echo and stress test good. High LDL . Statins for over 10 years. Age 64

[@sheddkkhan6758]

You can reverse it

[@carriewilkin679]

@sheddkkhan6758 I was told it can't be reversed.

[@joelthorne7434]

Helpful info. Thanks. I had a first-time calcium scan: All 0s except a 58 score for my LAD. I’m 66. I’ll have to re-double my health regime.

[@user-EinsteinSarge]

According to the risk calculator website my risk is 2.3%, however it didn't ask about Lp(a) which mine is elevated at 53 mg/dl. Since I appear to be low risk and my primary care doc just prescribed a low dose statin in response to my Lp(a) score, I can't get my doc to refer me to a cardiologist given my apparent low risk. I will ask for a coronary artery calcium score but doubt they will authorize.

[@MarcKatzMD]

@@user-EinsteinSarge just FYI, as I review in this video, CACS aren’t typically covered by most insurance but also typically shouldn’t cost >$100

[@user-EinsteinSarge]

@@MarcKatzMD Thank you, I did see that and I'm happy to pay out of pocket for it but trying to get my PCP to even order it is the issue (I have Kaiser Permanente). I wish I could get referred to a cardiologist to have them oversee my treatment instead of a PCP. Thanks again for responding.

[@mikelevenson7271]

Excellent presentation doc, 2 yrs ago I got a cac and to my shock it was 1260. I work out regularly and intensely, never any discomfort or chest pain. After extensive testing by my cardiologist it was determined that my arteries were clear and the calcium had manifested itself probably on the outside or within the arterial walls. I was cleared to go back to working out without restrictions.. Doc, can you shed some light on my particular diagnosis as it is confusing to a laymen.

[@MarcKatzMD]

Certainly. The first thing to know, as you mentioned, is that the calcium can grow inside or outside the lumen of the artery. If it grows on the exterior portion of the artery it can be a sign of underlying inflammation without causing blockages. What’s quite interesting about coronary calcification is that we’ve also seen in extreme endurance athletes like triathlon participants that those individuals can have much higher coronary calcifications but be in great cardiovascular shape. We won’t know definitively for years while following those studies to know if it’s a sign of negative outcomes to come or if it’s an adaptive response. Generally though in average individuals we see it as a marker of more advanced atherosclerosis than what we can measure on contemporary calculators based on noninvasive information. Hope that helps! Lmk if any specific questions I can help answer

[@mikelevenson7271]

@@MarcKatzMD Thnx so much doc, very informative..I workout very intensely for my age.. Now It makes sense why the technician who performed the sonogram on my heart and arteries asked if I had ever contracted a serious viral infection..

[@brenharris6214]

I sure do need all of the information . Exactly where I am now with doc giving me a risk score and asking me yo go get the calcium scan.

[@prashanthkumar7586]

What is the absolute risk reduction (not the relative risk) if you used statins? I heard it is about 1%.

[@stnln2180]

There's no such a thing as absolute risk reduction. However, there's definite steps that is very effective to reduce risk of blockage. kzbin.info/www/bejne/eWTVpIF5e7N0rZo

[@MarcKatzMD]

About 1% absolute risk reduction is accurate

[@MarkHolmes]

@@MarcKatzMD and what do you think of that 1%? 99/100 people are ingesting a pill that won't benefit them and yet carries risks - diabetes, muscles, brain fog, etc. I just don't get all the love for something that statistically is so ineffective. I've never had a cardiologist or Primary care doc ever do a deep dive into my diet, my exercise, my lifestyle - no, take this pill which will give you a 1% chance of doing better. And for that 1%, how much longer is their life extended? Days? Months?

[@danc3746]

Hi Doc...excellent vid! I am 58 and just scored a 209. My Cardio prescribed me 10mg Statin and a Bayer Aspirin a day, my cholesterol is only 137. I dont understand something...shouldn't a high risky score like mine trigger a more then just a stress test (he also scheduled that). Shouldn't a Angiogram be done to see if there is major blockage?

[@dossegundos7145]

No statins needed, I would ignore that recommendation, get a second opinion, find a low carb doctor that can help you.

[@zenden6564]

Yes get an angiogram.

[@arturorios1675]

very good info. very clear, concise. Thanks! BTW, where do you practice? Sounds it is not in US.

[@MarcKatzMD]

Thank you. I currently practice in New Jersey

[@joanteasdale2991]

I'd also like to know about aortic stenosis in the calcium buildup there how does that happen?

[@Mansmatters]

Excellent video. Very educational

[@davidcarr4464]

kzbin.info/www/bejne/eKu3m4OrntCbh6csi=WpB_94fJf3_zZDJO

[@mitchhoel6839]

You did a good job of describing the pathophysology from inflammation to calcification. Apologies if I missed it in the video, but I didn’t here discussion of the root cause. What is causing the inflammation in the first place?

[@alanjviglione5258]

Great video! You mention the importance of choosing a Coronary Calcium Scan ideally on those who it would change management, ie. the gray zone on the ASCVD risk calculators. But given how flawed or short sighted those are (why is literally not having a heart attack in 10 years the goal?) do you feel you’re missing key people here? PLUS, that 40yo with a score of 8 probably should consider a statin (90% percentile for age..) but very high chance he/she would have a super low Framingham risk score. Thanks!!

[@vinayharpalani8176]

Thank you for this video. Should the individual vessel scores, LM, LAD, LCX, RCA, and Other Agatston scores, add up to the Total Agatston score? I ask because mine do not, and I want to know if that is an error. Want to know if there was a calculation error, or if there is something more to calculating the total score than those individual scores.

[@MarcKatzMD]

Agatston score is completely separate and nothing to do with the actual calcifications. Total individual arteries should add up to total calcium score

[@chaz6399]

A person with a non-zero CAC, but no other cardiac pathology or symptoms, shows up at a new doctors office. The patient history form has a checkbox for "heart disease". Should this new patient check the box? The same person is applying for life insurance and the form asks if you have heart disease. Is the answer yes or no?

[@MarkHolmes]

excellent question. I have a non zero CAC , yet have experienced no events. I don't know how to answer that question either.

[@chaz6399]

@@MarkHolmes And thanks to your comment I realized my original post should have said "life insurance". I will fix that now.

[@DRjbp]

There's an abnormal inflammatory response associated with cardiovascular disease. It seems like the endothelial of certain individuals is more prone to injury. This process allows cholesterol. to migrate to the muscular layer of the Vasculature

[@MarcKatzMD]

Yes

[@sukursukur3617]

Is it possible to early diagnose leaks occurring from the inner wall of an abnormal vessel into the vessel with a blood test? For example, in a special blood test performed 1 month before a sudden heart attack, can the increase or decrease of some molecules in the blood be monitored until the heart attack occurs?

[@phyllismorris1927]

Very well explained. Are risk charts available?

[@MarcKatzMD]

What risk charts do you mean?

[@imteazahmad7124]

Hi, Can one go for this test if he had heart attack and already has one stent in his artery?

[@MarcKatzMD]

There would be no reason to get this test in that scenario because should already be on high-intensity cholesterol lowering therapy

[@bobw196]

Thank you for the video. Regarding 10:41-10:46, you mention ". . . patents who are already on a Statin mediation . . ." Do Statins affect the results? I'm 67 years old, healthy (5'8" 155 lbs. physically fit/active). I've been on a Statin for 15 years. Average total cholesterol +/- 170. Per family physician's recommendations, got the test. Results on the "widow maker", not good (423). Been battling low iron saturation, supplement with iron tablets, and take levothyroxine for thyroid. No symptoms, feel great! Next stop, the cariologist, thinking a CT Angiogram may be in order.

[@johndoe4265]

Got two zero CAC scores long ago, but in recent years couldn't find anybody local who still performed this scan

[@irishboy70]

Excellent video,I had high cholesterol(inherited) on was on statins for over 25 years and have run 4 times a week for over 35 years religiously. Doc said need to go for a scan. Score was 375 and 3 blocked arteries(LAD, RCA, CircumFlex). Luckily the exercise created collateral arteries and the statins turned the soft plaque into calcified plaque which is a good thing. I got 3 stents placed over 3 separate procedures and placed on Plavix and an aspirin. I have improved my diet removing ALL junk food and lost even more weight. My BP was always normal. Diet will help but if you had hereditary factors that typical means that your liver is making most 80% of the cholesterol so hence need for statin and reducing simple sugars reduces inflammation which is now seen as just as important or even more important than just the cholesterol number. Hope this helps. BTW I feel really great

[@SET12DSP]

Reversed my CAC by 30 % without statins just 3 simple supplements.

[@MarkHolmes]

@@SET12DSP and you're not going to tell us what those are?

[@SET12DSP]

@MarkHolmes Of course I will. Most people, it seems, just settle for standard medicine. Unfortunately, it just wasn't good enough. Especially seeing that it just leads to more medications and procedures. I am on the Linus Pauling Heart Protocol, which uses high dose vitamin C with Lysine and Proline amino acids. I take 5 grams of Vitamin C mornings and 5 grams afternoons with 15 grams evening. Lysine 3 grams and Proline 4 grams 2x per day.

[@MarkHolmes]

@@SET12DSP did you have to slowly ramp up to that? I take aged garlic extract (Kyolic), Konzentrated K (powerful k2 formula), nattokinase, L-Carnitine, high dose Fish Oil, tocotrienols. (CAC of 442 , 3 years ago - 385 in the LAD).

[@SET12DSP]

@MarkHolmes Mark I hear of people getting results on different acids, malic, citric, and absorbic , sodium ascorbate. Of these Malic, maybe the strongest. It was suggested to take breaks while on citric. These all have advantages and disadvantages. With sodium ascorbate, it is a bit easier on the stomach for some people as well as producing less diarrhea. If diarrhea is a chronic issue, then Lipo Spheric C is the best but very expensive at a $1 /gram Dr. Thomas Levy suggests it may be 5x more potent than ascorbic because it is fat soluble Some people make their own. So, in the end, I think the acids contribute a lot to the decalcification. But I also feel there is more to than that. And there is no substitute for C as it's needed to rebuild the artery correctly. Personally, I have no issues tolerating ascorbic, and it's just plain cheap. Now, how to start! You have to find your own bowel tolerance. To do this, you'll need to take C in divided doses. I use 3, but you can use more. I'd start with 3-4 grams of ascorbic acid powder. I use morning, afternoon, and night. If you get diarrhea, just back off a little. And maybe try a larger dose at night. I was told there is less trouble at night! And I concure as I can handle 25 grams after my evening meal easily. It may take a while to find out where your body is at. As someone told me, your body will tell you. I didn't quite understand that, but I do now. What is meant by that is if your body can use the C, it will use it all with no bowel issues. But if it doesn't need it, it will either give you diarrhea or loose stools. The loose stools are OK, I was told. I have them often with no issues, typically, but it can happen. But the effort of finding your tolerance is well worth it. I practice intermittent fasting, so my meals are time spaced, meaning I usually eat two meals in a 4-6 hr window. This stimulates autophagy, meaning getting rid of bad cells within your body, not to mention getting rid of multiple glucose spikes throughout the day by eating between means and its away of controlling your weight. I was formally was a 100lbs heavier. But I didn't really use intermittent fasting to lose my weight. I walked it off basically while being a vegetarian. I am no longer a vegetarian. But I am sugar and grain free. For me I use BulkSupplemets powder for ascorbic acid. Lysine and Proline. In water. Any issues get back to me... Good luck 👍

[@tomgraz7548]

Excellent description of the test and its true relevance to cardiovascular disease. The morbidity associated with CVD appears to be multi factorial. As an example my mom who had chronic hypercholesteremia (>300) had no identifiable coronary artery disease confirmed by angiogram prior to an aortic valve replacement at age 90. She lived to age 95 still active (even bowling). I am 70 and had a score of 0 but I still take a low dose statin more for its anti-inflammatory benefit. Again great video and please keep up the excellent educational content.

[@MarcKatzMD]

Thank you for the feedback 😊

[@phil00075]

Recently had a calcium test done after they discovered evidence of plaque from a pneumonia X-ray. They did the pneumonia x-ray because I had chest congestion from a cold that wouldn’t go away after 9 days. My score on the calcium test was 429. I was very surprised because my cholesterol has never been an issue (total about 150, LDL 85) and my blood pressure and blood sugar have always been normal. Non-smoker, non-drinker, not overweight, ok diet, and no symptoms of heart disease. If I hadn’t had the bad cold, I would never have known that I have the high calcium. Now they are prescribing 5g statin and aspirin. So I think there may be value to getting the calcium test even if you don’t have any apparent issues.

[@francoisenorwood5899]

At age 69 I was diagnosed with a CAC of 29.9 in LAD. It's 3 years later should I get an other one? I do have elevated cholesterol but triglycerides are low and HDL is 80. Not on statin (have refused them since my 40s when I was diagnosed with high cholesterol. I have low blood pressure, physically active (ex ballet dancer who keeps on training hard), strong heart. Thank you for sharing your opinion.

[@MarcKatzMD]

The decision to get a repeat CACS should be made between you and your physician and unfortunately I can’t give personalized medical advice online. What I can share is two things- first is that different medical societies have studied your specific question and most guidelines recommend repeat scanning for patients with CACS >0 in about 3-5 years. Second is that the reason we estimate a patient’s ASCVD risk over a 10 year period is that the benefit of statin medications is longitudinal. It takes time for atherosclerosis to develop and likewise for statins to show a benefit in stable patients not actively having a heart attack. Some opponents of statins say that doctors ‘push’ these meds. I acknowledge statins are the most profitable drug for big pharma ever to come to market. But they are safe and effective. Additionally, I acknowledge that with any test or therapy there is always a risk that must be weighed with its benefit. So if your CACS were to increase I would strongly consider starting one. Frankly if you were my family member I would want you on one to decrease your risk of heart attack or stroke! But that conversation needs to be had between you and your physician. Hope that helps! Reference: Golub, Ilana S., et al. “Major Global Coronary Artery Calcium Guidelines.” JACC: Cardiovascular Imaging, 2022, doi.org/10.1016/j.jcmg.2022.06.018.

[@MarkHolmes]

@@MarcKatzMD it seems I have read that you will normally see a 10-15% progression per year on a CAC, regardless. I'm a bit puzzled why you are not giving more credence to the actual risks / harms. They are real you know. It still comes down to the patient deciding if the benefit outweighs the risk. The NNT still bothers me. Sure 2% helped of millions is helping some, but then there is no discussion of how many millions are harmed and it doesn't take much to find those people.

[@MarcKatzMD]

@@MarkHolmes I always asses risks and benefits of every medication and therapy

[@sheddkkhan6758]

@@MarkHolmesyou can reverse it

[@doreenflynn2123]

Does a calcium score images show where the calcium actually is in the artery?

[@MarcKatzMD]

Yes

[@doreenflynn2123]

@MarcKatzMD I got a calcium score in my LAD artery of 605. When I had the angiogram done the results showed that my LAD was "widely patent" I was surprised and questioned the results. Is that possible??

[@MarcKatzMD]

@@doreenflynn2123 calcium can develop both inside and surrounding the artery. So the calcium can be present but not always obstruct the artery

[@3917BAD]

I had my test done, and my score total was 3071. 579 in the LAD. My primary thought that maybe the score was wrong. Non smoker, not overweight, no diabetes, work out often. Needless to say I was very surprised, and now very worried. No symptoms(angina, etc). Stress test was ordered but not for a few weeks. I feel like I need some More aggressive testing like a Lexi Scan, etc. Advice? Thanks.

[@MarcKatzMD]

Lexiscan is a form of stress testing (I have a full video on stress tests). Would definitely want you to see a cardiologist or lipid specialist if I was your PCP

[@gloriamaryhaywood2217]

May I ask your age?

[@nomorenews]

What is the upper limit of cac score in asymptomatic person?

[@ronniekirby5406]

Any further news? Your circumstances sound so similar to mine … curious Both cardiologists that I saw offered no hope … just take statins and aspirin 😩 and wait for a cardiac event

[@nomorenews]

@@ronniekirby5406 May I know your score and details?

[@danc3746]

Just an update, back in late August 2023 I had a full angiogram done and found that 209 score added up to 90% blockage in LAD and others. Double bypass surgery was performed 5 days later. IMO...any calcium score over zero means you have plaque in your arteries, how much and how dangerous can only be determined by a doctor going in and up there.

[@dondominguez1663]

Great video and all makes clear sense. Very little though is said about how exercise can be effective CACS and cholesterol numbers. Can you comment on that?

[@MarcKatzMD]

Excessive exercise (e.g. people who do marathon/triathalons) can show higher coronary calcification. But not sure if that’s protective or evidence of the fact that anything in excess can be harmful. Overall, exercise is good for you and can help your cholesterol. But you can never ‘out run’ genetics or your diet.

[@dondominguez1663]

Wonder if that has to do with the excessive exerciser refueling with bad carbohydrates rather than a balance of meat protein and fat? Anyway thank you for the reply.

[@welovedogs6835]

Hello Dr Katz Do you think this test is of any benefit to someone with multiple sclerosis? thank you so much for your help and this video

[@serious_in_seattle6917]

Can calcified plaque decrease with a strict vegan whole food natural diet?

[@nomorenews]

Possibly,but do add vit K2 mk7 and vit D3 in diet

[@kakaimysore8323]

Dr katz, can you clarify ,why such high scores are given from 40 to 4000, and persons with scores of 50 are suggested to take statins Whereas person with high scores have lived for 10 yrs then why statins for low score can only diet will help , person with low scores will unnecessary worry, and kindly inform at what rate calcification occurs does calcium score also includes calcium inside and outside the arteries.

[@MarcKatzMD]

Calcification occurs inside and outside the vessel. It is simply a marker of atherosclerosis. Regarding statins, there are different intensity dosages. Low, moderate, and high intensity. Each can lower cholesterol levels (and thus future risk of atherosclerotic cardiovascular disease or ASCVD) by 50%, respectively. So often your score also depends on your age. A score of 5 in an 80 year old isn't that bad. But a score of 5 in a 40 year old is considered abnormal. So it is hard to give feedback based on a specific score because you always have to look at a patient as a whole and not just a number. It is all about decreasing future risk. Lifestyle and medications do not eliminate risk of future ASCVD but can decrease the risk.

[@kakaimysore8323]

Thanks for your reply ,I did not follow about score of 5 at 80 Yr age ,what score Doctor is it calcium score?

[@MarcKatzMD]

@@kakaimysore8323 Yes a coronary calcium score (CCS). My point is that the same CCS can mean very different things based on the individual patient. So if a 40 year old and an 80 year old patient both have the same CCS it can be very different things for each individual patient

[@kakai-wt]

Thank you doctor you are great, no online doctors give detail clarification on this, once again I thank you

[@najlamohamed4900]

Thank you so much for this explanation I just wanted to ask when can you decide to use rotapro drilling for your patient and what is the contraindications for it ?

[@armeghanbagherpour2300]

Hi doc , would you recommend ASA 81 mg for someone with high score ? If yes what’s the cut off number ? Ex : 44 yo female with high CRP, Apo B on crestor 5 mg , significant FH of premature CAD . Do you recommend ASA ? Thank you

[@MarcKatzMD]

I cannot give personalized medical advise online. You should talk to your physician

[@ajaxt8794]

Dear Doc, please make video on k2 and calcium supplements. Either share the link... information that should be part of the video if I may say obediently from a layman's perspective. It should talk about the impact on people with calcification of heart artery and valves. Is it safe to take calcium or calcium carbonate + calcitrol or D3 + k2 for an arthritis patient suffering from calcification of heart.

[@MarcKatzMD]

Vitamin D supplements and calcium supplements have little to no impact on atherosclerosis

[@alipainting]

But what about the small particle ldl blood test, size and amount? Wouldn't that be a better test ? That's the stuff that causes atherosclerosis right?

[@MarcKatzMD]

That’s another blood test that we can use in a similar manner to CACS to better risk stratify patients

[@MANIACxCOP22]

I just took a CT Calcium test, and it came back at 1.4. My LDL went from 175 to 140. My doctor wants to put me on Crestor. I'm 43, I don't want to take any medicine yet. Any suggestions?

[@MarcKatzMD]

@@MANIACxCOP22 I can’t answer specific personal medical related questions. However I go into great detail answering your question in this video: kzbin.info/www/bejne/lX3LnHSje7qbeKssi=-byT6bLIgMDC8Zp3.

[@higuysrealtalkwithtracy4543]

My husband had a zero calcium score but a 90 percent blockage!!!! Now he has a stent. ❤❤❤❤❤

[@donnamcfarland162]

Yikes 😮

[@stephweissinger]

😮 how was that explained?

[@annalangham3950]

Red rice yeast

[@SET12DSP]

​@stephweissinger That was a plaque burden that caused the blockage. Calcification occurs over time. 1 out of 20 with a zero score has plaque that a CAC can not see without contrast.

[@Bambina336]

I did mine year ago and got score of zero, female 43yo. My brother just did his and got score of 110. He is already on statins, multiple BP meds, diabetes meds and is overweight. He is 53 yo. So for someone like him who is already on meds, other than modifying diet, stop drinking, what other things can doctor do to help? Why isn't K2 suggested to such patients? Along with D3, it helps remove calcium from arteries and many people with high CAC score benefited from it.

[@MarcKatzMD]

There are no studies showing benefit of vitamin D in removing calcium from vasculature to improve long-term cardiovascular health. I’m not sure what K2 is.

[@Bambina336]

@@MarcKatzMD It's vitamin K2 that works to remove the calcium from arteries. It works together with D3 and that's why its important to take both together. There are many doctors who talk about it, but not many went over each detail of this report as you did, so thank you! When I saw on his report the "86 percentile", it scared the life out of me. I thought that meant his arteries are already 86% blocked.

[@MarcKatzMD]

@@Bambina336 ah gotcha. Well, what I tell my patients is that Vitamin D supplementation has not been shown to confer cardiovascular protection. If deficient your primary care physician can certainly supplement but not for the sole purpose of CVD prevention. Additionally, Vit K2 plus Vit D does NOT influence progression of aortic valve calcification and Vit K2 has NOT shown to improve aortic calcification in patients in dialysis. Together the literature tells me these supplements are yet another supplement that fail to prove long term benefit. I typically tell patients that if you are having a healthy diet with green leafy vegetables you generally do not need vitamin or other supplements. However if someone feels quite strongly about taking them, I typically don’t have any issue as long as they do not interfere with any other medication‘s they are taking. The reason I trust the medication’s that we as cardiologist use to treat and prevent cardiovascular disease is because they have been proven in large randomized control trials to decrease cardiovascular disease and for some medication’s even decrease death. Almost every single supplement ever studied has not shown these types of robust results. Even Coenzyme Q10, which was at one point preached by cardiologists, has failed to show statistically significant benefit in patients.

[@jerseytony1]

D3 and K2 is Not recommended because there is NO Money. This Dr is a Criminal!

[@jerseytony1]

ZEro CAC is NOT safe. There could be Soft Plaque. Only CIMT shows that CAC is useless

[@Ryan-bn9ju]

Hey doc, I had a calcium score test don't roughly 8 or 9 yrs ago age 31 CAC score was one. My diet has changed much I just started a statin this year. My question is how much do these scores change year to year

[@Pat7629]

I am a 46 year old male and just got a score of 255. I have literally exercised 6-7 days/week for 31 years and have never missed a week ever. I have normal blood pressure and cholesterol, have never been overweight and no family history. I have done 45 minutes of cardio every day for decades and weight training. I was shocked at my score and it makes absolutely no sense. What can someone do who has a high score but has no possible areas of improvement in terms of their lifestyle (ie: diet, exercise, blood pressure and cholesterol)? All of those things are already optimal so I don’t know what else I can possibly do. Very bizarre.

[@MarcKatzMD]

Medical therapy. Otherwise keep doing what you’re done

[@madurisreekanth6649]

U r absolutely right bro. Keep going as you r.

[@bonjobi2860]

Vitamin D3 (5000-20000 IU) combined with K2 (300 mg) take calcium out of bloodstream and puts it back in bones and organs. I’m no doctor ; I just follow dr berg. He has lots of videos. Check out lowering calcium and D3. Just had my cac done and it was 1.

[@nomorenews]

Stay happy and stress free. Continue healthy lifestyle. Calcified plaques are better then soft ones. Do remember your exercise has created plenty of collateral vessels in your heart by now and they are a good thing to have

[@JM-ou5ro]

Just read your comment today after receiving a bewildering result and searching KZbin for answers. Very similar situation 45yo male, work out, lift, low body fat percentage, been active for decades. Got a score of 222, all in the LAD. 98th percentile. I'm really shocked and scared. I got a little boy I need to stick around for. How did things shake out for you?

[@SALTYDEPLORABLEGARBAGE]

Had a 1931 CAC and a stress test showed possible restrictions and turned out I had a 99% block in the upper end of the Left Artery Descending. Soft blockage. Bro died at 49 and Dad at 59 of sudden heart attacks. Terrible side effects with two different statins. Lost massive leg muscle to boot in the 9 months I took them.

[@MarcKatzMD]

Sorry to hear that. Thankfully statins are one of many meds in our armamentarium that we can utilize for patients intolerant to them. Hope you’re doing well!

[@childum]

I am 38 with a 255 CAC. Also have a mild aortic aneurysm. I discovered this from having bad anxiety since last December and doing a cardio workup. I have lived a pretty healthy lifestyle and have lifted weights since high school. Very frustrated with these findings, and having difficulty overcoming my anxiety

[@SALTYDEPLORABLEGARBAGE]

@@childum Things happen and we don't always understand why. I was in the military and in the fit shape of my life though I had trouble shaking off the chicken pox virus. I had shingles at 21 and by age 23 I was I began having stomatitis then bouts of severe generalized dystonia. Got forced out of the military due to continuing health issues. Developed a systemic autoimmune arthritis that affected many systems called Seronegative spondyloarthropathy. Took me 15 years to figure out how to slow it down, and now at 56, most things are managed with healthier health choices. A person has to figure out what works for them specifically. My anger at everything blocked my progress the most of those 15 years and at least two "shutdown" ( I did not necessarily want to commit suicide I just wanted "out" for awhile) attempts in my 20's mainly because I lost every perceived thing. No one told me I could over come so much. I have though but it isn't easy and it takes digging and researching and actually trying out many things. Most people will not do things, but sit back and moan about it for years.

[@SALTYDEPLORABLEGARBAGE]

@@MarcKatzMD Thanks, new conditions keep rearing their heads, but I keep rolling with the punches.

[@John-kc7wo]

Great Video Dr. My question; what happens if you change your diet, go on a statin, workout and your score goes up dramatically? I read that can be a good thing as the INFLAMED PLAQUE HAS CALCIFIED and that will cause you score to go up?

[@SET12DSP]

Yeah it goes up!!! But I'm not calcifying my arteries...nor my brain nor my eyes. I have able to reduce my CAC by 30%

[@MarkHolmes]

@@SET12DSP so tell us more. you're being disingenuous.

[@SET12DSP]

@MarkHolmes I wrote my reply this way as to get a return reply instead of writing at length and hearing of no interest in Linus Paulings Protocol. Now, there is what I call further enhancing of the Protocol. I use Dr. Thomas Levy's advice from his book "Stop America's #1 Killer " Proof that the Origin of All Coronary Heart Disease is Clearly Reversible Arterial Scurvy. Dr. Levy has many u-tube videos. One of his enhancements is using magnesium, as when magnesium is up in the body, calcium is down. Any questions please feel free to ask!

[@SET12DSP]

@MarkHolmes I can pretty much explain how it basically works if you'd like. I have been on this just about 3 years now. I have a check-up with my cardiologist on Wednesday, so it should be interesting when I ask them for a comment on my CAC Score going from 660 to 458. They didn't even have my score on their patient web portal for 5 months WTH. BTW I am 68. So the scores started at age 60 with 299, then age 65 at 660, and that's when I started the Pauling Protocol. Then, 20 months later, it was 458. It's said by many cardiologists that it can't be done. But I say really! Your machine just measured it. And then they may say, "Oh! That's just an error, and I say a 30% error? I don't think so as I worked on medical test equipment and noway errors of this magnitude would be tolerated on test equipment going out the door. Above all I believe in Linus Pauling as he was a 2-time Nobel Prize winner and was awarded 48 PhD's over his lifetime.

[@SET12DSP]

@MarkHolmes So, according to Dr Thomas Levy Cardiologist. The problem is purely a focal scurvy or a point in the artery that is depleted of Vitamin C caused by the mechanical stress of the artery next to the beating heart. When depleted, Lp-a comes to the damaged artery as a substitute for vitamin C to start the plaque build-up to shore up the artery that has cracks and holes in its walls. A high dose of Vitamin C is used to repair the damaged Lysine and Proline exposed strands. But Lp-a has to be controlled or neutralized, and to do this, Pauling uses the supplements Lysine and Proline to bind Lp-a then vitamin C can really go to work rebuilding the artery correctly instead of using a poor patch job to shore the artery up. A high dose C has to be used because if any toxicity in the body exists, vitamin C gets used up fighting bacteria. If one has any kind of dental issues, which can be a source for heart disease, the C gets used up so much as to short the artery of what it needs. You can have bad root canals or implants and not even feel anything, as Levy says. This is the one thing that can stop the Pauling Protocol from being successful. To battle oral bacteria, I use vitamin K2-MK7 with D3. I use a much higher dose than what is typically used as recommended by Dr. Kate author of "K2 and the Calcium Paradox" which is 100mcg of K2-MK7 per 1000i.u of D3. To much D3 can overrun K2-MK7 with calcium. You can take more K2-MK7 than D3 with no issues. That's about it other than I take 4 grams of Omega3 per day with 1600mg of CoQ10. So it's working for me with no blood thinners or statins.

[@katewinslet]

Wonderful video, thank you for explaining this so it's easier to understand. I am 53 yr old female, overall cholesterol 274, triglyceride 90, HDL 65, LDL 191 normal blood pressure, normal sugar, get plenty exercise since I walk for a living, don't drink, don't smoke eat pretty healthy and have never had medical issues. Am i a good candidate for this test? Doctor wants to put me on statin but I would only want as last resort

[@MarcKatzMD]

If your LDL is >190 guidelines recommend a high-intensity statin. So ideally a CACS is not indicated. Worth a conversation with your cardiologist

[@marciandjohn6320]

@@MarcKatzMD Please specify what these guidelines are and where can they be found? Thank you.

[@MarcKatzMD]

@@marciandjohn6320 (1) Full guidelines from ACC/AHA via this link: www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000677 (2) Regarding specific question of LDL >190: "In patients 20 to 75 years of age with an LDL-C level of 190 mg/dL (≥4.9 mmol/L) or higher, maximally tolerated statin therapy is recommended"

[@erikjanse3994]

Indeed very well explained. Thanks a lot. Have you ever seen or heard of someone reversing their CAC-score? Does the risk-level of a heart attack depends on how the calcification is distributed along the coronary arteries (e.g. highly concentrated at one place or spread over several places)? Thank you!

[@alex-sd]

Check out vitamin K2.

[@SET12DSP]

Mine has from 660 to 458

[@myfairyblueworld]

​@@SET12DSPcould you offer more information. Did you make lifestyle changes?

[@SET12DSP]

@myfairyblueworld I'm on a Keto diet, which is low carb high fat. I am also grain and sugar-free. I accomplished my reversal with the Linus Pauling Heart Protocol, which is a high dose ascorbic acid powder in divided doses 3-4 grams 3-4x per day with 2-3 grams of Lysine and Proline each 2x per day. I walk 4-6000 steps per day. I am 68 years old.

[@myfairyblueworld]

@@SET12DSP thank you. I wish you continued health.

[@alohakeithb]

Hi Dr Katz. My scan shows a score of 132 (moderate) with a percentile ranking of 25-50%. What does that last bit mean? I don’t understand the percentile part… does it mean that I am like 25-50% of the population my age? That’s a wide range it seems… would appreciate your help understanding…

[@chaz6399]

It means that 25% of people in your age range have scores better/lower than yours, and 50% of people have scores worse/higher than yours. It is a wide range. It 's essentially saying you're in the 2nd quartile. You should be able to find a calculator online that will take in your age and score and give you a precise percentile.

[@lovemykids993]

I have a question. My lipoproteins (A) come back 105. Dad history of heart disease and stroke, maternal grandfather died of heart attack. Sister died in early 40's from fluid building around her and lungs. Mom had cancer then ended up with kidney disease. Dad had stage 3a kidney disease. I already have mitral valve regurgitation I believe it is. Where the valve does not close all the way. Cholesterol levels are very high. My sons cholesterol is not good. I don't understand good and bad so I wish I had the numbers to show you. Just had the CCS TEST today. I believe it said 1-10 but not sure bc down below that it had other things. Been having kidney problems or bladder issues also, lot of pain. I also have pain in chest shortness of breath especially going up stairs hill etc..I'm 56 in june.. our family does not live out of there 60's . My dad with heart disease and kidney disease did make it to 72. Thanks. Barbara.

[@ZonaJim]

Will the CAC score be contraindicated for a person who's been on statins for years or decades?

[@MarcKatzMD]

Not necessarily

[@ZonaJim]

@@MarcKatzMD Thanks Doc. I've been on statins for 25 years and just had a CAC score of 2,082. So my doc had me do an angiogram and no blockages. She blamed the high scores on the statin.

[@n2daair23]

I’m 61, not overweight, no diabetes, ttl cholesterol 229, trig-109, hdl-72, ldl-135, don’t smoke-ever, lots of ranch work but not really an exercise program. Went to have a CAC scan just on my own and it came back at 1202. I’m really scared and my PCP is just kinda blowing it off. Hasn’t ordered any additional tests, no meds, no referral to cardiologist, NOTHING! Oh, he did say he would look at the results whenever they send it to him. That was a month ago. Any suggestions where I should turn next? Appreciate any help.

[@MarcKatzMD]

Would talk to your PCP in person about it and discuss seeing a cardiologist

[@n2daair23]

Thanks for getting back

[@madurisreekanth6649]

Be wat u r bro, don't go on meds, it's kills you.

[@tomhudder8055]

Doctor - when you get a CAC scan score, what do the individual numbers mean? For example, does an LAD:67 mean you have 67% blockage or does it mean something else? Thanks

[@MarcKatzMD]

Calcium score is NOT the same thing as percent blockage. You can tell that information by coupling the CACS (non contrast CT) with a coronary CTA (with contrast)

[@debihorton6807]

Why would we NOT want to know our own CAC scores? It was only after I ordered CAC test for family member that Docs were aghast of 1150 score and put him on statins and BP...3 years later, CAc score went up another 100 pts. Are statins helping? He has stress tests every year and never an issue, no chest pain...he is in excellent physical condition at 73 and we eat healthy and exercise. Since going on statins, his A1C went up a lot!!! So we are revamping diets again...never get any info from docs about diets and supplements, so we are on our own. Very disappointing and frustrating.

[@MarcKatzMD]

Statin therapy can increase calcium score but I view that as a good thing- you’re turning vulnerable soft plaque into something unlikely to rupture and cause a heart attack. I know physician communication can be irritating and frustrating and I’m sorry you seem to be experiencing that first hand. Overall, the I usually explain to my patients that the benefit of reducing risk of atherosclerotic cardiovascular disease (e.g. stroke, heart attack) outweighs the negligible impact that statin therapy has on A1C. Of course, every patient an individual is different and can be impacted by medications differently and that’s where having that discussion with your physician comes in. Always important to remember that we treat the patient and not just their numbers! I hope your family is doing well

[@roch369]

Thank you for this video. I had elevated score- dont know the number. If your cholesterol is fine would you still have to go on statins? Some ppl cant do statins because of muscle aches. Ive made lifestyle changes last 8-1/2 mnths- doesnt that stabile the calcium?

[@MarcKatzMD]

Lifestyle helps slow progression but statins can help even more and are known to stabilize plaque. Depends on individual person

[@williambuckley6128]

Aren't triglycerides a better marker than cholesterol for determining a CAC test us necessary?

[@MarcKatzMD]

No- LDL most strongly impacts ASCVD risk. That being said, I won’t ignore triglycerides and that information can also be useful

[@Silverhaired59]

What I don’t understand is how I had a heart attack 11 years ago and my cardiac cath showed a small blocked artery around the back of my heart with absolutely no build up in my other arteries and ten years later, when I got a calcium score done, it was zero. How does this fit into the current model of cardiovascular disease?

[@MarcKatzMD]

There are a few things that I am confused about in your statement. First, based on current guidelines it is not advised to get a coronary artery calcium score in patients who have had prior coronary artery bypass surgery or those with prior coronary stents. Part of the reasoning of obtaining a coronary artery calcium score is to guide medical therapy. If someone has had prior coronary stents or coronary bypass then by definition they already have a manifestation of atherosclerotic cardiovascular disease and should be on cholesterol lowering therapy like a statin. Second, it’s important to note that heart attacks occur in coronary arteries where deposits of atherosclerotic plaques with thin fibrous caps covering them rupture causing a thrombus, or clot, to form. These areas that are prone to plaque rupture don’t necessarily have to be in areas of coronary arteries that have significant blockages. Meaning, the degree of narrowing of an artery is not predictive of future heart attack. But to be frank, something doesn’t add up as I’m not sure how a CACS of zero is possible in an individual with a known history of coronary artery disease with prior stenting 🤷🏻‍♂️

[@Silverhaired59]

@@MarcKatzMD ah, I see your confusion. My heart attack was in a small artery around the back of the heart that was too small to stent. It was totally blocked. The surgeon woke me up during the procedure to show me just how “clean” the rest of my arteries were, though. They were all wide and clear. I had no surgical intervention done. I was put on 5 medications, including Simvastatin. Three months later, I could no longer hold my laptop computer with one hand, could barely lift the nursing home charts with two hands, and could no longer push myself up from being seated in a chair. We stopped the statin. My husband had a calcium score test done ten years later, which made me wonder what one would show on me, given that my surgeon was so excited about how clear my other arteries had been when I had a heart attack. I asked my PCP if we could do one, and since they are all patient-pay here, there was no one to say no if she wrote the order. So I had one done that showed zero calcium build up. I have never had an answer that made sense to me for the question of what could have caused the heart attack. My cardiologist (who I still see for POTS) said something about some plaque broken off from elsewhere, but if I have none in my heart, would I have any elsewhere? What model of heart disease explains what I have experienced? My HgA1c is 5.2, I have insulin resistance, I have Ehlers- Danlos Syndrome -Hypermobile type, Hashimoto’s thyroiditis, Lymphedema caused by the little-known lymphatic and fat disorder called Lipedema (which researchers now believe may be a connective tissue disorder of the lymph system) and weigh 355 lbs as a result. My cholesterol levels were not yet high when I had a heart attack in 2011. My blood pressure is usually low-ish and I now have to measure it before taking my beta blocker for POTS because it can be 90/55.

[@Phianoposis]

Interesting. What if cholesterol has always been great. No other health issues at 65 except psoriatic arthrits but a calcium score of 48- hs-CRP is high at 8.6 would a statin still be reommended?

[@MarcKatzMD]

Need to talk to your doctor in greater detail but it depends! The short answer in my opinion would be that a score of zero helps us hold off. A non-zero score means we should have a lengthier discussion about decreasing ASCVD risk- including possibly starting cholesterol lowering therapy like a statin

[@Phianoposis]

Thank you-This is what confuses me. Why take a cholesterol lowering med (statin) when your cholesterol is already low? Choles. 135 LDL 68 specifically Will talk to doctor of course. :) @@MarcKatzMD

[@MarcKatzMD]

@@Phianoposis as shown by the CACS, cholesterol levels are a marker of ASCVD risk. It’s not the ‘end all be all’. Got plenty of patients who have had heart attacks despite normal cholesterol levels

[@krishjagirdar8463]

Thanks for the info!

[@DEARRAEDDEAR]

Are there any risk in the scan on the body My Dr. Seems reluctant to order one for me. Any idea how much they cost?

[@MarcKatzMD]

Radiation exposure. Should ask your doctor why apprehensive about ordering. And did you watch my video because I explain that it typically costs $100 in the US

[@DEARRAEDDEAR]

@@MarcKatzMD Thanks for your reply! I had a triple bypass two years ago and my cardiologist said, that since I had history of heart blockages, it will definitely show buildup in my arteries and he thinks it’s un ethical. I’m not sleeping at night, constantly worrying about my heart. Should I consider consulting another doctor?

[@MarcKatzMD]

@@DEARRAEDDEAR in patients who should already have maximal tolerated lipid lowering therapy, like those with a history of coronary bypass surgery, CCS are not recommended as they are unlikely to change lipid therapy. That being said, each patient is different and requires personalized medical advice with their physician.

[@shadowmime-zeroatrop]

Mines coming up next week im a wreck as it is praying its not a bad score

[@debbienorman3402]

You mentioned the Mediterranean diet, do u have any thoughts on extra virgin olive oil or omega 3 supplements for someone who has an elevated ( mild/ moderate) calcium score and elevated ldl?

[@MarcKatzMD]

I don’t like over the counter O3FA. And using EVOO to cook and over salads is fine but I wouldn’t start eating it in its own just health benefits. Ask your physician to see what they think

[@jamesgordon8867]

Patients that have Coronary Bypass Surgery in their 40's. How many got this test?

[@rj6404]

Dental hygiene, gum disease plays a role triggering inflammation in the heart's vessels leading to serious cardio-vascular event .

[@MarcKatzMD]

Sure but it’s one small part of a larger issue

[@susanknight5875]

Thanks for your excellent presentation. It may be too early to know, but I was wondering if you have heard of COVID affecting this calcification. My score jumped from 77 to 264 in about a year and a half. I was under extreme stress during that time and getting very minimal sleep due to being the sole caregiver to my mom who was almost completely paralyzed. I don’t know whether stress and lack of sleep could create such an increase but I also got COVID during that time. Secondly, I saw some people commenting on taking vitamin K and possibly reversing their score. So far I have read that nothing can decrease your score, only slow the progression. Have you heard of any studies involving vitamin K and reduction of calcium scores? Thank you!

[@MarcKatzMD]

Haven’t heard of COVID causing calcification specifically. Same with vitamin K- it’s all nonsense

[@vickynegron1383]

Hi my husband had Covid as well and he just got diagnosed with hight calcium score when he was zero. 😢

[@bamafan1411]

I'm have been plant based for six months and I'm 52. Score was 199. Should I be on statin or continue plant based diet?

[@mikem8650]

Go low carb

[@carolm3402]

This is very informative; thanks so much for taking the time to do this! I haven't had a CAC test, but did have a coronary CT scan. How do the scores correlate? My CT scan score was 1V (small area of spotty calcification in LAD) and a low-dose statin is recommended to stabilize soft plaque (5 mg of Rosuvastatin). I'm a 66 year-female with A1C of 5.8, BP 128/74. Cholesterol levels have always been okay, but have crept up a little (177 total, LDL 108, HDL 48, Tri 104). This is very alarming to me. Do I need to get a CAC test?

[@MarcKatzMD]

First off, I cannot give personalized medical advise on the internet. Second, ask your doctor! These are great questions to ask someone who has access to your personal medical information and [hopefully] knows you. Generally speaking, coronary CT scans are the same thing as a CACS except a coronary CT can be done with contrast and is then called an 'angiogram'. A coronary CT angiogram provides information about blockages that cannot be seen on a CACS (or a coronary CT scan without contrast). The side effects of statin medications are often vilified with the same veracity as vaccines on the internet. However, within the field of cardiology we know the lipid lowering class of drugs are safe and effective at decreasing the risk of atherosclerotic cardiovascular disease. In conclusion- if you have specific questions about starting a statin medication or about your specific coronary CT scan then talk to your doctor!

[@deb73042]

If taking calcium is bad for your arteries, why do pharmaceutical companies make stains with calcium in them. I won’t mention any.

[@deb73042]

Ps thank you so much for your video presentations!

[@MarcKatzMD]

@@deb73042 consuming calcium or taking calcium supplements has nothing to do with coronary artery disease

[@MarkHolmes]

@@MarcKatzMD Not all cardiologists would agree with you on the benefits of statins and the lack of harm. You should also mention that just to be fair. Read Dr Malcolm Kendrick, Dr Aseem Malhotra, and many other researchers, scientists, etc. What about the NNT ? Not very strong evidence for statins, plus who needs increased chances of diabetes, muscle issues, etc? Why are we so beholden to pills? Stress management, wise eating choices, exercise, reducing insulin resistance - all seem to be better choices. Just my .02 worth. My cardiologist said he would have put me on a statin when I was first discovered to be a LADA diabetic 25 years ago. I guess the question is - how does he explain that at 73, I'm still alive without his pill? Total Cholesterol 200, triglycerides 64, HDL 60, LDL 111. Lp(a) - 9 mmol/L. , hs-crp .39 . Non-Smoker - walk 4 miles a day. No cardiac events so far. Good video - just maybe not showing the total picture?