Using the coronary calcium (CAC) score to predict cardiovascular disease risk | Allan Sniderman

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  • เผยแพร่เมื่อ 3 ธ.ค. 2024

ความคิดเห็น • 108

  • @krisvette5874
    @krisvette5874 3 วันที่ผ่านมา +31

    CAC is a very blunt measure. There is so much complexity in this. Unless you can rule out soft plague then a negative calcification score is not hugely helpful (but it is likely to be better than a positive CAC). Likewise the incidence of some calcium in coronary arteries is normal above a certain age (lower than 50yo). Many athletes have higher rates of calcium in their arteries but a lower risk of CVD than a non-active peer. Nor do statins reduce plague burden...but they increase plague stability (a little bit)....and possibly decrease inflammation a bit....so no doubt statins have some effect of CV event risk reduction. But many people with high LDL's have zero plague....so freaking people out about the 'advanced state of coronary disease they have with a positive CAC score' and '4 Alarm Fire' is alarmist. People with zero calcification also have STEMI's. You are placing far too much inference on this one test. Plague instability/ soft plague burden and inflammation are more predictive of risk. Scaring people with a positive CAC is not helpful.

    • @btudrus
      @btudrus 3 วันที่ผ่านมา

      "Many athletes have higher rates of calcium in their arteries but a lower risk of CVD than a non-active peer."
      BS. Many athletes are heavily sugar eaters and eating sugar causes atherosclerosis...

    • @RC_NotTheCola
      @RC_NotTheCola 3 วันที่ผ่านมา +2

      Yeah, I found out I had high cac score under 50 and so much stress from it. Only positive is it does light a fire to change if you hadn't already.

    • @crywolfe0
      @crywolfe0 2 วันที่ผ่านมา

      There is a name of a test to measure the soft plaque but I forgot what it is. Do you know?

    • @richardstantiford9027
      @richardstantiford9027 2 วันที่ผ่านมา

      Thanks for your explanation, which is reassuring for me as I had a high CAC score a few years ago, (54 yrs now) but I'm very physically active and do not take any medication as not keen on potential statin side effects on muscle function. I'll keep up the cardio and resistance training, and healthy diet, supplements and stay off the drugs for now.

    • @Djangoat68
      @Djangoat68 2 วันที่ผ่านมา

      @@crywolfe0Cleerly in US, CARI-Heart in Europe

  • @sapperstang
    @sapperstang วันที่ผ่านมา +2

    I’m 46 with a score of 148. Noticed a mention of calcification on an unrelated test so decided to get the cac score. It’s stressful and this channel makes it super scary.

  • @JayT365
    @JayT365 2 วันที่ผ่านมา +10

    High CAC score I paid for out of pocket got me an immediate MPI which disclosed anomalies which in turn got me quickly scheduled for arteriogram. Four stents later I walked out that evening feeling better than I had in several years. Then into rehab and eventually onto Repatha + Statin, regular exercise and diet, loss of 50 pounds, currently feeling (and testing) better than I have in 15-20 years. Drugs for HBP cut in half, number and dosage. CAC can change minds and improve lives.

    • @selma5885
      @selma5885 2 วันที่ผ่านมา +1

      what is MPI?

    • @JayT365
      @JayT365 10 ชั่วโมงที่ผ่านมา

      To:@Selma. MPI stands for myocardial perfusion imaging. It uses a radioactive IV to image how much O2 is making it to your heart in both rest and stress conditions. The image it produces is quite detailed given it comes from Geiger counters scanning your chest. Basically if there is an anomaly/imbalance in the amount of O2 anywhere in your heart muscle it can detect it. The acute follow-up (to an anomaly) is an angiogram and (usually) one or more stents, and long term is serious Cholesterol lowering and weight loss. Repatha, Statin, Ezetimbe, Fenofibric Acid, Omega 3+D3, exercise, diet.

  • @markleblanc451
    @markleblanc451 3 วันที่ผ่านมา +24

    I started Keto almost 7 years ago. After 1 year with an average LDL of 250 I decided to get a baseline CAC which was zero. After years of people saying “a CAC doesn’t see soft plaque and you still may be at risk”, I decided to get a CTA with contrast. This test also does a CAC which was zero and in the words of my cardiologist “you have zero plaque in the arteries around your heart. ZERO plaque! Not even 1 millimeter! This after 7 years of an LDL of 250+ and apoB of 140. 7 years of high fat zero carb (most days not all) carnivore. I hear so much about apoB being “causal” or highly “Associated” with heart disease in the medical community. In the context of the average American, yes I believe it can be. BUT, in the context of Keto, Carnivore and other low carb people it is not.

    • @terrileeg03
      @terrileeg03 3 วันที่ผ่านมา +4

      You are a unicorn, my friend! Count your blessings.

    • @btudrus
      @btudrus 3 วันที่ผ่านมา +4

      Neither cholesterol, LDL nor ApoB causes atherosclerosis.
      Atherosclerosis is caused by endothelial damage combined with high insulin...

    • @joerenner8334
      @joerenner8334 3 วันที่ผ่านมา +1

      ​@@terrileeg03No he is just stretching the truth. Or BSing entirely. Which is my guess.

    • @JillBrownfitness
      @JillBrownfitness 3 วันที่ผ่านมา

      @@joerenner8334 he may have clear arteries but with no fiber, let’s see how his colonoscopy turns out. Lol. Also if he’s not BSing, he also didn’t say his age. He may be 40 or under.

    • @JillBrownfitness
      @JillBrownfitness 3 วันที่ผ่านมา

      @@markleblanc451 care to share the results of your colonoscopy and your age?

  • @davidbarnes774
    @davidbarnes774 3 วันที่ผ่านมา +6

    The recently released ORFAN study followed up 40,000 people that had CCTA scans. Of the people that went on to have either a MACE or death from heart attack approx 66% of those who had a MACE and 63% of those who died came from the group that had NO detectable atherosclerosis. It is possible that those that had no detectable plaque (by standard CCTA analysis) went on to have no or minimum medication/treatment/lifestyle interventions compared to those who were found to have detectable plaque. The study found that AI assisted analysis of the status of the fat surrounding the coronary arteries gave a much better correlation to and prediction of MACE and death . Analysing this perivascular fat layer gave a much better indication of arterial inflammation. Hence a CCTA can not only give a CAC score it can now give a meaningful measure of arterial inflammation. Let's hope that this new analysis tool becomes standard practice soon.

  • @KatToupsMD
    @KatToupsMD 3 วันที่ผ่านมา +9

    What Mark LeBlanc has detailed is actually what I have seen in quite a few of my patients in 2 nine month clinical trials using a precision medicine approach to reversing mild cognitive impairment and dementia.
    I follow advanced lipid markers every few months as we use a ketogenic diet in our trials.
    I have seen many of my patients' advanced lipid markers improve to the point that they no longer need to be on a statin medication.
    Of course we work with the patients to eat clean fats, free range and organic food, exercise almost daily (including HIIT a couple times a week), and track and support their sleep and their stress.
    We also take steps to resolve inflammation.
    Thus I can't say it's all due to the ketogenic diet that their lipids get better, but we don't need to buy into the doom and gloom notion that cardiovascular disease is permanent and that all you can do is manage it.
    I do believe that a healthy keto diet done correctly can be beneficial for many people.
    It's certainly useful for helping to lower blood sugar levels, which is one of the factors that can damage blood vessels in the first place.
    But, there is no one-size-fits-all, so I would not say anything works for everyone.
    I am a big proponent of testing CAC in everyone. And I like to have a CTA for people with elevated Lp(a) and elevated CAC levels.
    Not for doom and gloom prognostication, but to help motivate people to change their epigenetic factors.
    And to help with the decision about whether to medicate or not.

    • @ThatGoodBarbequ
      @ThatGoodBarbequ 2 วันที่ผ่านมา

      I am assuming you’re using ApoB and LpA? Can you explain how you use these to determine need for statins? I’m only familiar with the dogma of ACSVD

  • @johndanczak
    @johndanczak 10 ชั่วโมงที่ผ่านมา +1

    Statins also increase CAC score due to stabilization of soft plaque, turning it from soft to calcified, thus more stable and safer. Calcium can be seen as the healing process to a more dangerous soft plaque. Therefore, calcified arteries are far safer than arteries loaded with soft plaque. So is a positive CAC score really bad?

  • @FireOElijahMC
    @FireOElijahMC 3 วันที่ผ่านมา +30

    I started questioning everything, especially advice from government health organizations after reading Health and Beauty Mastery by Julian Bannett, this book exposes so many shocking truths about the health industry

    • @mikaelajasonnn3
      @mikaelajasonnn3 3 วันที่ผ่านมา

      I got it, truly a good book

  • @gabymalembe
    @gabymalembe 2 วันที่ผ่านมา +3

    I had a CAC score of 1188 13 years ago at age 68, equivalent to arteries of a 90 year old. If my score increased 10% a year I should now have arteries equivalentto George Washington’s.

  • @SerafimMoreno
    @SerafimMoreno 2 วันที่ผ่านมา +1

    Presentation of subject matter is very interesting and the risk is great.

  • @mikevaldez7684
    @mikevaldez7684 3 วันที่ผ่านมา +6

    I'm 66, on zero meds: triglycerides are 56, Ldl-cholesterol is 70, apoB is excellent. My father lived to his 90s, healthy, he never exercised, ate the standard American diet, was driving at 90, living alone..... I'll surpass that .....😮💈🙋

    • @seascape35
      @seascape35 3 วันที่ผ่านมา +2

      You are a very lucky man! But most people have worse numbers and need intervention of some sort.

    • @mikevaldez7684
      @mikevaldez7684 3 วันที่ผ่านมา +1

      I did it with a simple plant based, whole foods diet. Zero animal proteins, which are full of cholesterol & saturated fats. Zero sugar, zero flour, zero processed foods. And you can do it, too🙏

    • @lonewolf7803
      @lonewolf7803 21 ชั่วโมงที่ผ่านมา

      @@mikevaldez7684 Dietary cholesterol doesn't clog arteries but congrats on your health.

  • @selma5885
    @selma5885 2 วันที่ผ่านมา +1

    What are thoughts on supplementing with calcium for women with osteoporosis in context of heart risk?

  • @troysmith2684
    @troysmith2684 2 วันที่ผ่านมา +1

    I'm 39 years old. Just had a Calcium score test and my result was a CAC Score was 1
    Which I'm very worried about now.
    I'm healthy, not over weight, boxing, kick boxing all my life. Have taken steroids in the past and smoked when I was 14 silly. Stopped smoking at 17 years.. used to go out with the lads alot drinking alcohol a usual teenager I guess..
    Always tried to stay healthy and in shape a serious gym person actually..
    I've now upped my dose of Vitamin K2 and going to wait 2 years then recheck my CAC to see if its raised further or now.
    With me having a score of 1 at my age has made me really really paranoid.. my doctor told me majority of people in there early forties have a reading of 1 and it's normal nothing to worry about.. I don't believe that tbh and taking all the steps I can possibly to try and reverse it back to Zero.. or better still just try to keep my score at 1...

    • @sapperstang
      @sapperstang วันที่ผ่านมา

      I’m 46 with a 148. So I would trade you any day.

  • @stevensevek6151
    @stevensevek6151 3 วันที่ผ่านมา +3

    My CAC score was 305 in January 2023. I wonder how much it may have changed since then. I'll be 78 in 2 months. My wife is 2 years younger than me and her score was 91.

    • @krisvette5874
      @krisvette5874 3 วันที่ผ่านมา

      It's probably gone up...but that would be entirely normal and in line with all your age group peers.

    • @btudrus
      @btudrus 3 วันที่ผ่านมา +1

      @@krisvette5874 No, it isn't normal...

  • @kirbywaite1586
    @kirbywaite1586 5 ชั่วโมงที่ผ่านมา

    Can you have coronary plaque yet have low/ normal blood pressure?

  • @bahmankam8405
    @bahmankam8405 3 วันที่ผ่านมา

    What do we take from hot plaque in comparison to calcified one to predict the patient well being.

  • @jeffharris8320
    @jeffharris8320 3 วันที่ผ่านมา +2

    A high CAC may suggest yes arteriosclerosis, but not or minimal atherosclerosis. If high it should also show up in higher BPs. I assume Im high risk anyway. Really at 60 everyone should assume they are high risk. According to my reading of the evidence one should eat much less than the mean 4000 Cs/ day & do all the other things we know about to avoid metabolic syndrome, type 2 & 3 diabetes. I guess I'm saying at 60 + whats the point, seems a waste of time, money & a radiarion exposure for what?

  • @RC_NotTheCola
    @RC_NotTheCola 3 วันที่ผ่านมา +1

    My CAC score is the single biggest stress in my life, I know it's not a death sentence but if feels like one when you are under 50 and find out you are over 200. Like at that point, its too late as you can't fix it just mitigate any increased risk

    • @davidbarnes774
      @davidbarnes774 3 วันที่ผ่านมา +3

      If you have no symptoms and make the necessary lifestyle changes and if need be some medication then you will reduce your risk. I am 75 with 1400 CAC score and feel well with no symptoms and eat well and exercise (possibly too much). However, as you say it is a major source of stress . Any little niggle in the chest can be blown out of proportion by the mind and in most cases for me is due to my exercise regime/stretching causing stiffness in my upper body.

    • @johnrobi0
      @johnrobi0 2 วันที่ผ่านมา +1

      Try adding 400 micro grams of K2 MK7 supplementation, and 5,000 iu of vitamin D. My brother in law just turned 62 and his score is 1900. He won't take any advice.

  • @michaelcooper5868
    @michaelcooper5868 3 วันที่ผ่านมา +1

    Can this test be done if you already have several stents?

    • @johnrobi0
      @johnrobi0 2 วันที่ผ่านมา

      Yes.

    • @lonewolf7803
      @lonewolf7803 20 ชั่วโมงที่ผ่านมา

      @@johnrobi0 yes but not recommended.

  • @fatcityhockey
    @fatcityhockey 2 วันที่ผ่านมา +4

    From Cholesterol to now CAC. Again they are trying to shoot the messenger. Hi cholesterol or calcium are both a result of damage to the inside lining of your arteries which these two substances the body uses to repair the damage. How about focusing on what causes this damage? Seed oils or any oil fried at high temperatures.

    • @johnrobi0
      @johnrobi0 2 วันที่ผ่านมา +1

      True. And high carb diets and stress.

    • @lonewolf7803
      @lonewolf7803 21 ชั่วโมงที่ผ่านมา

      inflammation and insulin.

    • @JayT365
      @JayT365 10 ชั่วโมงที่ผ่านมา

      You are missing the message. CAC is a start, not an end. It's also a cheap test. If you have a high score, you should get an myocardial perfusion image (nuclear stress test) to see if that Calcium is affecting flow (worst case a blockage). If you have HBP, you likely do (have blockage). There's no quick fix to a flow problem other than stents or bypass, sadly. A few cases of Repatha + Statins have shown healing and clearing, but it takes years. The rest of us (under aggressive therapy) manage to halt the progression. If you are young, obviously Keto and exercise, keep your weight down, check your BP and blood sugar.

    • @fatcityhockey
      @fatcityhockey 6 ชั่วโมงที่ผ่านมา

      @ Actually you are missing the point. The point is that cholesterol or calcium build up is not the disease. It’s a symptom of oxidative damage. It’s like the check engine light on your cars dashboard and the MD’s response would be to cut the wires do the light no longer comes on.

    • @JayT365
      @JayT365 2 ชั่วโมงที่ผ่านมา

      @@fatcityhockey It is indeed a later step in the disease, and no competent doctor would advise ignoring a high CAC score, especially when you also have HBP, hyper-cholesterol, etc. Neither should they say you're fine with a low score. The definitive test of CVD is MPI aka nuclear stress test. I preferred not to wait until I got a heart attack before I got an angiogram and stent(s). Capiche?

  • @joses5356
    @joses5356 3 วันที่ผ่านมา

    Did mine at 58 and it was zero. Apo b 111. My triglycerides average 200 to 300. All this did was give me more incentive to improve my numbers without meds.

    • @ShastaTodd
      @ShastaTodd 3 วันที่ผ่านมา +1

      Trigs that high mean you are eating a LOT of sugars/ high glycemic carbs.

    • @joses5356
      @joses5356 3 วันที่ผ่านมา

      @ShastaTodd yeah I lift 4 times a week and get hungry constantly

    • @lonewolf7803
      @lonewolf7803 20 ชั่วโมงที่ผ่านมา

      @@joses5356 Try to cut the sugars and starchy carbs. The more you eat them the more hungry you get.

  • @Malcolm-Achtman
    @Malcolm-Achtman 3 วันที่ผ่านมา +1

    The reason a person with an ApoB of 140 can have a CAC score of zero is simple. Apo B is not predictive of heart disease, nor is it causal. It's the wrong marker to look at. Just as LDL-C is a useless marker to look at. Instead, get an advanced lipoprotein particle test and focus on the number of small (dense) LDL particles. If they are high, then it reflects that you are metabolically unhealthy. If you are metabolically unhealthy, you are on a path toward cardiovascular disease. So, ignore your ApoB result and get busy looking into obtaining an advanced lipoprotein panel (e.g. NMR, or LPP+ from SpectraCell, etc.).

    • @lonewolf7803
      @lonewolf7803 20 ชั่วโมงที่ผ่านมา

      Also get an inflammation panel while you're at it.

  • @mmfruitveg
    @mmfruitveg วันที่ผ่านมา +1

    Dr Attia is a bit of an alarmist sometimes. I get it though, Doctors have a tough job these days. The complexities of CVD are many and people are very different. I'm 67 yrs old, I have been eating keto/caveman/paleo for 25 years, before it even had a name, lol...My total choles this past Oct was 202, Triglycerides 84, Lp(a) less than 15, ApoB 110, LDL 137, HDL 44
    I'm the same weight as I was at 40 yrs old. My belief is this, if a person can keep their blood glucose below 98, insulin levels below 6...then I really do think CVD will not rear its ugly head. Cutting carbs to the level of energy expended is key, eating high quality meats, fish, fat, butter, nuts, a little fruit now and then and doing reasonable exercise seems to work for me!....Oh by the way, my last CAC was 2 years ago and it scored 21, 5 years before that it scored 6...So I have a tiny bit of calcium but my Doc said not to worry as it will "never catch" me in time...LOL...got my fingers crossed

    • @lonewolf7803
      @lonewolf7803 20 ชั่วโมงที่ผ่านมา

      Based on those numbers, your cardiologist would be shoving high dose of statins down your throat. lol. But don't blame him. That's what he learned in med school and reinforced by big pharma.

    • @mmfruitveg
      @mmfruitveg 19 ชั่วโมงที่ผ่านมา

      @@lonewolf7803 No statins for me I won't do it, I watched my dad wither away while on statins, could barely walk when he was 75. There are other ways to lower LDL, APob, APo(a) meds are not always the answer unless a patient is so sick already that intervention is neccessary

    • @mmfruitveg
      @mmfruitveg 19 ชั่วโมงที่ผ่านมา

      I recently had a carotid artery scan on both sides of my neck to check for plaque,,,,,,,nothing,

  • @deanschanzenbach7506
    @deanschanzenbach7506 3 วันที่ผ่านมา +20

    I’ve had higher cholesterol pretty much my entire adult life. Had this test done at 45 and my score was zero

    • @nequestns
      @nequestns 3 วันที่ผ่านมา

      Me too and scored 1. The Cholesterol boogeyman is one of the biggest frauds perpetrated by the pharmaceutical and medical community in the history of mankind.

    • @xiaoyang4571
      @xiaoyang4571 3 วันที่ผ่านมา +10

      At 45 years old, a score other than zero is, as Peter said, “a 4-alarm fire”. But a zero score doesn’t mean low risk because a lot of atherosclerosis is non-calcified soft plaque at that age.

    • @mikevaldez7684
      @mikevaldez7684 3 วันที่ผ่านมา +3

      Additionally, if you were to go all plant based, zero animal proteins, your soft plaque would be flushed out & replaced by hard, calcified plaque, which is not a bad thing at all, but actually much less life threatening. 🙋🙏💈🗡️

    • @krisvette5874
      @krisvette5874 3 วันที่ผ่านมา

      @@xiaoyang4571 Yep - CAC is not a hugely predictive or useful test....it needs to be taken in context.

    • @krisvette5874
      @krisvette5874 3 วันที่ผ่านมา +4

      Yes - many people with high LDL's have zero plague....it shows the complexity in this disease and the cholesterol thesis is not 100% accurate.

  • @Hail2MasterChief
    @Hail2MasterChief 3 วันที่ผ่านมา +2

    Thanks Pete! 🎉😂

  • @kcsunnyone
    @kcsunnyone 3 วันที่ผ่านมา +1

    The ads that ran during this brief were vulgar and obscene. Someone needs to veto what they’re running on your content

    • @ShastaTodd
      @ShastaTodd 3 วันที่ผ่านมา +1

      get an adblocker

    • @lonewolf7803
      @lonewolf7803 20 ชั่วโมงที่ผ่านมา

      @@ShastaTodd Or pay for Premium.

  • @drsvs
    @drsvs วันที่ผ่านมา

    Why are you doing this test other than to convince the patient to medicate? Your decision was made when you saw the APOB.

  • @Fair-to-Middling
    @Fair-to-Middling 3 วันที่ผ่านมา +2

    Not really worth getting until you are in your 60's since it only shows the tip of the iceberg. I had mine done at age 65 and got a score of 0. Good? Time will tell.

  • @chrishabgood8900
    @chrishabgood8900 3 วันที่ผ่านมา +2

    Mine was 0, boom!

  • @kcsunnyone
    @kcsunnyone 3 วันที่ผ่านมา

    How much does this test cost

    • @ShastaTodd
      @ShastaTodd 3 วันที่ผ่านมา

      mine was ~$400

    • @lloydhlavac6807
      @lloydhlavac6807 2 วันที่ผ่านมา

      Mine was $88, plus a $40 doctor's referral fee.

    • @sapperstang
      @sapperstang วันที่ผ่านมา

      Mine was $150.

    • @markburke2224
      @markburke2224 วันที่ผ่านมา

      In the Minneapolis area it is about $100.

    • @lonewolf7803
      @lonewolf7803 20 ชั่วโมงที่ผ่านมา

      $100 cash.

  • @mikevaldez7684
    @mikevaldez7684 3 วันที่ผ่านมา +2

    Boring, uninformative. Very generic info 😢

  • @user-ny4xd3cv5b
    @user-ny4xd3cv5b 3 วันที่ผ่านมา +1

    This is your worst guest ever. It's not a positive or negative. It's the degree of calcification which is extremely valuable

    • @kirbywaite1586
      @kirbywaite1586 5 ชั่วโมงที่ผ่านมา

      I think he's using positive to mean excessive.

  • @johndanczak
    @johndanczak 10 ชั่วโมงที่ผ่านมา

    Statins also increase CAC score due to stabilization of soft plaque, turning it from soft to calcified, thus more stable and safer. Calcium can be seen as the healing process to a more dangerous soft plaque. Therefore, calcified arteries are far safer than arteries loaded with soft plaque. So is a positive CAC score really bad?

    • @JayT365
      @JayT365 8 ชั่วโมงที่ผ่านมา

      CAC is a single tool, many are needed. If your CAC score is over 400 and you have HBP then you ought to follow-up with a myocardial perfusion image aka nuclear stress test, which depicts how well O2 is getting to areas of your heart. That's pretty definitive. If the image is anomalous (imbalanced) you then get an angiogram, and you get stents or a bypass, because you have an acute problem. Longer term: Repatha + Statins, diet, exercise, etc. All that works well, but it takes time.