CAC Testing

Heart disease can be a confusing field for anybody, even doctors. One of the things that compound the already confusing nature of the disease is the advertisements that are produced by big advertising agencies trying to get doctors and patients to buy into the benefits of treatments.

Let’s show you a recent advertisement promoting the use of a statin called Lipitor or atorvastatin. These are the medications to lower cholesterol levels.

Notice what captures your eye. A famous researcher takes this statin - therefore, it must be a good thing for you too. And he’s obviously really smart. You should be so smart.

And, LOOK!, it reduces the risk of having a heart attack by 36%!

That does sound impressive. If I could truly reduce my risk of having a heart attack by 36%, I might consider taking a statin myself.

When I think that there’s a 36% reduction in having a heart attack, that would seem to mean that without the medication I’m at, say, 50% risk of a heart attack. If I take the statin medication, I’m now at 14% risk of a heart attack - or something of this sort. Thus a 36% lowered risk.

But look at the fine print included at the bottom of the article. If you took a sugar pill in this group, you had an approximately 3% chance of having a heart attack in the time frame of the study. If you took this statin, you had an approximately 2% risk of having a heart attack.

OK. That’s a 1% decreased risk. 3% to 2%. Nice. But that’s not a 36% lower risk in my usual way of thinking.

That is unless you think that going from about 3% to about 2% should be advertised as 1/3 lower risk. In the finer print that drops from 3% to 2% amounts to 36%! Which kinda does sound impressive. But it’s not very impressive (IMHO).

Is taking the medication with only a real 1% lower risk of a heart attack worth the side effects that the drug might cause? Aches and pains. Type 2 diabetes (you know that it does cause Type 2 diabetes in a significant number of cases?). Memory loss. Fatigue. Brain malfunctions. And do I trust the 1%?

Since it doesn’t sound really impressive to have a 1% lower risk of a heart attack, they worked out a statistical trick to make it look so good everyone will want to take it.

At another time, we’ll go into a bit more detail on issues like this.

RISK FACTORS VS DISEASE PROCESS

But the purpose of bringing this up now is to point out that there are things that are considered to be risk factors. For instance, if you have high blood pressure, you have a higher risk or likelihood of having a heart attack.

Statins are currently recommended by many doctors for people who have risk factors for heart disease. These risk factors include a family history of heart disease, high cholesterol levels, and low levels of so-called good cholesterol.

One challenge with this approach is that a “risk factor” is not evidence that you actually have the disease. High cholesterol is only a risk for cardiovascular disease.

Example: I have a patient who had a very sophisticated and advanced heart test done years ago (I’ll talk more about it in a minute). It’s called a Coronary Artery Calcium Score or CAC Score. It is actually a test for disease in the arteries of the heart.

Her CAC Score was 0 (zero). That demonstrates that she has essentially zero hardening of the arteries. She’s safe! Some would say she has a 15-year warranty against a heart attack.

Her problem? She had high cholesterol (actually quite high) and another doctor told her (pestered her) time and again to get on statins. But every time she went on them, she felt horrible. All sorts of aches and pains. She was tired. And just did not feel good. She’d go off the meds to get relief and then she would be “badgered” to get back on them.

But why? With a zero score on the CAC test, she had proof that there was either no coronary artery disease or, at the worst, only a tiny amount? Her body already knew how to prevent the disease so, Why take the drug?

CORONARY ARTERY CALCIUM SCORE: A TEST FOR DISEASE - NOT RISK FACTORS

In the news media, they like to use the word “Bombshell”!

In a way, the news about the CAC Score is a bombshell in the medical world. And yet it has received almost no attention.

Risk factors are different things than knowing there is a disease process…and how bad the disease process is.

Let me give an example. Playing soccer is a risk factor for a broken bone. An X-ray tells us whether you have a broken bone or not. Playing soccer does not tell you whether you have a broken bone.

A high cholesterol level is considered a risk factor for heart disease (though the claim is highly contested). But it does not tell you if you have heart disease. It, at worst, is only a risk factor - much like playing soccer is a risk for a bone fracture but is not an indicator of a bone fracture.

The CAC test is a fast, inexpensive, and effective way to KNOW whether you have heart disease (meaning hardening of the arteries or atherosclerosis).

It’s been researched for many years and there is a great deal of documentation regarding its benefits. But only recently (2018) was it finally endorsed by the American Heart Association as a recommended diagnostic test for heart disease.

Here’s an example of what the CAC test can do. One of my brothers and a friend of his had an early version of the test done some 20 years ago. My brother’s score was zero. Meaning that he had no heart disease at all, or, if there was some it was recent and minimal. Thus he had essentially no risk of having a heart attack. He’s still alive and well.

His buddy had many risk factors and was trying to make changes that would be positive for his health. He also did the CAC test and the score came back very high. I don’t recall what the number was - but it was very high showing that he had extensive disease (as opposed to only a risk). Unfortunately, he died of a heart attack within a few weeks of having the CAC test done.

The good news today is that there are definitely things that you can do to minimize your risk of a heart attack if you were to have significant disease present.

For anyone over the age of 40 who has any risk factors for heart disease, it might be a really good idea to find out how much disease you actually have. And follow up testing can tell you whether you are doing the right things to stop the disease.

This is a big deal! At least it is in my opinion as well as that of many other people who have researched it.

HOW TO LEARN MORE ABOUT THE CORONARY ARTERY CALCIUM SCORE

How might you educate yourself further?

One of the wealthiest men in Ireland at around 50 years of age thought that he was doing all the right things. His doctors told him that all was good. Just keep on eating as he was and exercising as he was and he’d live until old age.

That was until he had a CAC test done and it showed that he actually had a lot of disease and was thus at high risk of a heart attack. Further in-depth evaluation showed that the CAC was in fact correct and he did have significant disease in his coronary arteries.

He began a different kind of protocol to help his arteries and the effect has been very positive.

The point: He donated a lot of money to form an Irish Charity for the purpose of educating people about the benefits of the CAC test. They call it “The Mammogram of the Heart”.

I’d highly recommend that you go to the website run by the Irish Heart Disease Awareness Charity at:  https://ihda.ie/

There’s a lot of great information including documentation of the American Heart Association endorsing the use of CAC testing.

But the most important thing to check out is a fascinating documentary that he spent $2 million making. It’s called “The Widowmaker”. And you can watch it on the website.

If you are interested in getting tested, we can provide you with information about of places in the Northwest that provide CAC testing.

Unfortunately, at the time of this writing, there effectively is not a place in Yakima where you can get this done.

This is general information about where it can be done at a reasonable cost:

In Bellevue, they charge $99. I’m not sure if it includes the radiologist report.

At Inland Imaging in Tri-Cities, they charge about $125 which does include the radiology report.

In Pendleton, it’s about $100 with a radiology fee of roughly $50.

We can provide more details if you are interested. You will need a physician’s order to get this done. I think it’s a great thing for virtually any of our patients above the age of 40 or 50. It would be good to schedule a follow-up appointment to review the test when the results are in.

In conclusion, this might be a really great option for you if you have any reason to be concerned about heart disease.

[NOTE: This newsletter is for educational purposes. There may be times to use a statin, though, in the author’s opinion, it is used far too frequently. Make no changes in prescriptions without consulting a physician.]