Coronary Artery Calcification


	Coronary Artery Calcification Score

		We can now accurately measure the amount of calcified plaque clogging the coronary arteries of the heart. Everyone eventually develops coronary artery plaque ('rust'), and your goal is to have less plaque than the level considered normal for your age and sex! Cholesterol, specifically LDL cholesterol (the bad cholesterol), tends to be related to plaque deposition. But some people tend to have 'stickier' cholesterol, which is more damaging, than others. (That is partly related to LDL particle size and number which we can measure, using special labs.) It is partly related to Lp (a), homocysteine, c-reactive protein, oxidized LDL level, genetics, smoking, diabetes, hypertension and other risk factors. Hence some patients can have good LDL levels and surprise us with lots of plaque, and occasionally the reverse holds true! Some patients with high cholesterol do not lay down plaque! We previously tried to determine heart attack risk (coronary artery blockage) using stress tests or thallium scans. In order for one of these to be positive, there must be at least a 70% blockage of a coronary artery. This rarely occurs, except in long-standing progressive vascular disease. A few years ago it was realized that most coronary artery blockages (heart attacks) occurred because of small amounts of plaque in the arteries that became inflamed, allowing the cholesterol material to break through the inflamed cap of the plaque, causing sudden and severe blockage. Thus a patient with a 20% blockage with inflamed plaque could have a normal thallium scan, and 10 minutes later, rupture his inflamed plaque and have a massive heart attack! A 5-minute non-invasive CAT scan of the coronary arteries takes the guesswork out of estimating the amount of damage from the LDL cholesterol and other risk factors, and actually indicates how much calcified plaque is in the coronaries. We know that if you have zero calcified plaque, you have very little chance of having a heart attack in the next few years. Conversely, if you have a lot of plaque, we know that by lowering lipids aggressively we can stop plaque formation and inflammation, and even reverse and remove plaque! (not only in the heart, but in the vessels leading to the brain, kidneys, legs and penis!) We can lower lipids with medications (statins. resins, niacin), nutritional intervention, exercise, and other lifestyle modifications and monitor plaque by serial CAT scans every few years. We have been working with Dr. Steven Wolff, formerly of the NIH, one of the leading cardiology radiologists in the country. Since the Coronary Artery CT scan is considered preventative, it is not covered by insurance (though it is covered by corporate flex spending plans). We have arranged for Dr. Wolff's office to see our patients for three well-defined hours per week: Tuesday 8-9am, Wednesday 4:30-5:30pm, and Thursday 8-9am. The office is located at 62 East 88^th St. between Park and Madison, lower level. The cost is $400. Vera Mehta at our office, 212-879-4700, ext. 259 is in charge of our program to schedule and organize the Coronary Artery Calcification Scores. It is best to call Vera to schedule the test and to ask any administrative questions. (Second best is to call one of the MD's in our office directly, especially if there are any medical questions.) Vera (ext. 259) will take your credit card information and bill your account at the time of the scheduled procedure. Be aware that our office must pay for that time up-front, and if you do not arrive exactly during our scheduled hours, we must still pay for that time, and Dr. Wolff's office will then also bill you for doing it on their time! So if you must cancel, give us enough time to get one of our other patients into that spot, as we still have to pay, and hence have to charge for that unused time!! (Fortunately, this has not yet happened, and we try very hard to not let it happen!) We hope to get the results back to you in about one week. If you don't hear from us first, call or email 7 days after the test, and we will track down the results ASAP. Of note, President Clinton apparently was on statins for many years to control his cholesterol while he was overweight and out of shape. It is said that after his presidency, he became very fit and lowered his cholesterol using diet and exercise to the point that his cholesterol was normal even without the statins! He didn't realize was that he had apparently built up a lot of plaque over the years in his arteries. In addition to lowering cholesterol, statins (Lipitor, Crestor, Pravachol, Zocor, Lescol, Mevacor) also reduce plaque inflammation, stabilize plaque, and prevent plaque rupture. Upon achieving his cholesterol goals with diet and exercise, President Clinton was taken off his statins, and within a few months apparently ruptured enough of his now unprotected plaque, that he went from running five miles/day to needing a multivessel bypass! It is likely that Mr. Clinton's Coronary Calcification Score would have been very elevated, in spite of his well-controlled cholesterol with diet and exercise, due to accumulated vessel damage over the years. If he had known that, he would have remained on the statins to keep his plaque un-inflamed, to prevent rupture. (If he had not then needed a bypass, he would have continued campaigning, and for better or for worse, the Ohio election results might have resulted in a different outcome. Statin withdrawal may have affected a lot more than Clinton's coronary arteries!) Importantly, it has recently been reported that statin usage has independently been associated with a 50% reduction in seven different cancers-- breast, prostate, esophagus, stomach, colon, liver, and lung.