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5 Myths about the Coronary Calcium Score (CAC) | Tom Dayspring, MD

The Coronary Calcium Score can be useful, but several myths surround it. We cover 5 misconceptions regarding the calcium score and how to interpret a calcium score to lower our heart disease risk. Let’s talk calcium scan or calcium score. The calcium scan shows calcification in coronary arteries myth: “CAC score of 0 means no plaque” a CAC score of 0 doesnt mean no plaque CAC doesnt measure plaque. Measures calcification. Calcification happens late in plaque formation process. you can have a CAC of 0 and have soft plaque. Non calcified. study: people with lots of plaque, 14% had CAC of zero. most young people with obstructive CAD had a CAC of zero “diagnostic value of a CAC score of 0 small in the young" advanced coronary disease: ~30% of heart attacks or death in people with CAC of zero if CAC is zero odds are low you have obstructive CAD. but doesnt rule it out even with a lot of plaque, calcification may not have developed CAC =0 is good news, it’s a marker of lower risk, but it doesn´t mean immunity we can have plaque in other places besides coronaries CAC=0: 54% had plaque in the legs or the carotids CAC of zero is desirable, but far from perfect CAC=marker of advanced disease. CAC=0 may mean no plaque. or maybe there is. CAC doesnt rule that out CAC=0 doesnt mean zero calcification. just detectable calcification scan picks up calcification above certain size, not small calcium spots. ~4% with CAC=0 had calcification myth: CAC=0 means zero risk "LDLc or apoB is high but CAC=0 so I´m safe" “score of zero does not imply risk is zero (heart attack, stroke etc) or zero atherosclerosis (plaque)” “CAC of zero may provide false sense of security” CAC of zero indicates low 5-10y risk value of CAC score depends on age CAC=0 is the norm in young “CAC of zero in the young is normal, more power at older age. value of a CAC of zero increases with age” myth: "if CAC goes up, i´ll make changes" calcification=advanced plaque real power is in preventing plaque “Plaque calcification is a late event, not for pre-plaque detection (goal = prevent plaque)” some methods measure soft plaque. angiography. calcium not the cause of risk. marker of risk The more plaque, the more likely there’s calcification. calcification isn’t the problem. Calcification is part of the scarring of the artery, can make artery less likely to rupture “plaque disruption and thrombosis not in calcified segments; calcium not the cause” in general more calcium means higher risk, it´s a marker of more plaque and more advanced plaque, but something could increase calcium and not raise risk statins can increase CAC but risk goes down. statins stabilize plaque, including calcification CAC can refine risk. young with CAC that is NOT zero; older with a score of zero; borderline case with some risk factors but not clear if statin is appropriate, CAC can help decide Connect with me: Facebook:   / drgilcarvalho   Twitter:   / nutritionmades3   Animations: Even Topland @toplandmedia References: 1-One page primer: https://jamanetwork.com/journals/jama... 2-obstructive CAD: https://jamanetwork.com/journals/jama... 3-plaque in other territories even with CAC=0 https://www.ahajournals.org/doi/full/... 4-calcification even with CAC=0 https://europepmc.org/articles/pmc961... https://www.atherosclerosis-journal.c... 5-CAC=0 desirable but imperfect https://www.ahajournals.org/doi/epub/... 6-low 10y risk with CAC=0 https://www.sciencedirect.com/science... 7-prevalence of CAC=0 https://jamanetwork.com/journals/jama... 8-calcium is not the cause: https://www.jacc.org/doi/10.1016/j.ja... 9-Statins & calcium Disclaimer: The contents of this video are for informational purposes only and are not intended to be medical advice, diagnosis, or treatment, nor to replace medical care. The information presented herein is accurate and conforms to the available scientific evidence to the best of the author's knowledge as of the time of posting. Always seek the advice of your physician or other qualified health provider with any questions regarding any medical condition. Never disregard professional medical advice or delay seeking it because of information contained in Nutrition Made Simple!. #NutritionMadeSimple #GilCarvalho 0:00 What is the calcium score? 0:53 Plaque with CAC=0 3:53 Calcification with CAC=0 4:32 CAC=0 and Risk 8:01 Calcium score and Age 9:33 Window of opportunity 10:47 More sensitive tests 12:17 Calcium is not the cause 13:32 Statins and Calcium 15:25 Take-aways and strategy 16:50 Additional Resources