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Impact of Statins on Cardiovascular Outcomes Following CAC Scoring

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  • laketahoebob
    commented on 's reply
    Thanks to Tom for the link

  • Tom
    commented on 's reply
    laketohoebob,
    Yes, Dr. Brewer has made several videos in which he talks about the advantage of an ACE inhibitor over an ARB. https://www.youtube.com/watch?v=kxVCYx9iKF8

  • laketahoebob
    commented on 's reply
    My cardiologist just changed my Ramipril (ACE) to Candesartan (ARB) to get rid of my Ramipril cough. Can you point me to any information of the difference in efficacy between ACE and ARBs in reducing inflammation? Thanks.

  • Tom
    replied
    To my limited understanding the calcium strengthens the fibrous cap over the plaque. So, I am not quite sure what calcification on the "outside" of the artery means. Here is a diagram. See if you can figure out what area that your cardiologist means. Good to understand nuances if valid.
    https://pbs.twimg.com/media/D6d3E_3WsAQ34C0.jpg:large

    Leave a comment:


  • Quanticus
    replied
    After having had a CAC score done and wondering what it really meant beyond the risk models, I had a long chat with a doctor who sends a lot of patients to get CAC scores done. The doctor said that it is a valuable marker but imprecise. He told me that he had some people with high CAC scores who, when cut open, showed lesser amounts of heart disease than others with lower CAC scores. He then said that a CIMT test would help me evaluate my cardiovascular risk, and he was correct. I found out subsequently to getting my CAC score that taking statins for several years will typically increase calcification in a beneficial way (strengthening discrete plaques), and that additional calcification will increase a CAC score. This was discussed by John Lorscheider in one of his videos, and I first noted this when a cardiologist suggested it as the likely reason that the President's CAC score had increased over a year's time (annual physical a year ago now). The risk models that are used with CAC scores may be more appropriate for people who have never used statins.

    I value having a CAC score done as a marker for calcification which is roughly predictive of future cardiovascular disease. It is just a number though, and it doesn't provide a lot of insight into what is actually happening now in a person's arteries.


    My cardio doc felt the imprecision in a CAC may be due to calcification on the "outside" of the artery, so not relevant to occlusions. Never heard of it and I didn't question it, but will the next time. Any comments?

    Leave a comment:


  • mtbizzle
    commented on 's reply
    Are you on a statin?. I assume so, as 100 is usually a point to get on a statin, but maybe not. I ask because statins are known to increase calcified plaque (upward pressure on cac), while reducing soft plaque. Soft plaque is what matters most. So some would argue that a cac test is less valuable once you know you have plaque buildup and have been on a statin. See eg https://youtu.be/rA67ConEVU0

  • David
    replied
    Originally posted by Tom View Post
    Here is where there is a need for some interpretation. Both CAC score and CIMT test equipment/algorithms improve over time, but I think that there is likely something else going on to explain the difference in arterial age. Did you use the MESA calculator for your CAC score? I played around a bit with that calculator, and once you reach a CAC score of 100 and everything else is sort of typical for a 45 year old let's say, then that person's artery age is 73. If you have been on a moderate to high dose of statins, that may well be some of the CAC score increase. The problem with the CAC score alone is that it can only provide a limited amount of info, mainly about the past. Where the risk models come into play is that they sort of predict the future risk if a person doesn't change their lifestyle for the better. Since you did change your lifestyle significantly, I wouldn't totally discount the CAC score but I would factor in other things.

    Next, consider the CIMT test result. One of the big problems with CIMT testing has been repeatability if multiple CIMT tests are taken over time. It is important to find a quality test center to get good repeatability. The CIMT test gives a couple of important results, a person's plaque burden (discussed at length in a recent CIMT video by Dr. Brewer) along with the presence of discrete plaques (size of those if present).

    Let's consider a 45 year old male again. The CIMT test was done well after a significant modification of lifestyle along with use of a statin I would think. It is possible to decrease a person's plaque burden by strict lifestyle modification alone, but most people require at least a modest dose of a statin to help lower cardiovascular inflammation (using an ACE inhibitor vs. ARB for blood pressure also reduces cardiovascular inflammation). So yes, it is possible to pull out some of the plaque from your arteries under the right conditions where a 45 year old could get measured as having the arteries of a 37 year old. When the plaque comes out, there is some re-modeling of the underlying intima layer in particular. What's left for the plaque burden is smaller and more stable. You didn't mention anything about discrete plaques. Obviously if you have any in your carotid arteries, you almost certainly also have others throughout your cardiovascular system. Once those are over 1.3mm in size, then your risk is higher. Over time with a healthy lifestyle and lower cardiovascular inflammation, those discrete plaques become a bit smaller (maybe small ones disappear) and calcified enough to not likely cause you any harm. After a lot of changes and some passage of time, a lot of people do see significant improvements in their cardiovascular system.

    I hope that this brief analysis helps. Keep up the good work with your improved lifestyle.
    I had a 1.087mm heterogeneous plaque on my left side and a slightly smaller one on my right side. Unfortunately I don't tolerate statins, so have not been taking that or any BP meds. The best I can do is take the Bergamot.

    Most of my inflammation markers were pretty good. I did have an elevated MACR = 26. I am hoping that this goes down over the next 3 months when I get measured again.

    Leave a comment:


  • Tom
    replied
    Here is where there is a need for some interpretation. Both CAC score and CIMT test equipment/algorithms improve over time, but I think that there is likely something else going on to explain the difference in arterial age. Did you use the MESA calculator for your CAC score? I played around a bit with that calculator, and once you reach a CAC score of 100 and everything else is sort of typical for a 45 year old let's say, then that person's artery age is 73. If you have been on a moderate to high dose of statins, that may well be some of the CAC score increase. The problem with the CAC score alone is that it can only provide a limited amount of info, mainly about the past. Where the risk models come into play is that they sort of predict the future risk if a person doesn't change their lifestyle for the better. Since you did change your lifestyle significantly, I wouldn't totally discount the CAC score but I would factor in other things.

    Next, consider the CIMT test result. One of the big problems with CIMT testing has been repeatability if multiple CIMT tests are taken over time. It is important to find a quality test center to get good repeatability. The CIMT test gives a couple of important results, a person's plaque burden (discussed at length in a recent CIMT video by Dr. Brewer) along with the presence of discrete plaques (size of those if present).

    Let's consider a 45 year old male again. The CIMT test was done well after a significant modification of lifestyle along with use of a statin I would think. It is possible to decrease a person's plaque burden by strict lifestyle modification alone, but most people require at least a modest dose of a statin to help lower cardiovascular inflammation (using an ACE inhibitor vs. ARB for blood pressure also reduces cardiovascular inflammation). So yes, it is possible to pull out some of the plaque from your arteries under the right conditions where a 45 year old could get measured as having the arteries of a 37 year old. When the plaque comes out, there is some re-modeling of the underlying intima layer in particular. What's left for the plaque burden is smaller and more stable. You didn't mention anything about discrete plaques. Obviously if you have any in your carotid arteries, you almost certainly also have others throughout your cardiovascular system. Once those are over 1.3mm in size, then your risk is higher. Over time with a healthy lifestyle and lower cardiovascular inflammation, those discrete plaques become a bit smaller (maybe small ones disappear) and calcified enough to not likely cause you any harm. After a lot of changes and some passage of time, a lot of people do see significant improvements in their cardiovascular system.

    I hope that this brief analysis helps. Keep up the good work with your improved lifestyle.
    Last edited by Tom; 03-25-2019, 10:07 AM.

    Leave a comment:


  • David
    replied
    Interesting discussion. I had a CAC done in 2015. My score was 107. I had another CAC done in late 2018. My score was 159. It said that I had the arteries of a 73 year old. Then I went on a low carb diet beginning 1/1/2019. After 2 months of low carbing, I had a CIMT done. The CIMT said I have the arteries of a 37 year old! So according the CAC my arteries are 73 years old. According to the CIMT my arteries are 37 years old. I am hoping that the low carb diet and bergamot supplements have made such a dramatic difference and reduced my arterial age so much. But I don't really know which test to believe.

    Leave a comment:


  • fatmax
    commented on 's reply
    This interview will answer your question about soft plaque:
    https://www.youtube.com/watch?v=HgrGyzJb7FI

  • Tom
    replied
    I read that article and I agree with the bulk about what the author says. Is that excerpt at the bottom of my comments what you are basing your opinions on CIMT testing? I doubt that whoever wrote that part ever had any experience with CIMT testing. A CIMT test looks at the intima-media thickness. It doesn't measure the intima or the media because those don't change much in thickness, it is the distance between the two that fills up with LDL family particles inducing an inflammatory response of macrophages, etc. that is the problem. I don't know how the author came up with the 80% comment, because that again is not true as a CIMT test does definitely look inside the artery wall. What I think happened is that the author confused standard ultrasound testing (about worthless until the carotid arteries are 70+% blocked from what I have learned) from CIMT testing. It is critical to know the difference.

    Yes, CAC scoring is a method of assessing coronary artery risk, but it is just one marker. CIMT is not "outdated". I had to laugh at this part because my doctor two years ago told me that CIMT testing was still in the research stage, and therefore it was not appropriate for me with a CAC score of 227. Both of these statements, "CIMT testing still in the research stage" and "CIMT is outdated", are wrong. Education is the key, and a willingness to learn and understand the value of information within a framework. Again, I think that the author of the article that was listed was referring to standard ultrasound, not CIMT testing.

    After having had a CAC score done and wondering what it really meant beyond the risk models, I had a long chat with a doctor who sends a lot of patients to get CAC scores done. The doctor said that it is a valuable marker but imprecise. He told me that he had some people with high CAC scores who, when cut open, showed lesser amounts of heart disease than others with lower CAC scores. He then said that a CIMT test would help me evaluate my cardiovascular risk, and he was correct. I found out subsequently to getting my CAC score that taking statins for several years will typically increase calcification in a beneficial way (strengthening discrete plaques), and that additional calcification will increase a CAC score. This was discussed by John Lorscheider in one of his videos, and I first noted this when a cardiologist suggested it as the likely reason that the President's CAC score had increased over a year's time (annual physical a year ago now). The risk models that are used with CAC scores may be more appropriate for people who have never used statins.

    I value having a CAC score done as a marker for calcification which is roughly predictive of future cardiovascular disease. It is just a number though, and it doesn't provide a lot of insight into what is actually happening now in a person's arteries. What is better is to have multiple markers with each potentially providing more insight. Invasive and expensive tests just aren't possible for the bulk of people who haven't yet progressed far down the cardiovascular disease pathway. Beyond CAC score, for those who want to look at the evidence, a CIMT test will provide additional valuable information. For goodness sakes, anybody posting here should have looked at some of Dr. Brewer's videos. Otherwise, we would have uninformed people trying to convince other uninformed people on health issues. Not a good scenario. For anybody who doesn't think that CIMT testing is valuable, take a little time to watch a few videos. I could go on and on about the benefits of having a CIMT test, but Dr. Brewer gives an excellent presentation in the various videos on CIMT (there are several and maybe best to start with the earliest ones first). Use the search function to find the many CIMT test videos.



    Is Carotid Intimal Media Thickness (CIMT) Testing of Value for Coronary Risk?
    Carotid Intimal Media Thickness (CIMT) testing is not the optimal test for evaluating atherosclerosis. It is mostly measuring the media thickness. The media is much thicker than the intima. The intima is where the atherosclerosis occurs. So the CIMT misses most of this. 80% of what it is measuring is the normal wall of the carotid artery. CAC scoring is a much more accurate assessment of coronary artery risk. CIMT really is outdated for this evaluation.
    Last edited by Tom; 03-24-2019, 01:49 AM.

    Leave a comment:


  • rich
    replied
    I've had an MRI, a cardiac CT scan, and a chest x-ray this year, so I opted for CIMT. I also need to know about soft plaque. Does CAC tell you anything about soft plaque?

    Leave a comment:


  • fatmax
    commented on 's reply
    Link was moved to:
    http://www.stayinghealthytoday.com/c...off/#more-1849

  • Tom
    replied
    So let's see. You want everybody to believe that you have the correct interpretation based upon that article. I got an error 404 on that link. This is the problem with people who can't objectively evaluate a lot of new data. Who should I (or anybody else viewing here) trust more, you or Dr. Brewer? It isn't even close. By the way, I did watch "The Widowmaker Movie" and read up on a lot of other CAC score information as I had a CAC score done myself. I have experienced both a CIMT test and a CAC score test, and have taken the time to learn a lot about both.

    Leave a comment:


  • fatmax
    commented on 's reply
    My view is based on this excerpt of an interview of Matthew Budoff and from other interviews of him:

    http://www.stayinghealthytoday.com/c...atthew-budoff/

    "Is Carotid Intimal Media Thickness (CIMT) Testing of Value for Coronary Risk?
    Carotid Intimal Media Thickness (CIMT) testing is not the optimal test for evaluating atherosclerosis. It is mostly measuring the media thickness. The media is much thicker than the intima. The intima is where the atherosclerosis occurs. So the CIMT misses most of this. 80% of what it is measuring is the normal wall of the carotid artery. CAC scoring is a much more accurate assessment of coronary artery risk. CIMT really is outdated for this evaluation."

    Here are his credentials:
    http://www.cardiometabolichealth.org...ew-budoff.html

    I recommend you watch 'The Widowmaker Movie' and search YouTube for other interviews of him.
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