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  • CAC Score blew me away

    My doctor wanted to put me on a statin and used a CAC assessment to help convince me. I assumed the result would not be awesome but I did not expect to hear 1415! And this after receiving "normal" scores from Lifeline in January for Carotid Artery flow, A-Fib, AAA and PAD. I am trying to be as informed as possible and was wondering if someone could give me assistance with interpreting the results, particularly with respect to the wild distribution of calcium in the different arteries.

    For instance: Right Coronary-1175, Posterior Descending-117, Right Main-16, Posterior Descending-0.

    My take would be that my RCA has suffered more inflammation over the years (I'm 53). Not sure if that is correct, but this distribution of scores certainly doesn't support the notion that LDL is an equal-opportunity artery slayer. I would like to get a better handle on it before my cardiology consultation next week. Thanks in advance for any comments.

    BTW, I'm thankful that I found you guys. It feels a lot less lonely now.
    Stan

  • #2
    Hey Stan! Welcome.
    I definitely get how you feel. One thing that has been a real eye-opener for me from Dr Brewer's channel, is that a lot of the issues he talks about are pretty common, but are often 'silent', hard to catch, and undiagnosed. I wouldn't have bet in a million years that I had some sort of glucose problem, but after getting it tested, it's not exactly normal. Some people have an 'ignorance is bliss' attitude, and while that freaked me out a bit, I'm glad I know more about the issue and how to respond to it. Hopefully you pick up some good info as well.

    There are definitely people who know much more about CAC than I do around here. I've just heard that it's a CAT scan that measures calcium deposits in the heart, which is an indirect way to measure plaque deposits -- specifically, calcified (hard) plaque. But I'll link a few videos/sources of info that may be helpful:

    https://www.youtube.com/watch?v=QOWF0KTNu2g - "How to Reverse 20 years of Arterial Plaque: I Did: Ford Brewer MD MPH"
    https://www.youtube.com/watch?v=ysifMKWKZLY - "How I Reversed My Coronary Calcium: Case Discussion: John Lorscheider"
    https://www.youtube.com/watch?v=ysifMKWKZLY - "How I Reversed My Coronary Calcium Score by 59% in 16 months"
    https://www.youtube.com/watch?v=rA67ConEVU0 - Video from Joel Kahn, discussing statins & CAC -- statins seem to increase CAC, but that's not necessarily a bad thing, as event rates (and soft plaque, which can cause an event) goes down.


    Re. interpreting the results -- I can't begin to venture a guess at why the numbers are so different, but I can copy some passages from published research to help give you a sense of what the data says about that number...

    In an American College of Cardiology Foundation/American Heart Association (ACCF/AHA) consensus(9), data from six large studies that collectively included 27,622 asymptomatic patients were aggregated and the relative risk of major cardiovascular events was calculated for patients with a positive CAC score and for those with a CAC score of zero. The following results were obtained:
    • - CAC score of 100-400-relative risk of 4.3 (95% CI:3.1-6.1);
    • - CAC score of 401-999-relative risk of 7.2 (95% CI:5.2-9.9);
    • - CAC score = 1000-relative risk of 10.8 (95% CI:4.2-27.7).
    https://www.ncbi.nlm.nih.gov/pmc/art...PMC5487233/#r9


    If you want to venture wading through it, here's the "ACCF/AHA 2007 Clinical Expert Consensus Document on Coronary Artery Calcium Scoring" -- https://www.sciencedirect.com/scienc...636?via%3Dihub


    Dr Brewer has a free Cardiovascular inflammation video-based course on his website, if you want some insight into what it is & how to test for it --
    There's also a guide + links on how to get these tests done. The Cleveland Heart Lab is a great place that your doc (or you) can use to get many of these tests run.
    https://mailchi.mp/e7913628b730/prev...mmation-course

    I hesitate to 'recommend' any medication or course of treatment as I'm not a doc, but it's definitely worth asking your doc about Rosuvastatin (AKA Crestor) when you head in next week. I say that mostly because that is the specific statin that has been used in studies by Paul Ridker to reduce CV inflammation, and it's the statin that Dr Brewer discusses often for this effect. See Dr Brewer's video on the JUPITER trial -- https://www.youtube.com/watch?v=SWs30V3gDNQ
    See also this video, which also treats the topic of which statin to go for, and the topic of CV inflammation and CVD: https://www.youtube.com/watch?v=qaoCYz405sw

    This is getting pretty long!! I'll mention two last things then leave it at that:
    1. Olive Oil! https://www.youtube.com/watch?v=mvEiU3J5I5g
    2. I'm not sure how much you've poked around Dr Brewer's channel, but his #1 theme is the impact of (usually undiagnosed) blood sugar issues (for example, insulin resistance) on cardiovascular health. This study from UCLA -- https://healthpolicy.ucla.edu/public...ef-mar2016.pdf -- makes the point about how widespread the issue is, even though it wouldn't even occur to most that they could have some risks here (as with me). Over half of Californians (half of those 18+!! Wild) have prediabetes or diabetes, which will cause issues even if it's silent. So, it's a great idea to get tested for that as well. Usually the best way is with a 2 hour oral glucose tolerance test (OGTT) -- a cheap test that measures your blood sugars (1) at fasting, (2) 1 hour after drinking a 75g sugar drink, and (3) 2 hours after drinking that drink. It measures your system's ability to handle/respond to a 'glucose challenge', which happens to some degree or another whenever you eat carbs. If your glucose tolerance is not great (a lot of info can be found on this around Dr Brewer's pages), a low/lower carb diet can be an excellent way to knock out CV inflammation.


    Cheers,
    Taylor


    Comment


    • #3
      The Carotid Artery flow test you mentioned is probably the standard ultrasound test which typically doesn't indicate an issue is present until there is 70+% blockage of an artery. As such, I think that it is basically worthless for the most part unless all a person is interested in knowing is when to get another stent put in. I do recommend that you consider having a CIMT (carotid intima-media thickness) test done which is not the same as the standard ultrasound test. A CIMT test will give you useful information about the amount of plaque and discrete plaques in your carotid arteries which correlates well with your overall cardiovascular system. You may be able to understand how much soft plaque, mixed or calcified plaque is in your cardiovascular system. The soft plaque is what causes most strokes and heart attacks, not the calcified plaque that is detected by a CAC score test which mainly looks at the past and not the present. Just make sure that if you have a CIMT test done, that it is done by a well-trained tech. I posted the link to one of many CIMT test videos by Dr. Brewer below, and there are other videos that discuss using a CIMT test center with good repeatability (use the Search function).

      https://www.youtube.com/watch?v=KQdplHWQ9ZU&t=401s

      Comment


      • #4
        Thanks for the feedback. I am definitely going to request a CIMT test and an OGTT, as well as several blood tests. I think I will be doing a stress test the same day I meet with a cardiologist. My sister has some thyroid issues and has encouraged me to check into that as well. I hope my PCP is open-minded enough to help me with some of the "non-traditional" approaches. I have many questions that she is not going to be prepared to answer. I am encouraged though that when she does not know the answer she admits it instead of quoting the typical response. I also am trying to prepare for a hard sell from the cardiologist to put me on the fast track to surgery. He's got to make money, too, right?

        Blood tests I'm planning (so far)
        MACR - I get these annually - they just now became significant to me! Shouldn't the result be a number? My last result was a measurement - no calculation..?
        hs-CRP
        Lp-PLA2
        Fibrinogen
        MPO
        TSH
        PTH

        Again, thanks for the feedback. I am glad to hear any advice of experiences and will post back when I get results.
        Stan

        Comment


        • mtbizzle
          mtbizzle commented
          Editing a comment
          Re. the MACR. It's a calculation in a sense, but not like some other biomarkers... the microalbumin and creatinine should be directly measured. Then the ratio is determined. The test is really looking at microalbumin, as a way of determining the degree of damage to the 'filter' of the kidney. The tissues that make up this filter are the same tissues that make up part of the arteries.

          This is one of the things that really made me pay attention to the connection between blood sugar & CVD... Diabetes is well known to cause kidney issues and cause lots of microalbumin to leak into urine -- hard to ignore what must be going on to arteries if that happens to kidneys.

          The creatinine is a way to calibrate the microalbumin number, adjusting for irrelevant factors that would influence the microalbumin number. Creatinine is a v common way to 'adjust' numbers from urine tests (for example, if a person is v dehydrated or has drank a TON of water, their urine will be more or less dilute -- creatinine helps adjust for these factors).

          My gut is that it's a great thing that your PCP is up front about what they don't know. Let's be honest. Docs are often seen as experts with all of the answers. That's just not true, even for specialists. In my opinion, behind humble and honest is a great treat to have in that sort of position. I'm in the process of entering health care, and I get the sense that overconfidence is a bigger problem!

          Best of luck Stan
          Last edited by mtbizzle; 04-07-2019, 12:02 AM.

      • #5
        Good luck on your upcoming cardiologist visit. Just to make sure that there isn't a misunderstanding on your testing, the MACR (microalbumin creatinine ratio) that I am most familiar with for checking on kidney disease/cardiovascular issues is a urine test, not a blood test.

        Comment


        • #6
          Thanks. I actually did think that "micro" albumin came from a blood test. Not sure why I thought that - I knew that Albumin (without the micro) was from urine tests. Thanks for the correction.

          So, if I know my microalbumin (10 mg/L) and creatinine (0.88 mg/dL) how is MACR calculated? is it just (10 mg/L = 1 mg/dL) / 0.88 mg/dL = 1.13?

          Thanks again. I do appreciate the assistance.

          Comment


          • mtbizzle
            mtbizzle commented
            Editing a comment
            I'm not 100% posituve, but my educated guess is that you can't calculate macr unless they were both measured from the same sample. If they are from the same urine sample, you could try to just do the calculation like you say and see if the number is a value that "makes sense" given the reference ranges.

            Also note that creatinine and albumin are both in the blood as well I believe. I think they are measured in a comprehensive metabolic panel. I don't think these are the values you want! Needs to be a urine test here, not blood.

            Just pulled up a page on this that may help you out w this - Google
            "Microalbumin - Cleveland HeartLab
            PDFCleveland HeartLab › uploads › 2017/11"

            Also

            "healthinsight uacr"
            Last edited by mtbizzle; 04-10-2019, 04:18 AM.

        • #7
          The MACR that was quoted in my test results was in mg/g, and so it matters on the conversion depending upon the benchmarks you use. The recommended healthy level was quoted as less than 30 mg/g. If I did the math correctly for a mg/g result using the albumin and creatinine values above, then your score would be about 1136. So, check the math as I could have always made a mistake. If the math is correct, then my test results said that a level over 300 indicated clinical albuminuria. If the lab actually did a urine test specifically for MACR, I don't know why they wouldn't do the math for you. Perhaps you are getting some numbers from your blood test?
          Last edited by Tom; 04-08-2019, 11:50 PM.

          Comment


          • #8
            MACR is a urine test. It's looking for the amount of protein your kidneys are spilling. The kidneys are basically just filters. If the filter membrane has holes in it, protein ( albumin) spills through. Guess what the filter membrane is? The intima. I know they say less than 30 is OK. That's for kidney disease, not CV risk. For CV risk it's 7 for men and 14 for women.https://medlineplus.gov/lab-tests/mi...atinine-ratio/

            Comment


            • #9
              Originally posted by Ford Brewer View Post
              MACR is a urine test. It's looking for the amount of protein your kidneys are spilling. The kidneys are basically just filters. If the filter membrane has holes in it, protein ( albumin) spills through. Guess what the filter membrane is? The intima. I know they say less than 30 is OK. That's for kidney disease, not CV risk. For CV risk it's 7 for men and 14 for women.https://medlineplus.gov/lab-tests/mi...atinine-ratio/
              Dr. Brewer,

              I think that you mentioned this in passing in a previous video. I know that you have a lot of videos in the queue, but explaining this a bit more (CV risk for men at 7 and 14 for women) would be useful to a wide audience. I thought that my value of 13 was doing well enough given the 30 number that the test notes is normal, but I guess not from what you said. I looked at the webpage you referenced above, and it and nothing else I could find gives any further breakdown into how somebody came up with those CV risk numbers. Thanks.

              Comment


              • #10
                Originally posted by Tom View Post

                Dr. Brewer,

                I think that you mentioned this in passing in a previous video. I know that you have a lot of videos in the queue, but explaining this a bit more (CV risk for men at 7 and 14 for women) would be useful to a wide audience. I thought that my value of 13 was doing well enough given the 30 number that the test notes is normal, but I guess not from what you said. I looked at the webpage you referenced above, and it and nothing else I could find gives any further breakdown into how somebody came up with those CV risk numbers. Thanks.
                Tom, check this - Google "Microalbumin - Cleveland HeartLab
                PDFCleveland HeartLab › uploads › 2017/11"

                A few studies popped up when I googled "microalbumin creatinine cardiovascular". I'm sure there'd be some good info in them/in their citations if you wanted to do a bit of digging.

                Comment


                • #11
                  Originally posted by mtbizzle View Post

                  Tom, check this - Google "Microalbumin - Cleveland HeartLab
                  PDFCleveland HeartLab › uploads › 2017/11"

                  A few studies popped up when I googled "microalbumin creatinine cardiovascular". I'm sure there'd be some good info in them/in their citations if you wanted to do a bit of digging.
                  Thanks. I remember seeing a series of the Cleveland Heart Lab webpages for their tests several years ago before I had an MACR test done, but I couldn't find them during recent searches.

                  Comment


                  • #12
                    I finally have been told that I'm being referred to a cardiologist. This after a normal EKG and "unremarkable" stress test. Seems like no one has a sense of urgency. Good thing I don't have a life-threatening disease or anything.

                    Comment


                    • #13
                      Yeah, the flip side of not knowing is knowing and not being able to do a lot about it in the very near term. You can congratulate yourself for starting down the path to be healthier as it is almost never too late (obviously better sooner than later). Try to stay positive. The health care system works slowly if your risk of having a stroke/heart attack is low in the very near term, otherwise they would have moved quickly. In the interim, if you haven't done so you should spend time looking at the many good videos that Dr. Brewer/John Lorscheider made over the past few years on inflammation, CIMT tests, CAC scores, how to prevent heart attack/stroke, etc. If you have any doubts about your blood glucose levels, get a glucometer with test strips and do some measurements. Above all, try to make sure that you get plenty of sleep and can de-stress to a degree.

                      Comment


                      • #14
                        I hope this helps. When I was 46 I got a CAC score of 1092 (all in RCA and LAD). You've handled it much better than I have. Perhaps it was because I had been reading about the CAC for over a year before I finally did it. After I saw the number, I came unglued. I couldn't differentiate between anxiety attack, angina, or MI. I admitted myself to ER and ended up getting angioplasty. I had 2 arteries blocked 95%. Before I saw the number I was asymptomatic. As far as treatment goes, I believe I did the right thing. But it was a really hectic week. Panicking only makes things worse. Take it seriously, but stay calm and make rational decisions. One thing I would caution you about. You'll find a lot of LDL / ApoB skeptics on the internet, especially in the low carb space. Some even say high LDL is good. You can find a group of people to tell you anything you want to hear. While LDL isn't the entire story, it is a factor, and more isn't better; it's worse. Best wishes to you.

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