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Journalism of Courage
A 50-year-old man came to my OPD the other day to get his reports assessed and seek guidance about whether they indicated any risk of heart disease. He was a non-smoker and non-diabetic. But his LDL (low-density lipoprotein or what we call bad cholesterol) was borderline high. In other words, it was neither too low to neglect, nor too high for medication. His other parameters were all normal. But there was this one test that changed my diagnosis.
I recommended the calcium score test, a simple CT scan that does not need an invasive procedure with dyes. It measures the amount of calcified plaque that has built up in your arteries, which can trigger heart attacks and strokes. A high score puts you in the at-risk category and though it doesn’t mean you will get a heart attack the next moment, it indicates a probability which can be lowered with drugs and lifestyle modification at an early stage. This mapping is important because this actually is evidence of a developing blockage, which rarely shows up in routine blood tests. We often get surprised by sudden heart attacks and wonder why people with normal parameters experience them. A calcium score test is a good predictive marker.
My patient scored just above 100. To me any calcium score above 1 is a risk. Without the scan, I would not have known of his plaque clusters, which could rupture, trigger clots and block blood flow in the heart. It indicated that he needed cholesterol-lowering drugs to prevent plaque formation and blood thinners alongside diet, exercise and lifestyle modification. Another patient of mine with similar readings and profile, 62, scored zero, which means he did not need any medication.
Most patients have some sort of comorbidity or a family history. That’s why I tested my patients randomly and found that one in five was calcium-positive, which means one in five had plaques.
Calcium deposits in arteries form because the muscle cells in the blood vessel wall start to change into bone-like cells when they are old or diseased. The calcium deposits in your arteries are not related to the calcium in your diet or the Vitamin D supplement you may be taking. They occur because the cells in your blood vessels are not working as they should.
For me personally, zero is safe but anything above one means that you have a risk of heart disease, no matter how low. The presence or absence of calcium is more important than a degree. The score is like an early warning system. Zero to 100 means you have some plaque though the overall risk of heart attack is still low. A score of 100 to 300 means your predicted risk of getting a heart attack is moderate to high and will require medication along with lifestyle changes. Over 300 means you are at high risk and your cardiologist will need to put you on statins to reduce your cholesterol levels.
I would recommend it to anyone with more than 10 years of diabetes, those with borderline co-morbidities, smokers and those with a family history. A zero score means a heart attack is least likely in the next five years. Once you have had a heart attack, you do not need this test as you are anyway under a treatment protocol. A follow-up gap of at least five years between CT scans is recommended.
(Dr Shetty is lead cardiologist and medical director at Sparsh Hospitals, Bengaluru)
