In general lots of good comments already. I think the Claude AI summary RapAdmin provided was particularly informative.
I looked into this myself in the past and the general consensus is against serial measurement of CAC scores once you’ve decided to treat with a statin, or a statin plus Zetia, or statin plus Zetia plus …
I violated this rule myself so I understand why others might as well. But the CAC score’s best use (as of today) seems to be risk stratification. If you were on the fence about whether to take a statin and you got a zero score, you might decide to not take the statin and repeat the test in a few years. That is defendable.
Once you decide to go on the statin, the question is what are we going to do with the new test information? Would you decide to stop the statin if you like the results? What changes in treatment depending on the next test? If the answer is nothing, then probably the next test is not warranted.
But of course if you are paying for the test yourself, and you want it, I see no reason why you can’t get it. It is your body and your money and should be up to you.
Anyway, despite saying all of this, I may get another one in a few years, although I doubt it. Both of my tests yielded horrific numbers, the 2nd worse than the 1st.
At some point one accepts that they have to almost consider themselves as belonging in the secondary prevention group of patients (rather than the primary prevention group), despite never having had an MI yet. I don’t think my cardiologist particularly cares what my future CAC scores are; I am on maximal recommended medical treatment already, my LDL is ~ 40 mg/dL and there is not much else to be done in the absence of symptoms.
I think the main purpose for my father was if his score went up, we needed to think about the possibility of adding stents. And if it went down, which it did, he can feel exuberant about this progress. I think the placebo effect could be beneficial in many cases. You feel like you are getting in better shape and that changes your game mentally. Especially since he was shocked the first time by his relatively high numbers.
My understanding is that stenting stable CVD is not appropriate. For years we all assumed that a stent could be helpful for people with “clogged” arteries but it turns out that, in the absence of symptoms, stenting has shown no benefit. So it is basically no longer recommended.
It is a weird thing because if you are having a heart attack, stenting is crucial and can absolutely save your life. And it seems so physically obvious that it should help in other situations also. But we’ve basically learned it doesn’t. At least this is my current understanding. Obviously I am not a cardiologist.
This having been said, I completely agree with you that the benefit of seeing a lower number is huge, even if it is measurement error. It motivates us normal humans. There was a problem, he has taken action, now the problem was inspected again and shown to be diminished. He is making progress. It makes it easier to keep doing whatever we have been doing. It is great.
As a follow up, I spoke with my father’s doctor about the lower CAC score. He said he truly believes the score was lowered.
I asked him about the statistical variance issue. He said that is true if the measurements are done at two DIFFERENT clinics on DIFFERENT machines. Since my father’s scan was done at the SAME hospital on the SAME machine, statistical variance should not be a large factor.
So, the doctor believes that my father’s low ApoB and lifestyle has truly lowered his CAC score. We’ll measure it again in 2 years and update then.
I don’t know much about CAC scores etc, but there should still be statistical variance independent of that. I don’t understand this doctor. What’s important is to lower the risk of events. But of course you should follow his cardiologist’s advice.
It’s not possible to reverse atherosclerosis fully yet – it’s built up in the wall, and no treatment has proven to do so, and no drug is allowed to claim it.
Reading between the lines of some of what Simon Hill has said is that to note regression with certainty serial CCTA is needed with a 5 year interval, at least in his case.
I believe that what the doctor meant is that there will be some variance, but not a large amount if the same machine is used. My father’s reduction in his score was near the top of the range for variance and the doctor believes that because of these factors some reduction took place.
I understand that there is no current treatment for the reduction of calcified arterial plaque, but there are some treatments to do just that under development. I am hopeful.
Either way his score should have gone up significantly over the past two years and it didn’t, so LLTs are a big win IMHO. I’m just sharing what my father’s doctor said.
What I’ve read is that soft plaque is the real issue, and CAC score doesn’t tell you anything about that. It’s what CCTA with Heartflow can show. CAC is outdated and CCTA is better as long as it’s not contraindicated, it’s the future.