"Your heart scan score means nothing"

1. June 2007 William Davis (7)
Charles was visibly confused.

He'd gotten his CT heart scan after hearing one of the local scan center's ads on the radio. His score 2773, obviously in the 99th percentile for any age.

"Do you think the score means anything? My primary doctor said that it was meaningless because it was all in the deep wall of the artery. He said that it has nothing to do with risk for heart attack. As long as I feel good, he says don't do anything."

What exactly did his doctor mean, in the "deep wall of the artery"?

What the doctor is referring to is the fact that some people with a long history (many years) of diabetes or kidney failure (also for many years) tend to develop calcium deposits in the media, or muscular layer of arteries. The media is the tissue thin layer just below the intima, the most inner layer of arteries that we usually associate with atherosclerotic plaque and the layer that is most prone to calcium accumulation that we score on heart scans.

Aging, generally into your late 70s, 80s, and onwards, also increases the likelihood of medial calcification. Lastly, longstanding deficiency of vitamin D encourages medial calcification.

Is there any way to distinguish intimal vs medial calcification on a heart scan? No, there is not. Having read many thousands of CT heart scans, I can tell you that there is no practical way in 2007 to tell the difference.

Then how did this doctor "know" that Charles' calcium was "deep walled" or medial? Simple: He didn't. This was yet another example of ignorance based on old thinking. Unfortunately, he did Charles a serious disservice by dismissing his heart scan score that predicted a 25% per year risk for heart attack.

Interestingly, whether calcium is intimal as in atherosclerotic plaque, or medial, both are strongly associated with risk for heart attack. In other words, if calcium is confined to the intima, heart disease risk is present. If calcium is limited to the media, risk is still present.

In all practicality, the only difference we make of the intima vs. media argument (that is, when the distinction has been made by some other means like intracoronary ultrasound, the test that is truly necessary to distinguish the two patterns) is that medial calcification may be more powerfully related to vitamin D deficiency. Thus, someone with heavy medial calcification may require closer attention to maintaining a perfect year-round blood level of 25-OH-vitamin D3. But that's the only practical difference.
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Comments (7) -

  • Anonymous

    6/1/2007 5:26:00 PM |

    Will maintaining the Vit D level at the optimal range, reverse the media calcium build up?

    Thanks,

    Marilyn

  • Dr. Davis

    6/1/2007 9:24:00 PM |

    Our emerging experience in the Track Your Plaque program suggests that medial calcification may, in fact, be MORE amenable to regression/reversal.

  • mike V

    1/10/2008 3:31:00 PM |

    Dr Davis:
    I am 72.
    I recently had a CTA scan with "no detectable paque"
    I am also aware of recent research which shows evidence of menaquinone both preventing and reversing calcification.
    Is scanning thought to be less sensitive to medial calcification (as opposed to intimal), and at risk of being 'missed'?

    If so would preventive menaquinone be justified in a 'clean' case like mine?
    Thanks, MikeV

  • Dr. Davis

    1/10/2008 4:25:00 PM |

    Hi, Mike-
    No, the scan quite reliably detects both intimal and medial calcification. Taking K2 is very optional. How about some traditional, fermented cheese? I do not believe that K2 supplementation would yield substantial heart benefits. However, if bone health is in question, that migyht be a reason.

  • mike V

    1/10/2008 4:52:00 PM |

    Thanks, Doc:
    My cheese score is already fairly high.
    I forgot to mention that I have already been taking fish oil, coQ10,vitamin D3, magnesium etc for some years, so I *heartily* endorse your standard recommendations.
    You perform a great community service.  

    mike V

  • buy jeans

    11/3/2010 9:51:22 PM |

    Interestingly, whether calcium is intimal as in atherosclerotic plaque, or medial, both are strongly associated with risk for heart attack. In other words, if calcium is confined to the intima, heart disease risk is present. If calcium is limited to the media, risk is still present.

  • viagra online

    4/19/2011 8:54:39 PM |

    The media is the tissue thin layer just below the main fact because is one of the lasted arteries, the most inner layer of arteries that we usually associate with atherosclerotic plaque and this'll be an important discussion at the universities. Absolutely. 23jj

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Your heart scan is just a "false positive"

Your heart scan is just a "false positive"

15. August 2006 William Davis (0)
I've seen this happen many times. Despite the great media exposure and the growing acceptance of my colleagues, heart scans still trigger wrong advice. I had another example in the office today.

Henry got a CT heart scan in 2004. His score: 574. In his mid-50s, this placed him in the 90th percentile, with a heart attack risk of 4% per year. Henry was advised to see a cardiologist.

The cardiologist advised Henry, "Oh, that's just a 'false positive'. It's not true. You don't have any heart disease. Sometimes calcium just accumulates on the outside of the arteries and gives you these misleading tests. I wish they'd stop doing them." He then proceeded to advise Henry that he needed a nuclear stress test every two years ($4000 each time, by the way). No attempt was made to question why his heart scan score was high, since the entire process was outright dismissed as nonsense.

I'm still shocked when I hear this, despite having heard these inane responses for the past decade. Of course, Henry's heart scan was not a false positive, it was a completely true positive. I'm grateful that nothing bad happened to Henry through two years of negligence, though his heart scan score is likely around 970, given the expected, untreated rate of increase of 30%.

The cardiologist did a grave disservice to Henry: He misled him due to his ignorance and lack of understanding. I wish Henry had asked the cardiologist whether he had read any of the thousands of studies now available validating CT heart scans. I doubt he's bothered to read more than the title. The cardiologist is lucky (as is Henry) that nothing bad happened in those two years.

Do false positives occur as the cardiologist suggested? They do, but they're very rare. There's a rare phenomenon of "medial calcification" that occurs in smokers and others, but it is quite unusual. >99% of the time, coronary calcium means you have coronary plaque--even if the doctor is too poorly informed to recognize it.
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