"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

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    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.

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    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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I had a heart attack--and I don't know why!

I had a heart attack--and I don't know why!

25. October 2006 William Davis (0)
Kevin came to my office for another opinion.

A husband and father of two teenagers, Kevin had his first heart attack at age 39. Kevin received two stents to his right coronary artery. The entire process took place in a flurry with little explanation over 48 hours, start to finish.

He smoked a pack of cigarettes a day, but the only history of heart disease in his family was his father, who, also a smoker, had his heart disease uncovered in his late 70s.

His internist subsequently prescribed Zocor even though Kevin's LDL cholesterol was a relatively unimpressive 128 mg/dl.

Kevin subsequently asked his cardiologist, "Where did I get the heart disease from?"

"Cigarettes. And genetics. You can quit the first. There's nothing you can do about the second." End of explanation.

This left Kevin frightened and demoralized. If much of the cause of his heart disease couldn't be identified, why bother quitting smoking? Why not enjoy what time he had left?

Kevin was understandably shocked when I told him that genetic causes were 1)identifiable, 2)quantifiable, and 3) correctable.

Kevin's full lipoprotein analysis subsequently showed the most dire combination that commonly accounts for coronary disease in young people: Lp(a) with small LDL particles. This, along with smoking, fully accounted for this young father of two's heart disease.

Along with starting Kevin on a new program for correction of his patterns, I also persuaded him to get a heart scan. What usefulness is a heart scan after the fact? Plenty. Even though Kevin's right coronary was no longer "scorable" because the steel in the stent obscured our measurements, the two remaining unstented arteries would still yield a score. This provides a baseline for future comparison. Even after a stent, Kevin could "track his plaque".
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Estrogens and CT heart scan scores

Estrogens and CT heart scan scores

2. July 2007 William Davis (1)
A recent study from the Women's Health Initiative (WHI), the large study that originally showed no reduction in heart attack with use of estrogens in postmenopausal females, has just published a new study.

In this new effort, women who took Premarin (horse estogens) had up to 61% lower CT heart scan scores. This new study was confined to the women from the original WHI study who had entered the study between the ages of 50-59 years (average 55 years old), since this was the significant subgroup of women who actually showed a reduction in heart attack risk, whereas other groups showed no benefit or a slightly increased risk.

For a full discussion of this fascinating result, see the Track Your Plaque report, Can estrogen reduce CT heart scan scores? at http://cureality.com/library/fl_06-017estrogen.asp. (This report is open to both Track Your Plaque Members and non-Members.)

I truly wish that the issues surrounding female hormone replacement were clearer. This new perspective adds just another interesting twist on a strategy that too many people, in my view, dismissed too readily with the initial WHI results.

To add to an already confusing situation, the WHI study was sponsored by Wyeth Pharmaceuticals, the maker of Premarin, and many of the investigators participating in the study obtained financial compensation from Wyeth. On the one hand, we have to give credit to the company and the investigators for publishing the initial study that panned the effects of Premarin. On the other hand, it makes any positive data somewhat suspect, particularly since there is a far less costly and probably superior preparation called human estrogens.

Incidentally, Wyeth is also behind the maddening FDA petition to prevent "compounding" pharmacies from dispensing human hormones like estrogen unless made by a drug manufacturer. They hide behind claims of concerns over safety. Nonsense. This is pure profiteering and protection of their enormously profitable franchise and has nothing to do with public safety. If there were genuine concerns that the compounding pharmacies, around for decades with an excellent reputation, pose safety issues, why not just lobby for improved oversite?

If only we had data like WHI that used human estrogens and human progesterone. I suspect that we'd see bigger, better effects with less of the ill effects peculiar to the cross-species use of Premarin and the synethetic progestin, Provera.
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Comments (1) -

  • Anonymous

    5/12/2008 3:33:00 PM |

    What about Men's estrogen levels and plaque?
    Men with benign prostate enlargement are now being told this is primarily due to high Estrogen levels and most prostate complex supplements have beta-sitosterol or its equivalant to lower Estradiol(estrogen) levels.
    How will this alter their plaque levels,if at all?

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