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Extensive Plaque Burden
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Extensive Plaque Burden

I just received the report from a heart scan that says: total calcium score 1241 with the left anterior descending artery taking the brunt at 782. Question: how long does it take to get this bad? I had a CT scan 10 years ago and they told me then that one artery was blocked 25% and that probably wasn't anything to worry about. I have no symptons at this time other then when I walk uphill (@~16min./mile) and have already put in ~2 miles, I get out of breath pretty fast. I am a 74 year old male, non-smoker, 5'-11" weighing 240#. My total cholesterol is high at 280, but for the past year I have refused to take Statins because I had a very bad experience with Vytorin that sent me to the ER. I had been taking Vytorin for about 3 years and prior to that Lipitor, Pravachol and Zocor for about another 7 years or so.
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367994_tn?1304957193
I had a CT scan 64 slice a year or so ago.  My total cholesterol was over 1000 and my LAD is totally blocked.  

The calcium score refers to soft plaque within the lining of the artery.  The danger of soft plaque is that it presents the highest risk for a heart attack.  The soft plaque that accumulates can break through the lining into the lumen (vessel channel) and lodge where it can seriously occlude the vessel and limit blood flow.

The 25% blocked vessel indicates hard plaque (calcified) that resides in the lumen, and as it accumulates it can begin to obstruct blood flow...25% blockage does not warrant much medical attention....and almost always not anything to be concerned over...70% or greater may begins to cause a problem (chest pain) and may require intervention or medical treatment.

The cholesterol medication would be to stop any progression of soft plaque. I hope this helps provide an insight, and if you have any follow-up questions or comments you are welcome to respond.  Take care.
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Avatar_m_tn
Thanks for your reply. There is one thing I have a problem with though. The CT scan is basically computerized X-rays, the way I understand it. So how can it detect soft plaque? Calcium deposits are a different thing, I was basically trying to find out how long it takes (years, months) to develop that many calcium deposits. I have been on Statins for more than 10 years, so what are they good for other than causing side effects?
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367994_tn?1304957193
The more slices (different angles) the better for a 3D effect.  The images are reassembled to provide a view of the vessel anatomy.  A plain x-ray is just one dimensional.

Almost every individuals with the U.S. population has some hardening of the arteries and calcium buildup.  The soft plaque within the lining of the vessels has the largest risk for a heart attack (I believe > 90%).  The soft plaque can break through a crack in the lining and eventually into the lumen that can cause a heart attack, also the soft plaque can cause stenosis by a bulge into the lumen.  Sometimes the bulge remodels the vessel, and there isn't any vessel stenosis (bulge to the outer side).

There are many factors that can contribute to plaque accumulation and a recent finding that many young men returning as a casualty had advanced coronary artery disease confirmed by an autopsy.  Medication for high cholestoral seems to prevent the progression of CAD but medication will not prevent so an individual should also exercise, proper diet, etc.

Sometimes with exercise, proper diet, etc. can reduce the cholestoral level so medication can be avoided.

Hope this helps, and if you have any further questions you are welcome to respond.
Take care, and I wish you well going forward.



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976897_tn?1379171202
You are correct, a calcium score is only hard plaque which has become calcified, in fact it doesn't account for soft plaque at all because calcium isn't involved. There is concern of how misleading a calcium score can be. It is believed that African Americans have a much higher level of soft plaque, which makes their results very misleading because as Kenkeith correctly says, the soft plaque is the real danger.

For backup see here....
http://www.medpagetoday.com/MeetingCoverage/RSNA/23660
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367994_tn?1304957193
I think the misleading issue is that it lacks the predictability it claims to have.  I was classified as a high risk to have a cardiac event within a year....waiting for other shoe to drop :) going on two years.  It is almost a given that under most circumstances there can be an educated guess by the doctor about the vessel anatomy (i.e. high cholesterol) and no useful purpose for a CT scan.  The utility for a CT is a quick diagnosis in an emergency.  
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976897_tn?1379171202
yes I agree, it's a non invasive way to see if angioplasty is required. I'm not sure about an emergency though, never heard of that one. Everyone I know who was rushed to hospital in an emergency has been wheeled straight to a cath lab because minutes wasted are muscle cells lost.
I think a CT has a couple of good uses. It can be used in a screening process for those felt to be at high risk, or it can be used to search for problems that an angiogram didn't/couldn't reveal.
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