Stress tests, calcium score and predictors of CAD

I had a nuclear stress test.  Showedpotential problem.   I was advised that a tomography showing calcium would be a test that could avoid the need for an angiogram.

I had tomography on new ge machine.  Showed calcium score of zero.  Then advised two different opinions.  ONe was that with a calcium score of zero, the nuclear stress test was probably not indicative of a problem.  That the position of my heart my have caused  the indication, but that this is not unusual in nuclear stress test, they have a high error percentage.

Was then advised that I should have an echo stress test.  That this would be more definitive.  That is scheduled for today.  If that shows nothing, is there any argument for angiogram, which I would prefer to avoid (father died during angiogram).

I recently read of Cardolite stress test.  If I will have had nuclear and echo, is there any argument for Cardolite stress test?

Related question:

I have elevated cholesteral.  MY GP suggested cholesterol medication be started immediately.  Two Cardiologists have two different opinions.  One suggested that with zero calcium score, that this isn't necessary as calcium score is far better predictor of CAD.  Other said that I should go on the cholesterol medication.  I would prefer not to, unless it is needed and I don't know what the science says.  Do you know if the science says that with zero calcium score that elevated cholesterol is or is not an indicator of statistically significant increase of likelihood of CAD?

Thank you for your guidance.

[CCF-M.D.-MJM]

Hello,

It is very difficult to answer this question.  The most important questions I would ask are how old are you,what are your cardiac risk factors and what are your symptoms.  If I was completely convinced your symptoms were cardiac--I would do a stress test, I would recommend a cath. If your symptoms convincing or if your symptoms were marginal and you have a lot of risk factors I would do a stress test (exercise echo, nuclear stress test).  If your stress was negative, I would  stop and treat any risk factors you may have.  If your stress was inconclusive and your symptoms were convincing, I would recommend cath.  Obviously for a positive stress over a significant heart territory, I would do a cath.

Calcium score does not enter into my equations yet.  Certainly a calcium score can help risk stratify you for major cardiac events over the long term, but it does not tell you specifics about the extent of your current blockages.  A CT angiogram or a cath angiogram can do that--cath is still the gold standard.

Regarding your cholesterol, it depends on what your lipid panel shows and the number of risk factors.  If you have coronary disease by angiogram, I would start a statin for almost any level of LDL cholesterol baring a contraindication.  The data for statins prevent coronary disease is too good to ignore.  I do not consider calcium score when prescribing  a statin--there is zero data for that.

I hope this helped answer your question.

[Barbarella]

It will be interesting to see what the Cardiologist who will respond to your post will have to say.  I don't know how old you are.  A Cardiologist told me one time that it takes decades for your arteries to clog up with Cholesterol. My regular doctor said even if the arteries are clean to take statins to "prevent" any blockages in the future. I was very scared to take statins (I have very high Cholesterol) and my son suggested that I take the scan of the heart and brain to see if I have any blockages, if not then not to take statins. I decided to take Zocor instead I was scared what the scan will show, I know this sounds crazy but this is how I am.

[petmitt]

thanks for your response.  Can you describe the "CT angiogram" you mention?  Is this also an invasive procedure?

Here is a study with significant n re:  calcium scoring as predictor of CAD. Does this impact your opinion with respect to consideration of calcium scoring in this process?

http://www.newportbodyscan.com/GuidetoCoronaryCalciumScoring.htm