EBCT Calcium Scores

[Robert J. Feinberg]

Please provide interpretation of test results below and preventive measures to be undertaken:

Age:     39
Sex:     Male
Race:    Caucasian
HT/Wt:  5' 9" , 175
BP:     Moderate
Family History:    Positive for CAD;  father-multiple angioplasty (age 55-68) and bypass surgery X5 at age 70;  mother high BP; brother poor lipids; both grandfathers positive for CAD

Myself: former smoker (age 16 - 26.@ 3 packs per week)
        active; exercise 3x per week
        diet: good, sensitive to avoiding trans choles. rich   foods; asymptomatic;  Mevacor  & 83 mg. aspirin for 3 years  (Mevacor was effective in reducing my lipids)

Berkeley Lab:
Total CHL: 154   LDL 80   HDL 52
TRIG              110
APO B PART#     70
EXT RANGE LP   22
C-REACTIVE       0.2
HOMOCY           6.6
SINGLE PREDOMINANT LDL PEAK (269A) IN THE "A" PATTERN REGION

CARTYLITE STRESS TEST:  Negative after completing Bruce Protocol

EBCT:  Total Calcium score 80 - Multple vessels in LAD & LCX

My cardiologist switched me to Lipitor 20. Due to conflicting discussion re: EBT utility(false negatives)in asymptomatic patients,I am concerned.  Is my calcium score, based on my age, suggestive of plaque likely to rupture? Should I view the EBT results as a sign of things to come?  Is location of  calcium in vessels that one would normally see see first develop CAD?  Does my particle size suggest  plaque  within  the vessel itself?  Are my EBT results type one would see in young men who have heart attacks w/o having prior symptoms?

Suggestive treatment?
Follow up tests?  Concern level?

[triq]

For what its worth, I had a CT calcium score in "mild/moderate" range in 2002 along with normal stress test and no cardiac symptoms (had tests as part of required physical). GP ordered tests.  Cardiologist did not know what to do with calcium score but was worried that the calcium was essentially all in one area in my LAD so we did cath and found a 95% narrowing which was stented and I have done well.  Another cardiologist recently told me that he would never have done the cardiac cath without symptoms and with a normal stress test (elevated cholesterol and LDLwere me risk factors at age 59).  I feel that my first symptom may have been death so in my case I feel that the calcium being all in one spot was a significant red flag to justify more aggressive tests.
All tests have false positives and negatives . I do wonder iif there have been any studies to show if the majority of the calcium is in one spot if there is a corresponding significant narrowing.

[CCF-M.D.-MJM]

Hi Robert,

This is a very good question, but difficult to answer.  I have to admit I have never order an EBCT before and am still not sure how they should be used in clinic practice.  I also copied the following quote from the J Am Coll Cardiol 2000;36:326-40

American College of Cardiology/American Heart Association Expert Consensus Document on Electron-Beam Computed Tomography for the Diagnosis and Prognosis of Coronary Artery Disease


"The majority of the members of the Writing Group would not recommend EBCT for diagnosing obstructive CAD because of its low specificity (high percentage of false-positive results), which can result in additional expensive and unnecessary testing to rule out a diagnosis of CAD."


Is my calcium score, based on my age, suggestive of plaque likely to rupture?

EBCT simply does not answer this question. We are not good at predicting plaque likely to rupture at this point.  In fact, the plaques that show up on EBCT -- calcified plaques -- may be the least likely to rupture.

Should I view the EBT results as a sign of things to come?

I would not.  If I were you I would never have another EBCT.  At this point I think they create more questions than the answer.  At this point you know you have calcium in your coronary arteries.  You are a young person.  This alone should be a call to action to aggressively reduce your modifiable risk factors.  You should continue not to smoke.  You should eat right -- at this point the best "diets" I see are the Mederteranian diet and the principles in the South Beach Diet.  Avoid saturated and trans fats.  The so call right fats are mono and polyunsaturated fats, like those found in most nuts, olive oil.  Avoid red meats.  Maintain a healthy body mass index (do a google search for body mass index or (BMI) calculator.  It adjusts your weight for your height..  I healthy number is between 21 to 24.  Most Americans are closer to 28.  Maintaining a low weight will help reduce your risk of diabetes and hypertension.  If you have hypertension or borderline hypertension, treat it.  I agree with changing to a stronger statin like atorvastatin (Lipator).

Is location of calcium in vessels that one would normally see see first develop CAD?

Not sure if there is a literature supported answer to this question.

Does my particle size suggest plaque within the vessel itself?

Again, not sure how to answer this question.  You are on a great statin medication now.  I would continue the atorvastatin and even consider increasing it. I would consider cholesterol subtyping to help with a statin in a borderline situation.  I agree you need a statin sot he subtyping is not relevant to me at this point.

Are my EBT results type one would see in young men who have heart attacks w/o having prior symptoms?

You would fit into the category of a low to moderate risk with a risk of cardiac event of 2-4% over a 4 year period.  My advice is treat yourself as I have outlined above -- treat your modifiable risk factors.  The EBCT cannot pick which people are at highest risk within this subgroup.

If you are aggressive at modifying your risk factors, my immediate concern is low.  You are certainly at increased risk as you age -- like the rest of this us -- try to not to focus on the risk.  Don't let fear of things that haven't and may not happen ruin your life.

Good luck and I hope this helps.