
Marshall Allen is a beloved health care journalist who just died of a heart attack. The real tragedy of this story is 52-year-old men don't have to die of heart attack nearly as often today. The same goes for Alice Stewart who died suddenly recently, probably of a vascular event like a heart attack or a stroke. Many of us have pap smears, mammograms, and colonoscopies to identify life threatening diseases early. A coronary calcium score is the equivalent test for the coronary artery disease that causes a heart attack. A coronary calcium score tells you how much cholesterol plaque is in your heart arteries. If your calcium score is not zero, you have cholesterol deposits in your artery that could rupture leading to a clot that blocks the artery and causes a heart attack.
It makes sense for men to have that test in their early 40s and women in their early 50s. It is a low radiation dose CAT scan that can be obtained in most communities at low cost. A 2024 study found that a coronary artery calcium (CAC) score can identify patients with a low risk of heart attacks or strokes. The study found that patients with a CAC score of 400 or higher had a 6.8% risk of heart attack, while those with a score of 1–399 had a 1.9% risk. A score of 100–300 indicates moderate plaque deposits and a relatively high risk of heart disease over the next 3–5 years. A score greater than 300 indicates more extensive disease and a higher risk of heart attack. The calcium score tells you how much cholesterol plaque you have in your heart (and other) arteries. If your score is over 0, you have some plaque. If it is over 100, you should be on optimal medical therapy for coronary artery disease. The highest risk patients are those who have already had a heart attack. Patients who have had a heart attack and go on optimal medical therapy are ten times as likely to be alive in 5 years compared with patients receiving usual care which is the care that most of us get.
The plaque that causes a heart attack may not block the artery at all prior to the event as you can see in the slide at the beginning of this article. Early cholesterol plaques push the arterial wall out and do not block the artery at all. Many women have heart attacks related to cholesterol plaques that do not block the artery. A heart attack happens when the plaque ruptures and initiates clotting. The artery goes from no blockage to complete blockage in a matter of seconds. Patients with this problem often have normal stress tests and a normal heart artery catheterization. The calcium score is the only widely available and inexpensive test to positively identify people who are at high risk and need optimal medical therapy.
What does OMT look like for someone with a calcium score above 100? Thank you!
Thank-you