Should we be thankful for calcified plaque?

What many people don’t realize is that when doctors try to assess your level of heart attack risk, we are generally using population-based statistics to estimate the risk of the individual person in front of us. What do I mean by saying “population-based statistics”? 

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What that means is that as a doctor, I know that if you show me a group of people (“population”) where everyone has a high cholesterol level, then I can confidently tell you that after 10 years there will be more heart attacks in that group, compared to a separate group of people with low cholesterol. But not EVERYONE in that group is going to have a heart attack. It’s just that it is more likely. Think of it in terms of two separate groups of 100 people. In the high cholesterol group of 100, at the end of 10 years maybe there are 20 heart attacks, compared to only 10 heart attacks in the low cholesterol group. Being in the high cholesterol group DOUBLES the risk of heart attacks. But there were still 80 people in that group who DIDN’T have a heart attack.  

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So when we assess your risk, we are making assumptions. We assume that if you have high cholesterol, then you will be just like the other people in the high cholesterol group. But even if you have high cholesterol and are in the more “dangerous” group, how do we know if you are going to be one of the 20 people who had an event vs one of the 80 who didn’t?

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We don’t. We simply move on to assess your other risk factors. And as the risk factors add up, it moves you into smaller and smaller groups (“people with high cholesterol AND high blood pressure” or “people with high cholesterol, high blood pressure AND diabetes”). And we know that your risk level changes based on which “group” you end up in.

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And this of course is the reason we want people to move into “groups” with low cholesterol, low blood pressure, low blood sugars, etc where there are fewer heart attacks and it is less likely. 

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But this is obviously an inexact method of assessing YOUR unique risk. The problem is that for years it was all we had to work with. 

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Over the past 20 years, we’ve been trying to move from “population-based” risk assessment to more individualized assessments. And while there is still a LOT of work to be done, we are getting closer and closer to being able to give individual people a risk assessment that is unique to them, and not dependent on their similarities to large groups of comparable people.

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One tool that we are using more and more to assess an individual’s risk is the Calcium Score. A Calcium Score is a simple radiology test that looks for evidence of “hardening of the arteries”. It is a low-radiation CT scan (“CAT scan”) that looks for evidence of calcified blockages in the heart. Plaque buildup in these arteries is what leads to heart attacks. The plaque in these arteries starts as a soft, waxy substance. But over time, as it grows bigger and accumulates, it also hardens and turns into rock. That rock is calcium, and calcium can be seen on X-Rays and CT scans. So when we do a CT scan of your heart and see calcium there, we know you have plaque. Definitively. No if’s, and’s or but’s. 

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With this test, we are no longer guessing whether or not you might have heart disease based on complex calculators that compare you to other populations of people with similar cholesterol levels and blood pressures. We are actually seeing that you genuinely do (or do not) have the plaque that can lead to a heart attack.

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And KNOWING that you have plaque allows us to do something about it. We can then work together to halt the growth of the plaque, and even melt it away (the official doctor term is “regression”, and yes it is possible). 

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Listen: the research is pretty grim: 50% of people are diagnosed with heart disease at the time of their first heart attack. And for about 1 out of 8 people, their first heart attack is fatal. Which means that despite our statistical calculators and population-based risk assessments, we are missing the boat on half the people out there, and for some families, that is a catastrophic error. 

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Do your heart a favor and get a Calcium Score. They are under $100, and frequently far cheaper than that. You may or may not like the result, but you’ll be thankful that you know, and then can do something about it. That way you can prevent yourself from becoming a statistic.

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At Wisconsin Cardiology Associates, we specialize in advanced methods of risk assessment, and can guide you through the process of evaluation. Have questions about the best way you can evaluate your risk of heart disease? Call us and make an appointment for a consultation.

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