Measuring your Heart Attack Risk: Coronary Calcium Score: History, Risk Adjustment
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- Опубліковано 7 лют 2025
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ABOUT THIS VIDEO:
Unfortunately, stress tests are utilized too often for screening. And they can give a false sense of security. Just ask Tim Russert's family - and countless others that have had events - often fatal - after having a negative stress test.
There are a couple of alternatives: CIMT and Coronary Calcium. I prefer CIMT for several reasons. But CIMTs are often difficult to access. Coronary Calcium is also good as a screening tool. (Contrary to what many believe, there's a good case for occasional use sequentially as well. See Budoff 2013 and John's video on CACS.)
This video covers the 2006 publication of the AHA scientific policy document on CAC for screening purposes. It also covers some basic history and interpretation of the Agatston score- still the best scoring method for CAC.
www.ahajournal...
www.ahajournal...
Loscalzo's article re: "Spirit of Embargo"
www.ahajournal...
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ABOUT DR. BREWER
Dr. Brewer started as an Emergency Doctor. After seeing too many preventable heart attacks, he went to Johns Hopkins to learn Preventive Medicine. While there, he went on the run the post-graduate training program (residency) in Preventive Medicine. From there, he made a career of practicing and managing preventive medicine and primary care clinics. His later role in this area was Chief Medical Officer for Premise, which has close to 1,000 primary care/prevention clinics. He was also the Chief Medical Officer for MDLIVE, the second largest telemedicine company. More recently, he founded PrevMed, a heart attack, and stroke prevention clinic.
At PrevMed, we focus on heart attack, stroke, and cognitive decline. We serve patients who have already experienced an event as well as those who have not developed a diagnosis or event. Dr. Brewer provides services via telemedicine or in person if you're in the Lexington, KY area. We find a lot of undiagnosed prediabetes or insulin resistance. Treating unrecognized risk factors like prediabetes allows reduction of risk and prevention of disease.
If you are interested in becoming a patient, please visit our website: prevmedhealth.com.
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TRANSLATIONS *** Please help by providing a translation of video captions for those that speak your language. Not everyone understands English, especially with my Southern US drawl. Click this link to provide translation services - help save lives!! bit.ly/PrevMed...
Interesting discussion, as usual. Thank you. I am wondering what your thoughts are on coronary CT angiography. This is a totally different test than a calcium score. The radiation dose is significantly higher & you have to have an order from your doctor. But it is the best (most accurate) non-invasive test to identify and measure plaque in the coronary arteries. You can have a calcium score done at the same time as well. The contrast allows the physician to actually visualize both the walls & the lumen of your coronary vessels. I think it would be very complementary to CIMT & having both tests would give the patient the most information.
Thanks. But I don’t do a lit of those. Are you saying you think every patient should gave CT angio as a screening procedure.
@@PrevMedHealth No, not at all. I think the radiation dose is too high. But it has come down significantly with the newer CT machines. I do think it would be a good screening tool once every 7-10 years. However, I’m assuming arterial wall plaque can accumulate much faster than that. It would just be great to actually know for sure what your coronary arteries look like noninvasively without a PCI. I know a radiologist who specializes in cardiac imaging & he told me he gets one every 10 years. He is asymptomatic.
Both my father & my grandfather had an MI in their 50’s & I just want to break the chain. To me I just feel like there is no substitute for being able to actually see what your coronaries look like.
I watch your videos every day. They are awesome!
Also, CAC doesn’t tell you anything about soft, vulnerable plaque.
Thanks.
Thanks - for the clarification - and the comment.
Yes. Very true. That has created boatloads of confusion.
You are, by far, one of the most detailed, data driven prolific UA-cam Docs I've watched.
PLUS, you are generous to give credit where credit is due, and you actually address viewer comments, making your Doc channel one of the most credible, IMO.
My wife and I will be reviewing your PrevMed docs to see if joining your team will be of mutual benefit over the next week or two (out of State ATM).
Thank you.
Totally agree
Yes, he is!
@@Gigi-z3z , and apparently a certain highly viewed TN UA-cam Doc has now blocked and deleted my post of his actual patient posts from ratemds. 🤷♂️
There were a few Board citations with penalties against this KETO (now Carnivore) Doc from the TN Dept of Health recorded on their Disciplinary Action Reports available online.
Apparently, he is allowed to verbally discipline other Physicians, but you can't mention actual Disciplinary actions against him on his own page. 😁
Hello Dr. Ford I did my Coronary Artery Calcium Score CT and my score is 171 this numbers are still high but I think we did a great job in reversing my plaque. Last year my angiogram shows 90 % 80% 50 % 40% Coronary Arteries blockage and I believe if I did my CAC score CT last year my score will be arround 600 to 1000 . Thanks Dr Ford you are heaven sent. God bless you.
Thanks.
My wife & I got our CAC scores for the first time this year (4.4, 5.5). Nobody gets out of this alive, but now we know it probably won’t be from a clogged artery heart attack in the near future.
That test has nothing to do with 50% of all death through heart attacks. You not including soft plaque eruptions through the intama ( inner lining ) causing heart attacks and strokes.
@@mikechurch5965 this generally doesn’t affect the accuracy of the test results as the amount of different types of plaque correlate very well.
@@mikechurch5965 CIMT does detect soft plaque, however CAC does predict future events very well.
Thank you for this video. 3 years ago I had a calcium score as recommend by my primary Dr. after my cholesterol had remained at 200 +/- for 5 years. With normal blood pressure and heart rate but a family history of heart issue my calcium score was 675 which I couldn't believe. The cardiologist I saw wanted to put me on a statin and aspirin without any testing or even asking about life style. At 67, 6', 165# I took out all things white from my diet (pasta, sugar, salt, rice} ate more vegetables, fruit and salmon. I lost 20# and cholesterol went to 130. Earlier this year I found Dr. Brewer's UA-cam videos and immediately starting looking for a someone to do a CIMT. I was able to find a Dr. 60 miles away trained in the Bale/ Doneen method and had the CIMT with inflammatory testing. I received the results last week with only a small plaque on one side and an artery age of 50. Either the calcium score had some error or life style changes did some good but the CIMT made me feel better about my heart health and the road I'm on to stay healthy.
Congratulations! Keep it up.
Turning 60 this year. Got CACs Feb 28. Wife got Zero. I skunked her with a 6451.12. Gallows humor aside, I'm asymptomatic, walked 2.5 miles up and down a mountain this morning. Tomorrow going in for CIMT, heart ultrasound and nuclear stress test. My thing is, I
Can't find any scores at my level and I don't know how to frame it mentally, other than an internal primal scream.
Bill Whitmire RESEARCH MK7, d3, IP6 physic acid. ALSO Dr.berg calcium arteries and Dr Mercola. Helped me and others. Hope you do improve. Good to know now👍
I have a few patients with that level score- & higher. You can still stabilize that plaque.
Bill Whitmire Maybe look at Heartflow CT FFR, or CT Angiogram?
@@PrevMedHealth Got Results Back. Nuclear Stress Treadmill-Normal. Echo-Normal. CIMT Mild Plaque Both Sides. I'm attacking all fronts BTW. Was somewhat Paleo with lapses. Now full Keto. NO sugar. NO PUFA oils. Gradually closing my eating window. Cardo has me on 20mg rosuvastatin, which I chose based on your material for anti inflammatory properties. When cleared for Exercise I intend to follow a regimen designed to create collateral circulation. A fella from Michigan named Pat Theut has a video series on his personal journey through nutrition. He approached his sub 1000 score as an engineer in 2003. Wound up with Vit. D3 and Mk4+Mk7 to manipulate the calcium in his widowmaker, Fascinating story and He's an enjoyable speaker. "The Vitamin that Reversed My Heart Disease." From your material you seem to favor not disturbing stable disease. I would rather eject this thing from my chest and not be on meds the rest of my life, but that doesn't seem to be one of my options. I see the wisdom of not trying to unstack my game of arterial Jenga, lest the whole thing tumbles down.
Thanks for sharing that. And good luck.
I’m a 63 year old male who had a CACS in August 2018 and to my horror had a score of 725. I found a local Dr. who has been trained in the Bale Doneen protocol. I had the entire inflammatory panel run and all my levels were in the “optimal” range. I had a CIMT conducted and it showed no plaque burden and an arterial age of 43! I’m exploring the possibility of a “false positive” CACS. I haven’t come across anything regarding a false positive in the literature. Has anyone seen any information about false positive CACS scores?
Congratulations. I'd be interested in hearing that also.
I appreciate the high quality content, and I hope to watch more uploads of yours later.
You mentioned calcium score as having value in helping to motivate people to make and sustain diet and lifestyle changes. I sure would like to hear more about the research in this area.
Yeah, my husband passed a stress test no problem. The next year had a near heart attack which ended up with one stent in the 90% blockage and a cardiologist to "watch" the 50% blockage. I do not trust the stress test no longer.
Findings:
Patient's total calculated calcium score is 71.
Coronary artery calcium distribution is as follows.
Left main = 0
RCA = 0
LAD = 71
Circumflex = 0
PDA = 0
This reflects a mild or minimal risk of coronary artery disease with
definite, at least mild identifiable calcified plaque. This places
the patient in the 25-50th percentile with respect to age and gender
matched controls.
Just got the results today !
For sharing, Mr B. I’m guessing you’re happy with that.
@@PrevMedHealth Not exactly. I had my carotids done a few years ago and there was 'no significant stenosis' What I wonder about is that the only calcium is in my LAD and my observations on that is the question whether it is significant to have a score of 71 in the widow maker ? If you shed any light it is appreciated. I am 63 and my first test 3 years ago was 51 , all in the LAD. Am I headed for the stent ? I don't know.
Sure. "had my carotids done a few years ago and there was 'no significant stenosis' sounds to me like carotid ultrasound. Those will say 'no significant stenosis at up to over half the lumen clogged with plaque. If it was CIMT, it should have given you mm of IMT or arterial age. So, you probably had plaque in there already. I get patients all the time that are mislead by their providers that carotid ultrasound is the same as CIMT. I had another one this week. If you truly had a CIMT, it would be another issue.
I am pretty sure it was a carotid ultrasound and not CIMT
My bloods and lipids are all normal, but my CAC score, which I obtained this year, is 616 (high). The scan cost me $75. Many heart attacks give no prior warning.
Have you considered a Cv inflammation panel and Insulin survey? Call Cliede or Charmaine at (859) 721-1414
My mother’s cardiologist who is quite a senior member in his field said people with stents get no benefit from calcium scores since the metal obscures the results. Plus the field is so divided. Steve Nissen thinks it’s useless but others swear by it. So it’s always difficult to decipher what really is true these days
Thank you for answering that question. I kept pestering my husband to ask for a Calcuim score after his stent and all the cardiologist would tell him is he CAN'T have the test for the test of his life. No explanation why.
Thanks
redhotz21 I’m glad I could help
Sorry doc, this video is pretty vague. Skipping all over, and not even useful 😢
A recent calcium scoring test I took gave a detailed breakdown of where in the heart the calcification took place. The left main artery, the right coronary artery, and the posterior descending artery all came back with a score of zero. Left anterior descending artery had a score of 201 and the left circumflex came back with a score of 32. The total score was 233. I don't know what this pattern of having nearly all the calcium in one place means. 233 is not a good score. I understand that much.
Thanks for sharing.
Dr Brewer I have read that the correlation between IMT and CAC is not that high which would mean that you could have false negatives as well as false positives from an IMT. Furthermore the invasive tests are seen as being more reliable in predicting the presence and extent of coronary artery calcification.
In my experience I first had an IMT with which I was not happy before having my calcium score measured to be near 400.
I need to find a lab for this. Thanks
Radnally usually a screening program you can google for your area. $50-$150 insurance doesn't cover it.
@@kristyneking1962 thanks
My brother survived a widow maker heart attack. He looks very healthy on the outside.
I got both done thanks to you!! When is Todd coming back to San Diego? 😊
I had a cac score of 1188 ten years ago at age 68, arterial age 90. I haven’t retested since I was depressed for 6 months after I got that score. But if I’ve had a typical increase of 15% a year that would put my current arterial age at around 340!
My calcium score back in Jan. 2019 was 227. Watching your videos, I found out about CIMT. I mentioned it to my cardiologist and he said CIMT was "experimental". He had me instead do a Carotid Doppler (ultrasound) test. I got the results this week and they don't seem correlated to the calcium score:
Conclusions:
- CCAs/IMT
Mean Carotid IMT in this patient is low (less than 25th percentile of the
population value adjusted for age and gender).
- Carotid Bulbs/ICAs
No plaque seen in the right carotid bulb or cervical internal carotid artery.
There is no stenosis in the extra-cranial portion of the right internal carotid artery.
There is small amount of plaque in the left carotid bulb as described above.
There is no significant stenosis in the left internal carotid artery (estimated luminal narrowing < 50% by velocity criteria).
The ACC/AHA dropped CIMT in 2013 when they decided basically to put everyone with an LDL over 70 on a statin. At that point, they said just make exceptions for those with a negative CACS. That’s actually acceptable. But it puts people on statins even when they don’t have plaque. That’s also acceptable on a population basis. But most of the individuals I see do NOT want statins if they don’t have plaque.
But when the ACC (American College of Cardiology) & AHA guidelines previously included CIMT, I wouldn’t call it “experimental”. However, I probably shouldn’t debate use of that term. Here’s the point: why do we continue to pour so many resources into stress testing when this test has so many advantages?
And, by the way, if any of these tests show plaque, I’d recommend statins. (As does the ACC, as does the AHA). It would be helpful to know if the plaque is soft (“hot”) or calcified.
@@PrevMedHealth The Carotid Doppler results didn't characterize the plaque (soft vs. calcified). I will mention it to my cardiologist but the concept has never come up in our discussions.
The stress testing appeared to be something that needed to be done before doing a calcium score measurement. Mine concluded "The patient's functional capacity was excellent for age."
We already knew about calcification as a secondary finding from a prior CT scan I had done following recovering from pneumonia, so the chain of procedures was 1) lung CT scan finding moderate calcification in the left anterior descending coronary artery -> 2) resting & stress echo -> 3) measuring CACS -> 4) statins.
Then I asked for the Carotid Doppler test desperately looking for a way to get off statins (which I feel have impacted my energy levels and something about my general metabolism). Despite the relatively positive results, my cardiologist said we should continue on the statin path as this is the "widow maker" scenario (calcification in the left anterior descending coronary artery).
Hb A1C=5, HS CRP=0.6, LPA: 23 mol/L (before statin), Fasting glucose: 105 mg/dL (after statin), 58 mg/dL (before statin)
Are cardiac stress tests the "bread and butter" of cardiology or hospitals? Is it a common tool that they are using to uncover a blockage of high percentage that most people won't have? The negative stress tests percentages are common, yet they often do not detect blockages that a patient should know about-BEFORE an event occurs.
Good points. Yes. There is a lot of $ made with stress tests.
Ford Brewer MD MPH The reason that I wondered about this is because I was on the phone talking to my cardiologist's nurse about whether a test result came in yet. Several times in the background, I heard the staff telling people on the phone that their cardiac stress stress was negative. I began to surmise that they make those calls for a good part of the day-every day. There are several doctors on the staff, of course.
Don’t you think it will be interesting to get one done?
Since these tests are oftentimes wake up calls for non health conscious people, it's puzzling that health insurers don't typically pay for them. I had the heart calcium score test done for $59 and the high result (360s) was extremely upsetting. I plan to do at least 1 followup at about the 2 year mark. I'm also looking into getting a cimt test. These seem to be a better option for serial testing because they don't involve radiation. My goal is to slow or even reverse the progression of my v disease. My hope is that my high score is the result of over 5 decades of eating the wrong diet, being overweight, and not getting enough exercise. We shall see.
Good plan! & I agree.
I have 104 calcium score. So pl sugest what can I use. Vitk2 is suuficient
Have you had an ogtt or insulin survey? Or cgm? Until you do, you don’t know.
Hi Dr. Brewer: I had an MI 4 yrs ago & had 2 stent implants (age 69). Have been on Lipitor since then, 40 mg a day. Anyway, during the procedure my cardiologist found that I also have an aortic arch aneurysm (approx. 4.7cm) which he has been watching via ultrasound testing every 6 months. Is there anything that I can do or take from a supplement point of view to stabilize any further progression of the aneurysm? I was told that if it gets larger than 5cm, I may have to have surgery which apparently is not the best kind of surgery to undergo. Any thoughts would be appreciated. Thanks for your videos, which are always very informative.
Thanks for sharing. The idea of an aneurysm is scarier than the reality. People need to hear from those that have them. I don’t know of a supplemental support specifically for that.
@@PrevMedHealth Thanks for the reply Doc! Just for further clarification, one is better off with an aneurysm of the decending aorta because surgery in that region is less traumatic for obvious reasons.
Look into thiamine. Elliot Overton, Mars chandler, Derrick Lonsdale. Thiamine supposed to help blood vessels and the nerves.
I can’t agree with the futility of the screen based on Framingham. At 46 years old, my Framingham Risk was 4%. I went in for a CAC CT scan due to family history. I was totally asymptomatic. I got >1000. I had two arteries blocked 95% and had no idea.
So you could walk up a couple flights of stairs and or be out of breath?
Wish you were out in Colorado...
Do you have a plan for out of state patients?
Visit his website. It says there the states he is able to take patients in.
I had mine done last year with my ccta I got 9.5 was having some chest pains but they didnt seem concerned still have a abnormal ekg but noone seems to know why frustrating
I just got a zero on my CAC. Still get chest pain though.Having a CIMT next week. Already had ekg,echo,stress with echo and all good. If My CIMT is normal am I pretty much good? Then it's something else or should I do a CT Scan with dye contrast? I am at My wits end.
Johnny Yum Yours could just be chest wall spasms.
@@ciri1993
What is that like a muscle spasm?
What about arterie spasm?
Johnny Yum In my personal experience chest wall pain can feel like a heart attack. That’s what mine was diagnosed as. I’m no doctor, but you should ask yours if it’s a possibility since all your other findings are negative.
@@ciri1993
Thanks. My Doctor said the dye not worth the side effects if no other red flags.
Did you find out what you had I also had the same results was it anxiety?
What CIMT provider is Dr. Brewer using or recommending?
CardioRisk mostly. Also Fred Callahan (a neurologist with a special background in this in Nashville ).
@@PrevMedHealth Thank you!
Dr. Brewer, I have a stent in place in 2014, I started to do calcium score starting in 2017. Just did one 2 weeks ago (8/1/2019), my report indicated score without stent, 137. Total score 517. So what's my score. Per this, even if all the plaque in my arties are gone, I will still have a score of 380. So is my risk in the 101-400 range ? or is my risk on the over 400 range ?
Dr Brewer: You seem extremely knowledgeable, but I have a real hard time understanding your points.
Sorry about that! It’s a constant struggle, balancing some of this medical science with clarity.
Too many TUMS®