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Ten Things You May Not Know About Your CT Heart Scan and Coronary Calcium Score — Transcript

by William Davis , MD · 3,356 words · 501 segments · language en · Watch on YouTube

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0:00I see that there's an increasing number
0:02of videos and other media talking about
0:05coronary calcium scans, which is great
0:08because I go back about 30 years. When I
0:10first started doing coronary calcium
0:12scoring, it was so long ago that we
0:14didn't have CT devices to do this. We
0:16had something called electron beam
0:18devices that focus the X-ray beam with
0:21magnets. It was a fantastic technology,
0:24but it was a competitive problem for one
0:27of the big imaging companies and they
0:29bought the company and the intellectual
0:31property surrounding that technology and
0:33and put it in a closet and closed it and
0:35locked it up. So, that wonderful
0:37technology has now been replaced by
0:39what's called multi-detector CT devices.
0:42And they're they're they're good. I
0:44don't think they're as good as the
0:45original electron beam devices, but
0:46they're still very reliable. and they
0:48have made CT heart scans and coronary
0:51calcium score accessible, often priced
0:54at around $100. The history of coronary
0:57calcium scoring started with Dr. John
0:59Rumbberger, a friend of mine who was at
1:01the Mayo Clinic at the time, who did an
1:04autopsy study in people who died of all
1:07different kinds of reasons. And he
1:09examined their coronary arteries and he
1:11showed that regardless of age, sex or
1:15cause of death that calcium
1:19occupies 20% of total atheroscerotic
1:23plaque volume in the coronary arteries.
1:26Meaning that visualization
1:29quantification of the calcium in the
1:31coronary arteries could be used as a
1:34gauge or an index of how much total
1:37atheroscllerotic plaque you have in the
1:39heart's arteries because before then
1:42there was really no easy way that was
1:43noninvasive to gauge how much carn
1:46aththerosclerosis you had. You could do
1:48a heart caization which even then
1:50doesn't give you all the information you
1:51need because you really want to see the
1:53disease in the walls of arteries not
1:55just the internal lining or the lumen we
1:57say. So Dr. Rberg developed this idea
2:01that calcium could be used as an index.
2:04And then Dr. Arthur Agson which you you
2:06may recognize that name because he
2:08popularized the South Beach diet a
2:10number of years back. He developed
2:12something called the Agston score. And
2:14all that was was a simple way to use the
2:17area of calcium and its density to
2:20develop a scoring system. And even
2:23though it was many years ago, that score
2:25is still the most common score used to
2:28report to you how much coronary
2:30athoscotic plaque you have. Normal is
2:33zero. Anything above zero is abnormal up
2:36to many thousands. And the higher your
2:38score, the more likely you are heading
2:39towards heart attack, sudden cardiac
2:42death, or the development of symptoms
2:44that necessitate such things as stent
2:46implantation and bypass surgery. Now,
2:49I'm grateful that this conversation is
2:51gaining a lot of momentum because 30
2:53years ago, it was very difficult because
2:55I had to educate doctors. All they
2:57wanted to know back then was how much
2:58blockage is there? That's not how
3:00coronary disease works. That's a
3:02conversation for another day. But most
3:04heart attacks occur not because of
3:06progressive worsening worsening
3:08worsening of a blockage. It happens
3:10because of a mild plaque maybe only
3:12blocking 30% of the diameter of an
3:14artery ruptures like a little volcano
3:17and that exposes the underlying tissues
3:21that are we say very thrombogenic very
3:23blood clot forming. It provokes
3:25formation of blood clots. So a 30 or 40%
3:28blockage can become a 100% blockage
3:32within moments. And that's what a heart
3:33attack is. That's why arteries are
3:35opened using stances, sometimes using
3:39what's called thrombolytic agents, which
3:40are agents that dissolve blood clots.
3:42But despite the growing conversations
3:45about CT heart scans and coronary
3:47calcium scoring, I still see lots of
3:50misinformation. We have plenty of great
3:52information from the likes of Dr. Matt
3:54Budof, for instance, at UCLA. He's
3:57published huge numbers of studies and
3:59others have too validating the use of
4:01carnary calcium scores. But let's talk
4:03today about many of the things that you
4:06may not be told. So even if you had a CT
4:08heart scan and a carnary calcium score,
4:11what are you not being told? Well, one
4:13of the things not being told is that
4:16people say things like, "Well, if I have
4:18calcium, I don't care about that. I just
4:20want to know how much soft plaque I
4:22have." That's a misconception.
4:24Calcium is an index of total plaque.
4:28That is all the components of
4:30athoscllorotic plaque. Calcium, yes, but
4:33also fibrous and fatty tissue. It's the
4:36fatty tissue, by the way, that's the
4:37most dangerous because that's the stuff
4:39that ruptures and causes heart attack.
4:41But calcium is an index or a gauge of
4:43total athoscotic plaque. So if somebody
4:47says to you, "Oh, we don't care about
4:48the calcium score because it signifies
4:50hard plaque." That's wrong. It's an
4:53index of total plaque. That's been
4:55proven time and time again. Another
4:58common misconception is that you can't
5:01see any of the other elements beyond
5:03calcium. You actually can. You may not
5:05be able to precisely quantify them, but
5:07having looked at about 10,000 scans over
5:10the last 30 years. I can tell you you
5:12can often, not always, but you can often
5:14see the other elements, you can see the
5:16contours of that artery. This can be
5:19important if you want to see progression
5:21or regression. The first time I saw
5:24regression of coronary calcium many
5:27years ago, I I I see that can't be true.
5:30So I went back and held up the before
5:32scan and the after scan. Yes, the
5:34calcium component of the plaque has
5:36shrunk dramatically. And the softer
5:40elements you could make make out their
5:42outline had also shrunk. So you can't
5:45quantify it as precisely as calcium, but
5:46you can see it progress or regress and
5:50it's really gratifying when you see
5:51coronary aththerosclerosis regress.
5:55Another common misconception, how fast
5:57does the score increase? Well, let let's
6:00think about this. If a score of one
6:04becomes a score of two a year later,
6:06that's a 100% increase, right? Even
6:09though it's an increase of only one.
6:11What if a score of a th00and increases
6:13to a score of a thund1 over a year?
6:17Well, that's an increase of only one
6:19unit and less than 1%. So, it's a little
6:22bit misleading to say how fast scores
6:24increase, but let's just for the sake of
6:26simplicity, let's just say if you have
6:29scores in the hundreds, say 200, 300,
6:32they typically progress at about 25% per
6:35year. Now lower scores like two or 10
6:39increase much faster. So it would not be
6:41uncommon if you did something silly like
6:43go on a statin cholesterol drug and your
6:46score is 10. A year later it's going to
6:47be 40 or 50. So much more than 25% per
6:50year. But once you get to the 100 200 it
6:53tends to progress at about a rate of 25%
6:56per year. Another common misconception
6:59that statin cholesterol drugs will slow
7:01the progression of your carnary calcium
7:03score. This is simply not true. We have
7:06a number of clinical studies now that
7:08tell us that statin drugs do not slow
7:11that 25% or so annual rate of
7:13progression. In fact, there's several
7:15studies that show it accelerates the
7:17increase in calcium. Now, because my
7:19colleagues are so in love with statin
7:22drugs, they often say things like, well,
7:24if it has more calcium in the artery, it
7:26stabilizes the artery. That's a fiction.
7:29It does not stabilize the artery.
7:31Calcium can occur in all different kinds
7:33of configurations in coronary arteries.
7:35Anybody who's done a lot of intraconary
7:37ultrasound where you pass an ultrasound
7:40probe into it into the coronary arteries
7:42and you see what the artery looks like
7:44in all in great detail in cross-section.
7:47Anybody done who's done a lot of that
7:48work like I have, you can tell calcium
7:51occurs in all different shapes, sizes,
7:53and and patterns. And to say that
7:55calcium that increases on a statin drug
7:58is stabil stabilizing is is is nonsense.
8:02Another thing you need to know about is
8:04no calcium score can be used to justify
8:08invasive heart procedures. So if you had
8:11a score of say 400 or a thousand or
8:142,000 lots and lots of carnary
8:16athoscotic plaque and calcium some of my
8:19colleagues will say well you need to do
8:21the real test a heart cathization and
8:23see if you need a preventive stent. I'm
8:26talking about people who are not having
8:27symptoms. This is these not people in
8:29the emergency room. These are not people
8:31who are passing out with chest pain.
8:33These are people like you and me going
8:35to work riding our bikes going for walks
8:38having no symptoms. If you have a
8:40coronary calcium score that's high, it
8:42can never be used to justify procedures
8:45like heart cathization or even a CT
8:48carnary angiogram. Why do they do that?
8:51Because it pays a lot of money. A lot of
8:54money. Even though when I first started
8:57doing CT heart scans 30ome years ago, I
9:00was accused of trying to make money off.
9:01Of course, it wasn't. It was meant to be
9:03a preventive tool to track the
9:05progression or regression of coronary
9:07athoscotic plaque. But hospitals after a
9:10few years caught on. Hospitals and my
9:12colleagues caught on that you could use
9:14a kernel score to scare people into
9:18getting procedures. And although that's
9:20wrong and it's malpractice, it's done
9:24every day in essentially every hospital
9:27because it's used a high score is used
9:29to scare you using words like we can't
9:33be responsible for your safety if you
9:35don't have these tests. you're a walking
9:37time bomb or you need the real test to
9:41show how much disease you have. So, but
9:43you cannot use a cardiac calcium score
9:45to justify procedures even though it's
9:47done all the time. Another common
9:49misconception is that a CT heart scan
9:52and coronary calcium score cannot be
9:54used to understand the meaning of
9:56symptoms. Chest pain, breathlessness,
10:00abdominal pain, whatever because heart
10:02disease doesn't always appear as obvious
10:04symptoms. It can be show up as some
10:05uncommon symptoms. But you cannot use a
10:09cardio calcium score to explore what
10:12symptoms mean because to understand what
10:14symptoms mean you need tests like stress
10:16test that is a graded exercise effort to
10:20see if if your chest pain or other
10:21symptom can be provoked. You can you can
10:24imagine that a cardiom score is static.
10:27It is not provocative. It does not
10:29involve graded exercise. And so if
10:31someone says, "Well, we need to do a CT
10:33heart scan to understand the meaning of
10:35your chest pain or breath or other."
10:37This is nonsense. You cannot use a
10:39coronary calcium score or a CT heart
10:41scan to try to associate symptoms with
10:44coronary disease. There are tests that
10:46do that, but it's not going to be a
10:47cardio calcium score. Another common
10:50oversight in CT heart scans that is that
10:53you can you can see what's called
10:55paricardial and epicardial fat. This is
10:59fat in the paricardial sack. So the
11:02heart is encased in a very thick fibrous
11:05sack called the paricardium. There's a
11:07little bit of lubricating fluid in there
11:09so the heart can move freely. But fat
11:11can also accumulate. This is a form of
11:13so-called ectopic fat. Fat accumulating
11:16where it doesn't belong which tends to
11:18happen in people who have a lot of
11:20abdominal visceral fat. That is fat
11:22surrounding abdominal organs. And so
11:25this is fat in the paricardial sack,
11:28some of which can cover the coronary
11:30arteries, so-called epicardial fat. And
11:33when you have paricardial and epicardial
11:36fat, it accelerates disease. Coronary
11:40aththerosclerosis, your coronary calcium
11:42score increases more rapidly. It puts
11:45you at risk for so-called
11:46cardiomyopathies, diseases of heart
11:48muscle, which are really bad things to
11:50have, and can increase your likely
11:53atrial fibrillation. So, you can see
11:55that fat and so your CT heart scan might
11:58say something like there's a moderate
12:00quantity of paricardial fat. You really
12:02can't distinguish paricardial from
12:04epicardial fat from a CT scan. So, it's
12:07hard to really precisely quantify the
12:09epicardial fat that surrounds coral
12:11arteries. So the the thing that would
12:13should be observed on your CT heart scan
12:15is the quantity of paricardial fat.
12:18Another thing often overlooked is the
12:21diameter of the thoracic aorta. The
12:24thoracic aorta is the big artery that's
12:26the first artery to emerge from the
12:28heart that receives the high pressure
12:31flow from your heart from the
12:33contracting left ventricle. So the
12:36thoracic aorta is prone to enlargement.
12:40So it can be measured easily. The normal
12:42thoracic aort measures about 3.0 cm. A
12:45little bit bigger in really big people,
12:47smaller in small people, but around 3.0
12:49cm. What if it's 3.7 cm or 4.5 cm? Well,
12:55that means something is at work causing
12:57it to enlarge, which can be bad for two
13:00reasons. One, it tends to develop
13:02aoscotic plaque that can fragment. It's
13:05very common. It can fragment and send
13:07debris usually to the brain. And that's
13:10when people say things like, "I had a
13:11mini stroke. I lost the capacity for
13:13speech. It lasted for half a day and
13:16then it came back." That's typically
13:18from fragmentation
13:20of the thoracic aortic plaque. Also, you
13:23can measure the diameter as I mentioned
13:25and you want it to be about 3.0
13:27centimeters. If it's enlarged, not only
13:29is it prone to develop athoscotic plaque
13:31that can cause strokes and many strokes,
13:34it can also over time lead to a thoracic
13:36aortic aneurysm, which is a big problem.
13:40If it gets to about 5.5 cm, that's the
13:43standard diameter when you have your
13:46aortic aorta replaced surgically. So,
13:48you don't want to allow it to get to 5.5
13:51cmters. So if your thoracic aorta say
13:54measures 3.7 centimeters, you need to
13:56take action such as the things we do in
13:58my programs, omega-3 fatty acids,
14:01magnesium to reduce blood pressure, all
14:03the things we can do to stop the
14:05progression. By the way, it's relatively
14:07easy to do, but you have to focus your
14:09attention on not allowing that thoracic
14:11aorta to enlarged. Now, if if that's not
14:14mentioned in your CT heart scan, you
14:16need to call the scan center and say, "I
14:18need to know my thoracic aortic
14:20diameter." If they say, "Oh, the doctor
14:22won't do that." Insist. Make a nuisance
14:24of yourself. It's so important that you
14:27have the diameter of your thoracic
14:28aorta. Last oversight is that even
14:31though a CT heart scan, the settings are
14:35optimized for seeing the coronary
14:37arteries. You can actually see other
14:40things with great clarity. You can see
14:42for instance the lungs in great detail,
14:45far better than a standard chest X-ray.
14:48So for instance you can see evidence of
14:50prior pneumonas. You can see that if
14:52someone was a cigarette smoker even in
14:55past many years past you can see the
14:57evidence of that especially of emphyma.
14:59You can see what are areas of absent
15:01lung tissue. We call them blebs. You can
15:04see early lung cancers. So the lungs
15:08should be looked at anytime you have a
15:09CT heart scan because of the incredible
15:12detail you can make out. Now, if none of
15:14this stuff was observed or reported on
15:17your CT heart scan, you want to call the
15:19scan center and really make a nuisance
15:21of yourself and say, "Hey, I need the
15:24diameter of my thoracic aorta. There was
15:26no comment." Take a look at your report.
15:27Maybe these things are in the report,
15:29but you might have to say, "I don't see
15:31any detail on what's what was seen in my
15:34lungs." Of course, the progression
15:36regression is something you have to do
15:38with serial. You have to have the scan
15:40repeated to gauge that. Now, if you want
15:44to put a stop to that otherwise
15:46inevitable 25% per year increase in
15:49score, you can do it. We've done it
15:51many, many, many times. Most important
15:54factors that you put to work to do that,
15:57omega-3 fatty acids. We now know from
16:00two very excellent studies, one of them
16:02by Dr. from Matt Budof at UCLA who does
16:04incredible great work on this on this uh
16:06topic that higher doses of omega-3 fatty
16:09acids typically above 3,300 milligrams
16:11we use 3600 milligrams of EPA and DHA
16:15per day that facilitates regression
16:17especially of the softer elements the
16:20stuff that ruptures and causes heart
16:22attack so it's become clear while it's
16:24been debated for decades how important
16:27are omega-3 fatty acids we now know with
16:29two excellent studies that not only are
16:31they important in reducing plaque
16:33rupture and reducing cardiovascular
16:35events. It also facilitates regression
16:38even when statin drugs fail. Another
16:41very important vitamin D. When we added
16:44vitamin D to our my programs number many
16:46years ago, it was the first time we saw
16:49calcium scores, cardiac calcium scores
16:51plummet. We saw scores of 700 drop to
16:54400 or something like that. And that
16:56only happened when we added vitamin D.
16:59So we use a dose of vitamin D3
17:01kickelifpherol
17:03in oilbased gel cap only never capsules
17:06or powders or tablets to assure
17:09absorption to a dose to achieve a 25
17:13hydroxy vitamin D blood level of 60 to
17:1670 nanogs per milliliter or thereabouts.
17:20Another factor we pursue in my programs
17:23is the elimination of wheat, grains and
17:26sugar. Not bacon, not pork fat, not
17:30butter. Why grains and sugars? Well,
17:32because sugars, sucrose, fructose, other
17:36forms of sugar and grains, wheat and
17:38grains that have the carbohydrate called
17:40amalopectin A are the trigger for the
17:44liver to take those sugars and
17:46carbohydrates and convert them to
17:48triglycerides. That's a process called
17:50hpatic or liver denovo lipogenesis
17:54making new fats. So the liver is very
17:57good at converting those sugars and
17:59carbohydrates to triglycerides.
18:02Triglycerides are packaged in the liver
18:04as very low density lipoproteins VLDDL
18:08particles. They get they gain access to
18:11the bloodstream. they themselves can
18:13cause coronary athosclerosis
18:15and those VLDLDL particles interact with
18:20LDL particles and convert them to small
18:23particles which are very aggressive
18:25causes for heart disease. So it's but it
18:28starts with consumption of wheat grains
18:30and sugars that convert get converted to
18:34triglycerides VLDLDL thereby small LDL
18:38and then lastly we have to address the
18:41status of your gastrointestinal
18:43microbiome. So we want to correct your
18:46colonic dispiosis
18:48or even more commonly when you have
18:50coronary disease small intestinal
18:53bacterial overgrowth. If you've been
18:56following my conversation, you know that
18:58small intestinal bacterial overgrowth or
19:00SIBO, we say SIBO, is exceptionally
19:02common in Americans. And if you have
19:04coronary disease, it's virtually
19:06guaranteed that you have SIBO. Meaning
19:09you've allowed feal microbes to overp
19:12proliferate in the colon, then ascend
19:14into the 24 ft of small intestine where
19:17they live and die rapidly and release
19:19their toxic compounds, specifically
19:21endotoxin, that enters the bloodstream.
19:24and is a major driver of coronary
19:27disease, coronary athoscotic plaque and
19:30also of plaque rupture. So we address
19:33colonic dispiosis and more importantly
19:36SIBO. We do it with my recipe for what I
19:39call SIBO yogurt. It's not yogurt. It
19:41looks and smells like yogurt, but it's
19:43not yogurt. We use my method of
19:45prolonged fermentation to allow multiple
19:48doublings of the microbe. That's how
19:49they reproduce. So that we get hundreds
19:52of billions of three species.
19:55Lactobacillus rutery, lactobacillus
19:57geride and basillus subtilus. Hundreds
20:00of billions of of microbes. We consume
20:02it half cup per day or thereabouts. And
20:05that has been spectacularly effective
20:07for us in gaining control uh or being
20:10part of the program in gaining control
20:12over coronary artery calcium
20:14progression. Now if this interests you,
20:16if you need some guidance, I invite you
20:18to of course see all my other videos. my
20:21definant health podcast, my thousands of
20:23blog posts, wooddavismd.com.
20:26But if you really want support,
20:28conversation, two-way interactions, uh I
20:31invite you to join my inner
20:33circle.drdavisinfinitehealth.com.

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