{"product_id":"paul-d-thompson-calcium-score-zero-13","title":"Calcium score zero: what it means 13","description":"\u003ch1\u003eCoronary Calcium Score of Zero: Reassurance, Limits and Repeat Scans\u003c\/h1\u003e\n\u003ch3\u003eJump To Section\u003c\/h3\u003e\n\u003cul\u003e\n  \u003cli\u003e\u003ca href=\"#what-coronary-calcium-shows\"\u003eWhat coronary calcium shows\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#zero-score-and-age\"\u003eA zero score depends on age\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#lipoprotein-a-caveat\"\u003eThe lipoprotein(a) caveat\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#repeating-the-scan\"\u003eWhen he repeats the scan\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#calcium-stays\"\u003eWhy calcium stays after cholesterol lowering\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#athletes-and-statins\"\u003eEndurance athletes and statin treatment\u003c\/a\u003e\u003c\/li\u003e\n  \u003cli\u003e\u003ca href=\"#full-transcript\"\u003eFull Transcript\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch2 id=\"what-coronary-calcium-shows\"\u003eWhat coronary calcium shows\u003c\/h2\u003e\n\u003cp\u003eCoronary artery calcium is laid down where cholesterol has built up in the arteries. Dr. Anton Titov, MD, asks cardiologist Dr. Paul D. Thompson, MD, how a patient should understand a score of zero, who would benefit from the test and when it should be repeated.\u003c\/p\u003e\n\u003cp\u003eDr. Thompson explains that when cholesterol builds up in an artery, the body deposits calcium there, a little like making bone, and the artery hardens. He thinks the calcium itself is part of a healing process. What it tells the doctor is that the patient is making atherosclerosis.\u003c\/p\u003e\n\u003ch2 id=\"zero-score-and-age\"\u003eA zero score depends on age\u003c\/h2\u003e\n\u003cp\u003eA zero calcium score is expected in a young person, Dr. Thompson says, even one with very high cholesterol levels. For that reason he does not use the test very often in young people, and he does not see a calcium score alone as the whole answer.\u003c\/p\u003e\n\u003cp\u003eIn an older person, a zero score means statistically only about a 4% chance of a heart attack or a stroke in the next 10 years, which he calls very low and very reassuring. He likens it to the Beatles song: a ticket to ride for about ten years. Still, a zero score does not totally remove the risk of a very high cholesterol level, because a young person with high cholesterol will put down atherosclerosis at some point. He would not ignore high cholesterol even with a zero score.\u003c\/p\u003e\n\u003ch2 id=\"lipoprotein-a-caveat\"\u003eThe lipoprotein(a) caveat\u003c\/h2\u003e\n\u003cp\u003eLipoprotein(a) is one other caveat he raises. Dr. Thompson's group reported two patients, both women, with calcium scores of zero and calcium scores of one who had very tight narrowing in their heart arteries. Both had extremely high levels of lipoprotein(a).\u003c\/p\u003e\n\u003cp\u003eHe describes lipoprotein(a) as a type of cholesterol that can take good levels and make them ugly. He adds that it can probably produce cholesterol that does not have a lot of calcium in it, for some reason.\u003c\/p\u003e\n\u003ch2 id=\"repeating-the-scan\"\u003eWhen he repeats the scan\u003c\/h2\u003e\n\u003cp\u003eHow often to repeat the scan is a mixed question, in Dr. Thompson's view. If the score is zero, he repeats it in five or six years when the patient has a moderately high cholesterol level or a high lipoprotein(a), because he wants to know whether to treat that person.\u003c\/p\u003e\n\u003cp\u003eThe appearance of calcium is also a risk factor. A score that is still zero five years later is a very good prognostic sign. New calcium on later scans is not a terrible prognostic sign, he says, but it does show that the person is depositing cholesterol. If somebody has a high calcium score, he will repeat it.\u003c\/p\u003e\n\u003ch2 id=\"calcium-stays\"\u003eWhy calcium stays after cholesterol lowering\u003c\/h2\u003e\n\u003cp\u003eCalcium does not go away when cholesterol does. Dr. Thompson describes a study by his group on regression of cholesterol in the arteries: lowering a person's cholesterol level can take cholesterol out of the heart arteries, but the calcium score never gets better. Once calcium is put down, he says, it is stuck.\u003c\/p\u003e\n\u003ch2 id=\"athletes-and-statins\"\u003eEndurance athletes and statin treatment\u003c\/h2\u003e\n\u003cp\u003eTwo further points complete his answer. Endurance athletes, not just distance runners, can have a lot of coronary calcium. He says this really frightens them and is something to pay attention to, but being a distance runner can produce a lot of calcium.\u003c\/p\u003e\n\u003cp\u003eStatins and cholesterol reduction also increase the calcium score. Because calcium is partly a healing mechanism, the body may put down more calcium as cholesterol is taken out of the plaque. Patients then ask what good the medication is if their disease seems to be getting worse. His answer is that the disease is becoming more stable because of the healing effect of the calcium. For that reason, when he treats someone aggressively with cholesterol-lowering medication, he does not repeat the scan, whether or not he knows they have coronary calcium.\u003c\/p\u003e\n\u003ch2 id=\"full-transcript\"\u003eFull Transcript\u003c\/h2\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Anton Titov, MD:\u003c\/strong\u003e Coronary calcium score, what a calcium score of zero means for the heart. On your blog you wrote that a zero coronary calcium score means a low risk of heart attack. A high lipoprotein little a, you added, can make a zero score misleading. Professor Thompson, how should a patient understand a coronary calcium score of zero? Who would benefit from a coronary calcium test? When should the test be repeated?\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e Those are a great set of questions. First of all, what is coronary artery calcium? When you put cholesterol in your heart arteries or any arteries, the body tries to heal it.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e One of the ways it heals it is by putting calcium down there. It deposits calcium. It is kind of a little bit like it makes bone in the artery.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e It hardens the artery. The calcium itself, we think, is part of a healing process, but what it tells you is that this patient, this dude, this dudette, is making atherosclerosis, because they have got deposits of calcium in their coronary arteries. Now, if you are young, a zero calcium score is expected, right?\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e A zero calcium score is expected if you are quite young. So you can have very high cholesterol levels and a zero calcium score if you are a young person. That is why I do not use them very often in young people, and it is also why a calcium score alone is not the whole answer.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e If you are older and you have a zero calcium score, that means statistically that you only have about a 4% chance of having a heart attack or a stroke in the next 10 years. That is very low. That is very reassuring.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e Now, it does not totally mitigate the risk of a very high cholesterol level, because if you are young, have no calcium, and you have a high cholesterol level, you are going to put down atherosclerosis at some point. But a zero calcium score, I say it is like the Beatles song: \"You have got a ticket to ride.\" You have got a ticket to ride for about ten years if you have got a zero calcium score. But I would not ignore high cholesterol even with a zero calcium score.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e Now, there is one other caveat, or one other disclaimer. We reported two patients with calcium scores of zero and calcium scores of one who had very tight narrowing in their heart arteries, and what did they have? They had extremely high levels of lipoprotein(a).\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e They were both women. They had very high levels of lipoprotein(a). Remember, lipoprotein(a) is a type of cholesterol that can take good levels and make them ugly.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e It can also probably cause a type of cholesterol that does not have a lot of calcium in it, for some reason. Now, another question that comes up often is: how often should you repeat the coronary artery calcification score? It is mixed.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e If the score is zero, I will repeat it in five or six years if the patient has a moderately high cholesterol level or a high lipoprotein(a), because I want to know: should I be treating that person? The appearance of calcium is also a risk factor. If someone has a zero score five years later, zero five years later, that is a very good prognostic sign.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e But if they start to have more calcium on subsequent scans, that is also not a terrible prognostic sign, but it does tell you they are depositing cholesterol. Now, if somebody has a high calcium score, I will repeat it. We did a study where we looked at regression, going away, of cholesterol in arteries.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e So cholesterol goes away in the arteries. If you lower somebody's cholesterol level, you can take cholesterol out of their heart arteries, but their calcium score never gets better. Once that calcium is put down, it is stuck.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e Now, the other two things you need to know: distance runners, endurance athletes, I should say endurance athletes, not just distance runners. Endurance athletes have a lot of coronary calcium. We will probably come and talk about that, but distance runners can have a lot of coronary calcium, and that really frightens the dickens out of them.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e It is something that we have to pay attention to, but you can get a lot of calcium from being a distance runner. The other important thing about a coronary calcium score is that statins and cholesterol reduction increase the score. What?\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e I thought this cholesterol drug, this statin, was reducing my risk of heart attack, and yet my calcium score is going up. That is because calcium is partly a healing mechanism. So if you are getting the cholesterol out of the plaque, taking it out of the coronary artery, the body may repair that by putting down more calcium.\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e So if I am treating somebody aggressively with cholesterol-lowering drugs, and I know they have coronary calcium, and even if I know they did not have coronary calcium, I am not going to repeat that scan, because that scan could show that the calcium is larger, that they have more calcium. And the patient often says, \"Well, what good is this drug? My disease is getting worse.\"\u003c\/p\u003e\n\u003cp\u003e\u003cstrong\u003eDr. Paul D. Thompson, MD:\u003c\/strong\u003e No, your disease is getting more stable because of the healing effect of the calcium.\u003c\/p\u003e\n","brand":"Diagnostic Detectives Network","offers":[{"title":"Default Title","offer_id":48388621074588,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/2225154603-1fb30cbb61ab710fedb36fa758f97c792b4923ca5aa3bfee88acf03b96794d89-d_1920x1080_c052d8e9-865c-4ff7-825e-48b49587f823.jpg?v=1794435401","url":"https:\/\/diagnosticdetectives.com\/de\/products\/paul-d-thompson-calcium-score-zero-13","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}