- You study the impact of coronary artery calcification on cardiovascular risks, and, in particular, heart disease risks in the setting of hypertension Could you discuss the impact of coronary calcifications on heart disease risks? We've been doing the studies on coronary calcifications for 10-15 years and while people in the world accepted our results, but our results didn't come into the treatment guidelines. The recent heart treatment guidelines of the American Heart Association for the first time mentioned coronary calcium score as a very good criterion to decide whether to treat patients with statins or not. The main finding that we saw is that you can see with a very, very fast CT scan that takes 16 seconds, with relatively low X-ray exposure - you can define if the patient has coronary calcification, if there is a calcium in the coronary artery. And if the patient has coronary calcium, then he has atherosclerosis, so this is already heart disease. What we found is that when we compare the long-term outcome, and "long-term" is not 5 years, but 12 - 15 years of follow-up, people with and without coronary calcium - we could see that those without calcium have very very few cardiovascular events, I mean, unlike those with coronary calcium who have higher risk with many events [heart attacks]. So even patients with diabetes, when they don't have coronary calcification, their prognosis is very good. [regarding heart disease] We believe that the coronary calcium is a summarized index of atherosclerosis, because today you measure the cholesterol, you measure the glucose, you measure the blood pressure, and you try to say, what is [heart disease] risk of the patient? I can give you one risk index - if he has coronary calcium, he is high-risk patient if he doesn't have calcium, he is a low-risk patient [for heart disease and stroke]. We did in several hundred patients repeated coronary CT scans, we saw that after three years those who didn't have coronary calcium in the first time, they didn't have calcium in coronary arteries in the second time. Because if you don't have atherosclerosis when you are 55, you will not have coronary atherosclerosis when you're 60 or 65, which means that if you are protected, you are protected [from heart disease]. So that probably implies a very strong genetic factor in atherosclerosis? It's a genetic factor, but it also gives you a picture - what is the risk of the patient? If he is already atherosclerotic, if he has coronary calcium - then you know that you have to be very aggressive to lower the blood pressure, to lower the cholesterol, you may start aspirin because this is a high-risk patient [for heart disease]. On the other hand, if someone looks like high-risk for heart disease, but doesn't have coronary artery calcifications, he is in good shape. This is very interesting, because if someone has CT angiogram of coronary arteries done, and has increased, relative for age, calcium in the coronary arteries but no atherosclerotic plaques - that nevertheless puts that person at risk for coronary heart disease? Definitely! But you don't have to do coronary artery catheterization, right? It is a very fast CT scan, it takes several seconds, and you can tell exactly how much calcium is in coronary arteries. You can give a number [calcium index score] and then you can say what is the heart disease risk of this patient.
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