What is a coronary calcium scan and can it help prevent heart attacks? Here's what to know

Heart disease is not directly inherited which means you won’t inherit a heart attack. However, it’s common to inherit tendencies that contribute to heart disease caused by clogging of the arteries, known as atherosclerosis.

In my case, for example, I inherited two such tendencies, including a very low HDL cholesterol (the good kind). In addition, I have the worst type of LDL cholesterol (the bad kind). The “worst type” means small, dense LDL particles that are more likely to contribute to atherosclerosis as compared with large fluffy LDL particles.

Because of these tendencies, my risk of heart disease is increased. Unfortunately, in my younger years, I didn’t have a clue about this and lived the typical American lifestyle with an emphasis on a horrible diet. Thankfully, at age 35, I became a vegetarian and ultimately lowered my total serum cholesterol from 220 mg/dl to 120. My hereditary tendencies remained, but at least there were considerably fewer nasty LDL particles floating around in my bloodstream causing trouble.

What is a coronary calcium scan?

Regardless, my younger years of careless living came at a price, and evidence from my first coronary calcium scan (CCS), which is a special computerized tomography scan of the heart that looks for calcium deposits in the heart arteries, showed that my arteries were clogging and calcifying.

Follow-up CCS results over the years showed continuing calcification and increasing CCS scores, and I attribute this, despite my shift to a pristine healthful lifestyle, to my heredity. I shudder to think what would have happened if I had continued my horrible diet. And although throughout my life I have exercised daily, it obviously was not enough to save me from the devastation caused by double bacon cheeseburgers and large fries.

My CCS score reached a “quite high” 550 on my latest results with no indication of a problem. In fact, a lack of symptoms too often contributes to an overconfident sense that all is well, but I know better, and it’s one of the main themes I constantly rail about. The problem is, if you assume all is well until symptoms tell you otherwise, it may be too late.

That’s what CCS testing is all about — early detection that prompts changes to enhance heart health. For me, that meant an increase in my statin meds which knocked my LDL way down to a much healthier and more “preventive” level. Thankfully, CCS testing is progressively gaining acceptance and it is especially important for folks with a family history of heart disease.

Stories make the point much better than a list of facts, and here is another one where CCS testing saved the day.

Why preventative medicine is important when it comes to heart disease

A reader I will call Bill is fortunate that his primary care physician is St. Keith Krawiec, who is also my doctor, and I know for a fact he constantly preaches preventive medicine to his patients.

Krawiec knew that both of Bill’s parents died of heart disease, which suggests the potential for a powerful “double-barreled” hereditary influence. In addition, Bill was on Lipitor, a statin drug to reduce serum cholesterol concentration. But despite Krawiec’s insistence over five years, pushing Bill to have a CCS, he refused.

Why?

In his mind, Bill was doing everything he needed to do to promote heart health. He exercised, his weight was good, and he assumed statin medication solved his cholesterol problem. Most important, of course, is that Bill had no symptoms, which as stated above caused him to be foolishly overconfident.

Finally, Krawiec convinced Bill to have a CCS and wow! Bill’s score was 5,596, more than 10 times higher than my high score, and by far the highest score Krawiec had ever seen. Such a high score indicates advanced clogging of the arteries that has been ongoing for a long time. As I have discussed previously, clogging begins with soft “mushy” cholesterol plaques, but over the years plaques are invaded by calcium, which “hardens” the plaques, cementing them in place.

Bill’s CCS score raised the alarm and he saw a cardiologist who gave him an echocardiogram and concluded that he did “fine.” Thankfully, Bill’s daughter, a nurse, urged him to get a second opinion, which he did with Preventive Cardiologist, Dr. Henry Sadlo.

I’ve mentioned Sadlo many times in my columns as he has championed CCS testing and saved many lives. Bill is very fortunate that he ended up with Sadlo who realized the implications of such a high CCS score, plus he asked Bill if he had been experiencing any shortness of breath. Actually, Bill had had a brief episode, but didn’t think it was important. Sadlo immediately ordered a heart catheterization and results revealed that multiple heart arteries were blocked by greater than 70%! This resulted in triple bypass surgery.

Since then, Bill has continued with cholesterol lowering medication and has cleaned up his diet. When comparing his cholesterol results from years ago with today, he has lowered it progressively from 230 to 189 to 131 on his latest test, plus he has cut his LDL dramatically.

Why is heart disease considered a 'positive' heredity indicator?

A family history of heart disease is considered to be a “positive” heredity. A guiding definition is that an immediate blood relative, meaning a parent or sibling, has had a heart attack, stroke, or was diagnosed with heart disease prior to age 60. If so, there is a greater chance of developing heart disease. The main message is, that because heart disease is the number one killer in the U.S. and too many folks die prematurely, we need more emphasis on preventive measures like CCS testing. This message is doubly important for those with a positive heredity because they have a smaller margin of error.

As Bill said to Sadlo, "It’s hard to understand the reluctance of many physicians and cardiologists to embrace the coronary calcium scan as a proven and proactive tool to identify potential heart disease. Due to the scan and your quick and decisive action, I feel confident that a bullet was dodged.”

Reach Bryant Stamford, a professor of kinesiology and integrative physiology at Hanover College, at stamford@hanover.edu.

This article originally appeared on Louisville Courier Journal: What is a coronary calcium scan and can it help prevent heart attacks