Coronary CT calcium scan

Um, he's currently the professor and chair of medicine at the Lewis Katz School of Medicine at Temple University, and he is a senior associate dean for clinical affairs and faculty success.

Uh, in this episode, he teaches us all about what we need to know about cholesterol, coronary calcium scores, and why normal lipid levels are not always good enough.

So without further ado, let's get to it.

And a reminder that this and most episodes will be available for CME credit for all health professionals through VCU Health at curbsiders.vcuhealth.org. Dan, we are so glad to make this happen.

Well, more than every once in a while, indicated or not.

You'll find a study and so that's helpful.

Would I send her for a coronary calcium scan? If I'm having that discussion and, and she, she's really wants more information, the answer is yes, but caution in young women and young patients in general.

The negative predictive value of a zero calcium score in young individuals is less than a negative, I'm sorry, a, the negative predictive value of a calcium score that's zero in someone who's older, right?

You know, we're in our sixties and she's just amazing.

And she went to the cardiologist and he said, well, I'm hearing from all my friends, go get a calcium score test.

So we get a baseline on you.

And she did.

And she expected this test to come back perfect because she does a lot of work, which we consider healthy.

She follows all the rules that they put out there.

And it came back that her calcium score was not zero, but it was higher than what she expected.

And it was not a problem, right? It was not anything scary, but she was so disappointed, right? She was so, she was literally in tears.

And the calcium score was considered the truth serum.

So although this paper has been presented a bit in the medical literature in the last two weeks, it's not overwhelmingly supportive of calcium scoring.

I disagree.

So it turns out 1,200 of the 6,000, I think we can agree, that's about 20% of the people in this study were in a borderline risk group, a borderline risk group from the prevent calculator equation, where a doctor... wasn't completely clear if they were going to necessarily add a statin, not add a statin, add aspirin, not an aspirin, consider major lifestyle change or not.

It's a measure of calcified plaque burden.

The 2026 dyslipidemia guidelines substantially expanded the role for calcium scoring as risk refinement and for the use of treatment decisions it recommends considering calcium scoring particularly when decision about lipid lowering therapy is uncertain and this has become a big part of my practice because of social media and honestly influencers that don't understand cardiovascular disease there has been a lot of negative talk about lipid lowering therapy particularly statin therapy.

I've had a whole episode on statins before.

I'm certainly not a statin defender.

And this is a way that medical treatment can become more personalized, right? Instead of throwing medication at every patient who walks in the door who has LDL cholesterol above normal, right? which I do not do, we can further risk stratify by imaging the coronary arteries.

And then we can decide if medical therapy is reasonable.

So calcium scoring is a risk stratification tool.

It's most useful when the result will meaningfully change a prevention decision, medical therapy or not medical therapy.

I don't know.

You got a little coronary calcium.

It went from zero to 12.

It's not a big deal.

You know, I was thinking- A little clear answer.

So-

I did a live show where I got a coronary calcium back in Vegas.

This was eight years prior to my next one, which was last year.

Absolutely.

They've done studies now on women when they're perimenopause, especially the CAT score, the coronary artery calcium score that I recommend everyone should have that's looking at hard calcium.

And they've shown women upwards into their late 50s, 60s, where they have a score of zero and then... all those hormones, their natural hormones tank and then cardiovascular plaquing goes up.

But if we can use bioidentical hormone, it actually reduces that risk and is very cardioprotective.