No, they do not. Statin drugs have zero impact on the 25% per year increase in CT heart scan scores.
A CT heart scan that yields a coronary calcium score is the best test available to determine cardiovascular risk—far better than useless total cholesterol values, better than the wildly inaccurate and semi-fictitious LDL cholesterol, detects coronary atherosclerosis years before it becomes detectable by a stress test, and reveals coronary atherosclerotic plaque before symptoms—such as heart attack—appear. In other words, it empowers you in your efforts to prevent heart attack and avoid need for procedures such as stents or bypass surgery.
Let’s say you get your coronary calcium score because, as a male at age 49, you are concerned that you might follow in your father’s footsteps who had a heart attack at age 53. You feel fine, exercise regularly, and take no prescription drugs.
Your heart scan score: 500. You are told that this puts you at increased risk for heart attack of about 5% per year. Your doctor tells you that you are a “walking time bomb” and that you must take a cholesterol-reducing drug, aspirin, a beta blocker drug, and cut the total and saturated fat in your diet, what my colleagues call “optimal medical therapy.” He also refers you to a cardiologist who advises you that you need a nuclear stress test (e.g., stress Myoview, Cardiolite, thallium) or CT coronary angiogram (a non-invasive angiogram performed on the same device that performed the heart scan). You opt for the nuclear stress test and pass. The cardiologist then suggests that you should consider the “real” test, i.e., a heart catheterization in which catheters are inserted in the arteries and an angiogram is performed to assess whether you need stents or bypass surgery.
What if you did nothing, but repeated the heart scan one year later? The score will be 25% higher: 625. A year after that: 781. As the score increases, so does your risk, such that a score of 1000 or greater carries around a 10-15% per year risk of death or heart attack. Obviously, something must be done. If nothing is done, CT heart scan scores increase at the average rate of 25% per year until catastrophe strikes.
What if you follow the advice of your primary care doctor and take Lipitor 40 mg per day, aspirin, metoprolol, and reduce fat? How rapidly will your heart scan increase? 25% per year—“optimal medical therapy” has no impact on the rate of progression of coronary calcium scores. This has been demonstrated repeatedly in clinical studies. Unfortunately, intensive marketing efforts of statin drug manufacturers trumps clinical studies and doctors commonly force statin drugs on their patients with positive heart scan scores. “Optimal medical therapy” can reduce the abrupt rupture of atherosclerotic plaque that causes heart attack by a minor degree over several years, but it has no impact on progression of disease as tracked by CT heart scans.
But there’s more wrong with this common medical scenario. Among the problems:
- Stress tests are almost never abnormal in this situation, i.e, an active person who exercises without limiting symptoms. It can serve a purpose, e.g., assess the safety of exercise. But the reason that nuclear stress tests (i.e., stress tests that including imaging of the heart with a radioactive material and thereby exposes you to about 300 chest x-ray equivalents of radiation, all internally) are preferred is that they pay better. A stress echocardiogram is a non-radiation form of stress testing that is at least as helpful as nuclear stress tests, but pay only about 25% of the fees of a nuclear stress test. You should ALWAYS insist on a stress echocardiogram before undergoing exposure to radiation that you cannot undo.
- A CT coronary angiogram, while it yields beautiful images, is unnecessary. Why is it performed? CT coronary angiography is notorious for overestimating the severity of blockages and provides a way for the cardiologist to strong-arm your way to the cath lab. A 70% blockage is detected, say, in the left anterior descending artery by CT coronary angiography that your doctor describes as a “widow maker,” who then frightens you into a heart catheterization. “Good news: the blockage is only 30%. Just take your Lipitor.” This happens everyday. The substantial fees of performing a CT coronary angiogram followed by heart catheterization are the motivating forces.
- Heart catheterization and prophylactic stent placement or bypass—This has been clearly shown in clinical studies to be of NO benefit. Taking someone who has no symptoms, is active, and install stents does not prevent heart attack, does not prevent sudden cardiac death, has zero impact on health except to expose you to substantial hospital costs and procedural risks. Yet this is done all the time.
So what should you do if you find yourself in this situation? This is what the Undoctored program is all about. Before I called it “Undoctored,” we called it “Track Your Plaque” because the program was built on tracking CT heart scan scores over time. And the program succeeds in the majority in stopping the progression or even reversing the score. But you will not find statin cholesterol drugs, aspirin, or advice to reduce dietary fat. You will find strategies such as wheat/grain elimination that prevents the formation of small LDL particles and reduces the flood of postprandial lipoproteins, vitamin D that reduces inflammation, iodine and thyroid optimization that removes the contribution of thyroid dysfunction to cardiovascular risk, magnesium replenishment for its effects on blood pressure and insulin, and efforts to cultivate a healthy microbiome. You can find more extended discussions on the how’s and why’s of this program in the Undoctored book and in our Undoctored Inner Circle website.
The reason I was told to take a statin drug made no sense to me! I had some heart issues last October and a series of tests. I had a Nuclear Medicine Rest & Stress test that could not rule out a blockage so the next test was a coronary angiogram. As I am 100 pounds overweight I was expecting to hear from the interventional cardiologist who performed the angiogram that my arteries were totally blocked! Much to my my surprise he told me my arteries were “clean as a whistle!” He even took me off the “heart healthy” diet and told me to order a cheeseburger for dinner that night! Much to my surprise the next morning the nurse came in and told me this same doctor had also ordered a statin drug for me. I refused it. I talked to the cardiologist when he made his rounds and told me it was a preventative! I am still not taking the darn statin drugs! Oh, and my lipid panel done in the hospital was great! Actual cholesterol was up, by triglycerides were now normal and not in the upper limits of normal. My good and bad cholesterol were very good as well!
Deb wrote: «Actual cholesterol was up, by triglycerides were now normal and not in the upper limits of normal. My good and bad cholesterol were very good as well!»
What were the numbers for TG and HDL? Be sure to see: Undoctored program goals
And these are usually the only two numbers from a standard lipid panel that matter. If there’s a concern about lipoproteins, the subfractions actually need to be measured by an NMR panel (which a cookie-cutter cardio is very unlikely to order). But don’t bother with either lipid or NMR labs while weight loss is still in progress.
re: «…told me to order a cheeseburger for dinner that night!»
With, I suppose, no advice to skip the buns and any sauces?
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My Triglycerides were 99 mg/dl, HDL was at 58
Deb wrote: «My Triglycerides were 99 mg/dl, HDL was at 58»
The program targets for those, linked from my reply above, have a cap of 60 for TG, and a floor of 60 for HDL. I don’t know what diet and lifestyle you are on, of course, nor for how long.
Your TG may have read artificially high due to the on-going weight loss. It is also the number most distorted if the lipid panel isn’t drawn fasting (which can happen these days with consensus cardios, who think it doesn’t matter). But the TG is likely somewhat above program cap anyway. It’s not alarmingly high, and usually responds near-term to Undoctored net carb guidance and other core program elements.
The HDL is already nearly within target range. It usually responds more slowly.
back at: «…bad cholesterol…»
If that’s actually a phrase used by your cheeseburger doc, you need to replace him with real cardiologist. What he was blabbing about was probably an ‘LDL’ number, which is usually fictitious, and always useless (except to indicate that low density lipoproteins need to be measured and reported by subfraction). The value of interest in the Undoctored program is Small LDL-P, ideally from an NMR advanced lipoprotein panel. This number cannot be teased out of a standard lipid panel. When your weight gets stabilized, you might want to run an NMR, and check Lp(a) while you’re at it.
Normally, a great test for assessing coronary disease risk is the CT arterial calcium scan (or CAC). No catheter, no contrast agent, and less radiation than an angiogram, but it is some rad, and you may have used up your rad quota for a while with that angio. Pencil in CAC for next year.
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“The substantial fees of performing a CT coronary angiogram followed by heart cauterization are the motivating forces.”
Is a heart cauterization like in the cowboy movies where they apply a red-hot iron to stop the bleeding? And is that before or after the doctors apply the leeches?
Stuart wrote: «Is a heart cauterization…»
Well, there is such a thing as heart cauterization (cardiac ablation for urgent a-fib abatement), but I think (as you do) that what Dr. Davis had in mind was catheterization, and the post has been revised to clarify that.
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Autocorrection strikes again!
I’m sure Dr Davis meant catheterization. After years of proofreading documents I’ve come to the conclusion that it’s impossible to proofread your own words. The brain sees what it expects to see.
Bravo Dr Davis. Your information is providing immense benefit to countless suffering
people such as myself. I hope to be able to someday shake your hand and thank you in person. Thank you!!!
Some, including some radiologists, are saying that the Carotid IMT Test (CIMT) is as effective or better than the CT Heart Scan/Calcium Score test because the CIMT show both calcified palque and soft plaque, while the CT Heart Scan shows only calcified plaque. And they maintain the extent of the plaque on the carotid artery correlates with plaque buildup elsewhere. What is your opinion on the CIMT test?
Charles Sanderson wrote: «Some, including some radiologists, are saying that the Carotid IMT Test (CIMT) is as effective or better than the CT Heart Scan/Calcium Score test because…»
It may be more likely that they are saying that because they don’t know what to do with an Agatston score (from the CT calcium scan). They don’t know how to interpret it, nor how to slow the growth of it (much less arrest or reverse it).
CIMT has arisen many times in the subscription forum, and each discussion has to begin with a precise identification of the test in use. Too often, it’s actually just a crude carotid ultrasound, which is relatively useless, other than to suggest that a CT calcium scan would be worthwhile. The freebie scan in the van at the BigBox™ parking lot was almost certainly not a CIMT.
If it actually was a CIMT, then the question arises of what software package was used. If the report did not include precise numerical quantifications, only a crude CIMT was administered.
Even with the most precise CIMT, Dr. Davis has stated that there’s only a 70% overlap between carotid disease and coronary disease. The CT calcium scan is a more reliable indicator of total coronary plaque than the best CIMT.
All that said, CIMT has a role. There’s no harm in running CIMT in addition to CT calcium. CIMT can be run as often as desired, as it involves zero radiation. It’s a valuable alternative for people who cannot get a CT calcium scan. Clinics will usually decline to CT for any number of reasons, including but not limited to: patient is too young, there’s recent other rad exposure, pre-existing metal stents (or perhaps a pacemaker), bypass grafts (these can be scanned, but not scored), or resting heart rate is too high.
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I recall reading somewhere that the CIMT results are dependent on the operator’s skill and can be quite variable between operators. To compare results over time you really need to have them done by the same operator on the same machine – difficult to achieve at intervals of a year or more. Automated scanning would at least remove one variable – operator error – but I’m not sure whether that’s in widespread use.
Thanks Bob and Stuart.