One of the notable developments in the past decade of cardiovascular medicine has been the increasing use of a CT scan of the heart to determine calcification in the cardiovascular system. The relative level of calcification is quantified as a “calcium score” that reflects how much calcium there is on the plaque on the inside of the blood vessels and heart. Those with no measurable calcification get a score of 0 which is excellent. Those with higher scores are viewed to be at increasingly high risk of heart attacks, even if they have no other blood markers in typical tests (such as cholesterol tests) that might suggest elevated cardiovascular disease risk.
Conventional Tests Often Fail To Detect Those At High Heart Attack Risk
Dr. William Davis of Milwaukee, Wisconsin, is a cardiologist who is a strong advocate of using the calcium score to determine the level of aggressiveness needed to treating cardiovascular disease. He views calcium score as a more direct measurement of heart attack and cardiovascular disease than commonly used risk factors such as LDL cholesterol. As he points out in his writings, there are a significant number of people who appear to be at low risk for heart attack based upon widely used LDL cholesterol tests but who fall over dead from sudden cardiac death due to cardiovascular calcification.
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Davis explains that conventional cholesterol tests, treadmill stress test, and ECGs fail to identify many of the people who are at high risk for heart attack, even those who otherwise get world-class medical care such as former US President Bill Clinton:
Quoted from Effective Ways to Detect Silent Heart Disease:
A common sequence of testing is to obtain an electrocardiogram (EKG), exercise stress test, and cholesterol (lipid) panel. Your doctor may also ask you about cardiac risk factors such as smoking, high blood pressure, diabetes, and family history.
How successful is this approach to detecting hidden heart disease? It fails to identify even advanced levels of heart disease in over 90% of people! By overwhelming majorities, future heart attack victims have normal EKGs, pass a stress test without a hitch, and have average cholesterol values. That is why most heart attacks, as well as the need for major heart procedures like bypass surgery, come as a complete surprise to both patient and doctor.1,2
Former President Bill Clinton provides a perfect example of the failings of the conventional approach to detecting heart disease. Mr. Clinton, an avid jogger, underwent a stress test annually for five years, and used Lipitor®, the popular, cholesterol-lowering prescription medication. With little warning, Mr. Clinton nearly collapsed, prompting a visit to the emergency room at New York-Presbyterian Hospital, where he was found to have severe, advanced coronary disease.
Mr. Clinton’s care was hailed as a glowing example of the success of high-tech medical procedures. To the contrary, Mr. Clinton’s need for bypass surgery serves as an example of the enormous failure of his doctors to detect a disease that requires decades to develop.
How can you learn from the millions of people like Mr. Clinton who are misled by the false reassurances provided by conventional testing? Three tests stand out as superior ways to uncover hidden heart disease or the potential for future catastrophe: CT (computed tomography) heart scans, lipoprotein testing, and the ankle-brachial index.
Getting a CT Calcium Score
CT heart scans are noninvasive tests that take multiple angles of X-ray images of your heart looking for plaque buildup. The test is scored to produce a “calcium score” ranging from 0 (no detectable plaque) to results that can range into the thousands for very severe plaque.
Since the test involves the use of X-rays, this is not a test you should have often because of the health risk that X-rays can pose and how it generally takes several months or longer for changes in diet, supplements, and medications to produce a marked change in calcium score. Prior to your CT heart scan or any other X-ray procedure (including dental X-rays), you should read Protect your DNA from CT Scans and X-rays Research Supports Nutrient Shields Against Ionizing Radiation and try to follow some or all of the suggestions in the article to minimize the damage caused by X-ray radiation.
Beyond prepping with some supplements for a few days prior to and after the test in order to minimize radiation damage, there is little else you need to do. According to the American College of Radiology and Radiological Society of North America, preparation for a cardiac CT scan for calcium scoring is simple:
Quoted from Cardiac CT for Calcium Scoring:
No special preparation is necessary in advance of a cardiac CT examination. You should continue to take your usual medications, but should avoid caffeine and smoking for four hours prior to the exam.
You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.
Metal objects including jewelry, eyeglasses, dentures and hairpins may affect the CT images and should be left at home or removed prior to your exam. You may also be asked to remove hearing aids and removable dental work.
Women should always inform their physician and the CT technologist if there is any possibility that they are pregnant. See the Safety page for more information about pregnancy and x-rays.
Understanding Your Calcium Score
An article for physicians entitled What does my patient’s coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk described a study that reviewed calcium scores for 9341 patients. The scores ranged from 0 to 4058, and from this and other data they developed a model to understand the risk represented by the scores alone and in conjunction with other common medical data. The review suggests four distinct risk groups. Low-risk is a calcium score of 0. Scores from 1 to 100 are typical risk, 101 to 400 higher risk, and over 400 is very high risk.
Once you’ve got a calcium score from your test, then you should come up with a plan to either maintain it (if it is 0) or lower it (for anything above 0) at an aggressiveness depending upon the magnitude of the score and your other test data, family history, and anything else that may affect your cardiovascular disease risk.
To come up with a good plan, you need to carefully evaluate the side effects of any medications you are taking and get at least a basic screening for diabetes and metabolic syndrome plus the calcium and vitamin D levels in your blood. This is particularly important if your calcium score is anything much beyond 0.
Health Conditions That May Accelerate Calcification
Elevated levels of parathyroid hormones (hyperparathyroidism) can cause high levels of calcium that are likely to accelerate arterial calcification. This should generally show up with high levels of calcium (hypercalcemia) in a simple blood chemistry test, and this may be a reason for subsequent tests for parathyroid hormones.
Disorders of the thyroid, abnormal vitamin D metabolism or very high levels of vitamin D in the blood (extremely uncommon, but it does happen), and parathyroid tumors (cancerous or not) may all contribute to hypercalcemia.
Some symptoms of hypercalcemia include kidney stones, bone pain, fatigue, muscle weakness, and abnormal ECG (electrocardiogram). When severe, it can cause heart attacks and comas and is considered a medical emergency. But the damage done by accelerated calcification to your heart and blood vessels can be happening even without any such symptoms.
Medications That May Accelerate Calcification
Some medications leach calcium out of the bones. Among them are some steroids, antibiotics, anticonvulants, diuretics, oral contraceptives, artificial estrogens, and anticoagulants. Some of these drugs remove the calcium from the body via excretion in urine, but others move it into the blood from where it is deposited throughout the cardiovascular system via accelerated calcification.
Warfarin (also known as Coumadin) is a widely prescribed anticoagulant (clot blocking drug) that is dangerous for many reasons, but it is especially harmful for long-term use because it exhibits the dangerous effects of causing osteoporosis and cardiovascular calcification because of its strong vitamin K antagonist activity. Vitamin K is essential to processes that keep calcium in the bones, where it belongs. Warfarin blocks these processes by interfering with vitamin K metabolism and in the process effectively moves calcium from the bones into the blood where it accumulates dangerously, elevating the calcium score.
Some people may not be able to avoid taking warfarin, particularly those with artificial heart valves or multiple genetic conditions involving excessive blood clotting. However, warfarin is prescribed extensively for other conditions such as avoiding DVT (deep vein thrombosis) in the legs and reducing atrial fibrillation. Unless there is strong medical reason otherwise, such patients should be working very hard to reduce all the other clotting risks they can control such as abnormal blood lipids, elevated inflammation, atherosclerotic plaque buildup, and mitochondrial problems that result in weak heart pumping action that could result in abnormal formation of clots due to slow blood circulation. Keeping the warfarin dosage as low as possible to allow vitamin K metabolism to help keep calcium in the bones is very important. Please see Supplements That Can Aid Warfarin Users By Reducing Abnormal Clotting and Bleeding Risks for information on how some supplements and diet modifications can help better control the risks of warfarin.
Supplements That May Accelerate Calcification
Many people take calcium supplements aiming to reduce the risk of osteoporosis, but under some circumstances these can also lead to faster cardiovascular calcification. In the presence of inadequate vitamin K and magnesium, it is much more likely some of the calcium will end up damaging the cardiovascular system via calcification instead of being put into the bones to make them stronger.
Vitamin D supplements in the absence of adequate vitamin K and magnesium also present a risk of raising calcium levels in the blood excessively. There are literally hundreds of studies pointing to the health benefits of getting your vitamin D levels into the 50 to 80 ng/mL range. However, when you do this, you are also likely to increase your body’s absorption of calcium from whatever foods and supplements you are consuming because most people start out with insufficient levels of vitamin D that are often around 20 to 30 ng/mL and sometimes even less. Raising your vitamin D to healthy levels could inadvertently lead to higher than desirable levels of calcium in your blood, particularly if you are taking calcium supplements. In the presence of other cardiovascular risk factors, such as inflammation, high ratios of omega 6 to omega 3 fats in the diet, and low vitamin K intake it is likely that that calcium will end up on the inside of your blood vessels and heart instead of in the bones where it belongs.
Suggestions for Lowering or Maintaining Low Calcium Score
One of your first goals should be to get your vitamin D and calcium levels into healthy ranges.
Vitamin D, as I mentioned above, should be between 50 to 80 ng/mL in most people unless there is a medical reason otherwise. Most people are going to need a few thousand IU per day of vitamin D3 supplements to achieve this, but the individual response to vitamin D3 varies tremendously so you are going to need to do some repeated testing and adjustment to get it right. Some people may do fine with around 2000 IU per day, others may need 5000 IU per day, and a few may need even more. Getting tested is the only way to know.
Calcium levels ideally should be around the middle of the reference range of whatever test you take, but if you are taking warfarin then you should be especially cautious about keeping them from crossing above the test reference range.
Most people would benefit from taking a vitamin K supplement that incorporates a long-acting form of vitamin K such as the vitamin K2 MK7 form that maintains activity in the blood for about 24 hours. It is commonly known that leafy green vegetables are a good source for vitamin K, but that is the K1 form that is not as good at maintaining steady levels of vitamin K metabolism as K2, particular the MK7 form of K2. For people not depending upon warfarin for clot reduction, an excellent product for vitamin K supplementation with a number of other good cardiovascular nutrients (including vitamin E mixed tocopherols, lycopene, lutein, vitamin C, and ginkgo biloba) is Life Extension’s Super Booster Softgels with Advanced K2 Complex. It is often about the same or just a little more expensive than much more basic vitamin K2 supplements from other companies. However, as this product contains significant amounts of vitamin K1 and K2 MK4 forms, it may not be suitable for some people taking warfarin for anticoagulation.
Warfarin patients can probably better benefit from vitamin K2 only supplements as they will help stabilize the peaks and valleys of vitamin K that can result in periods of elevated clotting and bleeding risks. This is because vitamin K1 and K2 MK4 forms tend to last only a few hours in the blood, thus producing more pronounced peaks and valleys in vitamin K levels than MK7 achieves. They will need guidance from their medical providers to adjust warfarin dosage as all vitamin K supplements have a strong effect on clotting potential.
Magnesium deficiency is widespread and causes the body’s healthy usage of calcium to be impaired. Supplementing with around 400mg of magnesium per day would be suitable for many people. Preferably use split dosages to avoid the laxative effect associated with many magnesium supplements.
After adjusting your intake of the above nutrients (calcium, vitamin D, vitamin K, and magnesium), then you should look at what you can do to lower other cardiovascular disease risk factors such as homocysteine, C reactive protein, lipid abnormalities, out of control general inflammation, and mitochondrial health. A detailed discussion of these areas is quite complicated and lengthy, so for the moment I will just summarize a few things you can investigate further.
Elevated homocysteine generally comes from low vitamin B levels, particularly, vitamin B12 and folate, or from inadequate methyl donors in the blood. Top nutritional supplements that you may investigate for lowering homocysteine including the methylcobalamin form of vitamin B12, the methylfolate form of folate, and TMG (trimethylglygine). Vitamin B6 (particularly in P5P form) and B2 (riboflavin) are also important, too. All of these B complex vitamins are relatively inexpensive, but the bioactive forms such as methylcobalamin and methylfolate do tend to be more expensive than the types used in most multivitamins. Some people may also get good results from increasing the amount of leafy green vegetables in their diets to boost folate intake or from common multivitamins, but this doesn’t always work because a significant number of people have metabolic problems with absorbing and bioactivating the forms of folate and vitamin B12 commonly found in foods and inexpensive supplements.
C reactive protein (CRP) tests can show if you have high levels of this inflammatory protein. Diet changes such as reducing wheat, sugars, and carbohydrates can help lower this. Supplements containing concentrated amla (Indian gooseberry) appear to have a drastic effect on reducing CRP in at least some people.
Fibrinogen tests can show if you have high levels of this clotting protein that may put you at higher risk for cardiovascular diseases such as DVTs and strokes. One of the more effective supplements that appears to work for lowering fibrinogen is pine bark extract. Both the Pycnogenol and Enzogenol brands appear to work, as do some unbranded quality pine bark extracts.
Lipid abnormalities appear to be largely driven by diet and weight in most people. Reducing carbohydrates, particularly foods containing wheat and HFCS (High Fructose Corn Syrup) or table sugar, is often very helpful. For those with a need to lose weight, such changes often help shed the pounds while at the same time improving blood markers for lipids and metabolic syndrome or diabetes.
Most people also have highly imbalanced intakes of omega 6 fats versus omega 3 fats and this contributes both to lipid abnormalities and inflammation. Boosting your omega 3 intake drastically by taking large amounts of omega 3 fish oil supplements is probably the easiest way to address this. Carnitine supplements often help with lowering triglycerides and making LDL particles larger and fluffier, and therefore less likely to injure the endothelial lining of the vascular system. Alpha lipoic acid is synergistic with carnitine supplements, meaning that adding a little of it makes the carnitine work much better. Niacin (in the form of nicotonic acid, not inositol hexanicotinate or niacinamide) can also help improve blood lipids and is one of the few supplements or drugs that can often raise beneficial HDL cholesterol.
Systemic inflammation is a major risk factor for cardiovascular disease. Fish oil can help with this. Interestingly, simply getting good dental care can also help tremendously as a mouth full of inflammation-causing bacteria is likely to not only damage your gums but also spread inflammatory cytokines throughout the body where they will harm cardiovascular health. Regular brushing, flossing, dental checkups, and the use of dental probiotic tablets are all good steps to combat this.
Most doctors these days are doling out statin prescriptions to anybody with lipid abnormalities. This is dangerous in my opinion because statins lead to depletion of the CoQ10 enzyme necessary for mitochondrial energy production. Good cardiovascular health depends upon a strong reliable heart that can adequately circulate blood. Low CoQ10 levels are therefore a big risk to cardiovascular health, doubly so because CoQ10 also acts as an important antioxidant in the body that helps block oxidation damage to LDL cholesterol. If you dare to take statins, take an oil-based CoQ10 supplement and have your CoQ10 levels periodically checked to verify it is working. Dr. Davis believes that most people taking statins will eventually develop symptoms of CoQ10 deficiencies such as muscle pains if they do not take supplemental CoQ10. It’s my belief that relatively few people actually need statins and those with anything less than severe lipid abnormalities would be better served by trying fish oil, carnitine, and niacin first.
The above is certainly not an exhaustive list of options for helping to slow or reverse atherosclerosis using supplements and diet changes. However, they are good steps for almost anybody and are relatively inexpensive to try out for a few months before repeating some of your common tests to see if they are working. For a more thorough list of supplements that you may want to investigate, see the article Atherosclerosis and Cardiovascular Disease.
Rechecking Your Calcium Score
Ultimately, you may want to recheck your calcium score again at some point. But as that is a much more expensive test than many cardiac related blood tests and also exposes your body to X-ray radiation, it is not something I would personally do any more often than every few years unless I had a very high calcium score (above 400) or was taking warfarin or another drug likely to cause arterial calcification. In such cases, more frequent rechecks may be warranted until some good progress at reversing the calcification can be verified.
What does my patient’s coronary artery calcium score mean? Combining information from the coronary artery calcium score with information from conventional risk factors to estimate coronary heart disease risk
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