Calcium Score Paradigm Shift in Cardiology

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Calcium Score Paradigm Shift in Cardiology

by Jeffrey Dach MD

A Cardiology “Paradigm Shift” occurred in 2004 with publication of the Raggi study on annual Calcium Score progression.(1)

This left chart shows the MAJOR FINDING: Less than 15% annual increase in calcium score is associated with a good prognosis.(upper line), regardless of high starting score.   On the other hand, greater than 15% annual progression (lower line) shows poor prognosis with increasing Myocardial Infarction rate.

When you see this chart for calcium score, let me remind you, there are no similar data charts for LDL cholesterol.  As a matter of fact, there was no difference in LDL levels for the 41 heart attack patients compared to 450 others free of heart attack.  There was no difference !!!   Dr Paoli Raggi says:

“Mean LDL level did not differ between groups (118 mg/dL versus 122 mg/dL, MI versus no MI).(Dr Raggi 2004 (28)  (Note: MI = Myocardial Infarction)”(1)

Dr Paoli Raggi found that LDL cholesterol is a useless marker for predicting future heart attack.  Above Left Chart Fig2 Courtesy of Dr Raggi 2004 (1)

Why is Calcium Score a Superior Predictor Over Cholesterol 

Cholesterol and subfractions are substances we measure in the blood stream, distant from the wall of the artery where the pathology is located. With calcium score, we are measuring the pathology directly in the wall of the artery.   Progression of calcium score indicates progression of pathological change in the wall of the artery.

Conclusion: 

Dr Paoli Raggi’s study in 2004 showed superiority of calcium score over LDL cholesterol in predicting future heart attack.  As a matter of fact, the cholesterol panel has been, (as of 2004),  replaced by the calcium score for routine management of heart disease.  This is the paradigm shift in Cardiology.  However, more than a decade later, mainstream cardiology is still in denial, having buried and ignored Dr Raggi’s 2004 study.  The financial stakes are too high to give up on the “Cholesterol Myth” and the billions from the cholesterol drugs.  As Upton Sinclair once said:  “You can’t get a Cardiologist to understand something if his salary depends on him not understanding it.”

Jeffrey Dach MD

7450 Griffin Road Suite 180/190

Davie, Fl 33314

954 -792-4663

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References:

1)  Raggi, Paolo, Tracy Q. Callister, and Leslee J. Shaw. “Progression of coronary artery calcium and risk of first myocardial infarction in patients receiving cholesterol-lowering therapy.” Arteriosclerosis, thrombosis, and vascular biology 24.7 (2004): 1272-1277.

Objective— Statins reduce cardiovascular risk and slow progression of coronary artery calcium (CAC). We investigated whether CAC progression and low-density lipoprotein (LDL) reduction have a complementary prognostic impact.

Methods and Results— We measured the change in CAC in 495 asymptomatic subjects submitted to sequential electron-beam tomography (EBT) scanning. Statins were started after the initial EBT scan. Myocardial infarction (MI) was recorded in 41 subjects during a follow-up of 3.2±0.7 years. Mean LDL level did not differ between groups (118±25 mg/dL versus 122±30 mg/dL, MI versus no MI).On average, MI subjects demonstrated a CAC change of 42%±23% yearly; event-free subjects showed a 17%±25% yearly change (P=0.0001). Relative risk of having an MI in the presence of CAC progression was 17.2-fold (95% CI: 4.1 to 71.2) higher than without CAC progression (P15% per year (P

Conclusions— Progression of CAC was significantly greater in patients receiving statins who had an MI compared with event-free subjects despite similar LDL control. Continued expansion of CAC may indicate failure of some patients to benefit from statin therapy and an increased risk of having cardiovascular events.

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