Astronauts and U.S. presidents share something in common. Both are required to have a scan taken of their coronary arteries to see how much calcium is deposited. That’s because the scan is considered the most robust predictor of a potentially fatal heart attack.
A high level of calcium is not only a tell-tale sign of imminent danger for the heart, it can also predict the risk of death from all causes. In fact, this scan could be the most important test you’ll ever take.
There’s nothing “sudden” about a heart attack. Most heart attacks are caused by years of atherosclerosis, the fancy medical word for a build-up of fat and cholesterol deposits called plaque in and on your artery walls.
The body attempts to reinforce the artery before a rupture occurs by depositing calcium, much like putting sealant over a cracked pipe.
This process can be measured by a coronary artery calcium (CAC) scan.
Calcium and Heart Disease Risk
Someone with a CAC score of 1000 – a large build-up of calcium – will have ten times the risk of a major heart attack as someone with a score of zero to ten.
The value of a CAC scan can be seen in at least one major study. This study found any CAC score above zero was linked to a five-fold increase in fatal and nonfatal coronary heart disease (CHD) specifically, and a three-fold increase among all types of cardiovascular disease (CVD).
But this is just the beginning.
The power of the CAC score goes well-beyond indicating arterial disease, because the root causes that drive cardiovascular illness are also behind many other killers.
Increases Death Risk From all Causes by 15-Fold
Researchers gave a CAC scan to 44,000 people who were in their mid-fifties, on average, and free from coronary heart disease. Five risk factors (RFs) were taken into account: smoking currently, having elevated blood fats, diabetes, high blood pressure and a family history of coronary heart disease.
Five years later, even accounting for the risk factors, the all-cause mortality rate for a CAC score over 400 was fifteen times greater than for a low score.
The authors concluded by writing, “…individuals without RFs but elevated CAC have a substantially higher event rate than those who have multiple RFs but no CAC…”
Last year a very similar study was published, but this time researchers tested over 66,636 participants and had a follow up period of 12½ years.
In that time there were 3,158 deaths, and two thirds of them were not related to cardiovascular disease.
The researchers found an eight-fold increase in the annualized all-cause mortality rate among individuals with a CAC score of 400 or more compared to those with a CAC score of zero. This rose to 16-fold for deaths from cardiovascular disease and 24-fold for deaths from coronary heart disease.
Those with no risk factors and a CAC score of 400 or more had a mortality rate more than five-fold higher than individuals with three or more risk factors and a zero CAC score.
Traditional Risk Factors Inferior to CAC
This study, among others, led Harvey Hecht, a cardiovascular specialist, to write an editorial in the Journal of the American College of Cardiologists saying, “Their report adds to the remarkably consistent mass of CAC data confirming its superiority to risk factors, and the erroneous allocation of treatment based on risk factors alone.”
A major landmark CAC study specified particular non-cardiovascular diseases linked to a CAC score over 400. They concluded, “Participants with elevated CAC were at increased risk of cancer, [chronic kidney disease, chronic obstructive pulmonary disease], and hip fractures. Those with CAC of zero are less likely to develop common age-related co-morbid conditions and represent a unique population of ‘healthy agers’.”
As Ivor Cummins and Jeffry Gerber M.D. write in the book Eat Rich, Live Long, “In short, a CAC scan is the ultimate test to assess your risk of death from most chronic diseases. It will enable you to take action to ensure longevity and tell you if your efforts are hitting the mark.”
Getting a CAC Scan
A CAC scan uses a special x-ray machine called a computed tomography (CT) scanner that takes multiple pictures of the heart in thin sections. When combined, these scans produce a view that can reveal calcium deposits in the walls of the heart’s arteries.
This simple ten-second scan requires no invasive injections of dye, but does expose patients to a dose of radiation, similar to that of a mammogram. The test costs around $150. I am opposed to unnecessary X-ray exposure, so I would recommend using this test wisely and rarely. From what my researchers have learned, it’s very valuable, but – my personal opinion – I would not make it an annual event. Maybe every few years.
Despite its simplicity, not all cardiologists are in favor of CAC scans because they believe there are no drugs they can prescribe to change the outcome. Reducing calcium deposits in the heart is impossible, they believe.
How to Reduce Coronary Calcium Deposits
Mr. Cummins and Dr. Gerber write in their book that problems with insulin signaling are the primary reason for the build-up of calcium. To reverse the situation, it’s vital to stabilize blood sugar by eating a low-carb, high-fat diet.
I bet that recommendation sounds familiar to you. . .
Dr. Gerber gives an example of one patient who took his advice, reducing his CAC score from 61 to 38 in 12 months, an impressive 36 percent reduction. The patient’s cardiologist was said to be “astounded and nearly speechless,” especially as his total cholesterol was a lofty 367. Of course, this is just one patient – nowhere near conclusive.
In addition to diet, statin drugs, when used with nutritional supplements, can also be of benefit, according to a small clinical trial.
A study of 45 patients over 18 months who were taking statin therapy, niacin and omega-3 fatty acids, resulted in 93 percent seeing an improvement in their CAC score.
Of the 45, 20 people saw a 14.5 percent drop in CAC score, 22 saw a slight decrease and only three experienced the formation of new calcium deposits. Statins are not a treatment I would recommend, and those results don’t sound all that impressive to me, but we’re telling you this so you’re fully informed of the options.
Some doctors have reported that a yearlong regimen of healthy supplements, including all the major vitamins and minerals, can reduce a person’s CAC score. One such doctor is Matthias Rath, M.D., who wrote about his success using nutritional supplements with patients in his book, Why Animals Don’t Get Heart Attacks… But People Do.
- Eat Rich, Live Long by Cummins and Gerber, Victory Belt Publishing 2018
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5397328/ Association of Coronary Artery Calcium in Adults Aged 32 to 46 Years With Incident Coronary Heart Disease and Death
- https://pubmed.ncbi.nlm.nih.gov/22718782/ Interplay of coronary artery calcification and traditional risk factors for the prediction of all-cause mortality in asymptomatic individuals
- https://pubmed.ncbi.nlm.nih.gov/31734198/ Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium
- https://www.jacc.org/doi/full/10.1016/j.jcmg.2019.10.010 Coronary Artery Calcium and Prevention Guidelines: Time for a Change (Again)
- https://pubmed.ncbi.nlm.nih.gov/26970999/ The Association of Coronary Artery Calcium With Noncardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis
- https://escholarship.org/uc/item/3dn0004c Interplay of Coronary Artery Calcium and Risk Factors for Predicting CVD/CHD Mortality: The CAC Consortium
- Why Animals Don’t Get Heart Attack…But People Do by Matthias Rath MD, MR Publishing 2003
- https://pubmed.ncbi.nlm.nih.gov/19092644/ Effect of a combined therapeutic approach of intensive lipid management, omega-3 fatty acid supplementation, and increased serum 25 (OH) vitamin D on coronary calcium scores in asymptomatic adults