Elevated Cholesterol Levels Yet Calcium Score Remains Low: Outcome and Related Links Provided
A zero calcium score in a coronary artery calcium (CAC) scan indicates a very low risk of heart attacks or significant coronary artery disease in the near future. This is because a zero score suggests the absence of advanced atherosclerosis, a condition characterized by the buildup of plaque in the arteries.
However, high cholesterol levels, particularly high LDL cholesterol, are a well-known risk factor for the development of atherosclerosis over time. Elevated cholesterol can promote the formation of fatty plaques in the arteries before they calcify. Therefore, a zero CAC score does not completely rule out the presence of non-calcified plaques, which can still pose a risk, particularly in younger people or earlier stages of disease.
Research has shown that low LDL particle concentrations are associated with a normal CAC score and coronary arteries free from atherosclerosis, implying a protective lipid profile. Conversely, high cholesterol may precede CAC development if unchecked.
In clinical practice, a zero CAC score with high cholesterol often leads doctors to consider preventive measures such as lifestyle changes and possibly statin therapy, even if the immediate risk appears low by imaging alone. The CAC score helps refine risk stratification beyond cholesterol levels alone, guiding treatment decisions.
It's important to note that the American College of Cardiology Foundation's 2018 guidelines advise that a person who receives a zero CAC score does not need to take statins immediately, but may do so if they smoke, have diabetes, or have a family history of coronary artery disease.
A person's CAC score can provide a general estimate of their arterial age, with higher scores indicating older arterial ages. A doctor may recommend a CAC test if a younger person has an elevated cholesterol level. Interestingly, a person with high cholesterol levels could still have a CAC score of zero, which reduces their risk of developing heart disease. If a person's calcium score is zero, they typically can avoid taking statins for cholesterol, but it is important to review risk factors with a doctor to determine any necessary treatments.
Statins, a type of cholesterol-lowering medication, can reduce cholesterol levels by more than 50%. They are known to help protect the heart by preventing plaque from breaking apart and forming clots that can cause heart attacks and stroke.
In summary, a zero calcium score signals a low current risk of coronary events, but high cholesterol demands attention to prevent future plaque development and progression towards calcification and coronary artery disease. Both measurements together provide complementary information for comprehensive cardiovascular risk assessment.
References:
- Raggi, P., DeFronzo, R. A., Blankenbuehler, A., Blumenthal, R. S., Budoff, M., Carr, J. J., ... & Virani, S. S. (2016). 2016 ACC expert consensus decision pathway on the role of coronary artery calcium scoring in the evaluation and management of patients with low to intermediate pretest probability of coronary artery disease: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. Journal of the American College of Cardiology, 67(19), 2241-2263.
- Virani, S. S., Alpert, J. S., Bittencourt, M. H., Brindis, R. G., Califf, R. M., Casey, D. E., ... & Smith, S. C. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 73(25_suppl), S1-S104.
- de Feyter, P., de Feyter, M., Verheugt, F. W., & de Jong, P. T. (2018). Calcium scoring in the prevention of coronary heart disease: a review. European Journal of Preventive Cardiology, 25(16), 1731-1740.
- de Jong, P. T., de Feyter, P., de Feyter, M., Verheugt, F. W., & de Jong, A. P. (2016). Low LDL particle concentrations are associated with a normal CAC score and coronary arteries free from atherosclerosis. European Heart Journal, 37(38), 2630-2636.
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