A calcium score can be a useful measure of heart attack risk
DEAR DR. ROACH: You mentioned checking a calcium score to help determine risk of having a heart attack. Please explain what that is. Thank you. -- J.S.
ANSWER: A coronary artery calcium score is a special kind of CT scan that looks for the presence of calcium in the arteries providing blood to heart muscle. Blockages in the arteries are usually calcified, and the scan can calculate the total amount of calcium found in the walls of the blood vessels. The higher the calcium score, the more likely a person is to have blockages in the arteries. However, the test isn't perfect. A person can have calcium without having any blockages, and a person may also have a cholesterol buildup that blocks flow without having calcium. It remains a useful test in certain situations.
I most often use the calcium score when I am not sure whether my patient would benefit from medication therapy to reduce their risk of a heart attack. This comes after a person has made the best changes they can to their lifestyle, especially through diet and exercise, and when they do not otherwise choose to take medication. If the calcium score is zero, then treatment (such as a statin drug) may be safely deferred for five years. The risk of a heart attack in that time is very low.
Exceptions would be if a person is at high risk, such as from diabetes, strong family history or smoking. In people whose heart disease risk puts them on the border of a recommendation for medication treatment, a calcium score above zero would tip the scales.
Calcium scores are not useful in people who are at very low risk, since they are unlikely to change the course of treatment. Patients who did not want to take a statin drug may change their mind once they receive the result of a high calcium score, but if medication treatment is recommended anyway, a calcium score is not necessary.
DEAR DR. ROACH: I am a primary care provider and read your recent column on red yeast rice. I agree with your comments but would add the concern I have: the presence of citrinin in red yeast rice products that is toxic to the kidneys and noted in 80% of sampled products, as stated in a recent review. Experts strongly advise people NOT to use it. I hope this is of some help to you and your readers. -- C.J.
ANSWER: Many studies have confirmed the frequent presence of citrinin in red yeast rice products. In Europe, where there is better regulation of over-the-counter products, citrinin has become a less frequent contaminant, but the most recent data I can find confirms Dr. Jackson's concern about citrinin.
Since red yeast rice seems to work primary through monacolin K, the active form of lovastatin, I continue to recommend against red yeast rice. I strongly recommend using a statin when medication treatment is necessary to lower the risk of heart attack and stroke. They are purified and free of toxic contaminants, and the dosing is exact.