Plaque that builds up in coronary arteries is composed of deposits of cholesterol that can calcify, which signals atherosclerosis or “hardening of the arteries,” the underlying problem in coronary heart disease. If plaque continues to accumulate, it can eventually narrow an artery and impede or block the flow of blood through it, leading to chest pain (angina) or a heart attack. A CT scan can measure calcium in the walls of coronary arteries. While the calcium score doesn’t reveal the extent of any blockage, the higher your score is for your age, presumably the higher your risk for a heart attack or stroke. To determine the actual extent of the blockage, you need additional testing.
I discussed your question with preventive cardiologist Stephen Devries, M.D., executive director of the Gaples Institute for Integrative Cardiology in Deerfield, IL. He recommends consulting your doctor about whether a cardiac stress test is needed. This is done by having you walk faster and faster on a treadmill while monitoring your electrocardiogram and blood pressure and seeing how fast your heart rate returns to normal after the end of exercise. It can reveal abnormal changes in your heart’s rhythm or electrical activity as well as compromised blood flow to the heart.
A “zero” score for calcium is generally good news, although it doesn’t necessarily eliminate the possibility of a blockage. And a high score doesn’t necessarily indicate a problem, because the calcium could have formed in the past with no progression of atherosclerosis. Risk is highest if one or both of your parents have had heart disease before age 60. Other risk factors include high cholesterol, smoking, high blood pressure, insulin resistance, diabetes, high triglycerides, being overweight or obese, a sedentary lifestyle and the use of birth control pills or estrogen replacement therapy. Sleep apnea, stress and excessive consumption of alcohol can also raise risk.
Given your high calcium score, Dr. Devries emphasizes the need for going “full throttle” on preventive lifestyle measures to lower your score and reduce your risk of a heart attack. He notes that your doctor may recommend that you take aspirin daily and, possibly, a cholesterol-lowering statin drug. But whether or not medication is recommended, Dr. Devries recommends following an anti-inflammatory diet as the key to your preventive program.
An anti-inflammatory diet, such as the one I recommend, emphasizes vegetables and fruit, whole grains (in place of processed foods made with flour), nuts, more fish and less meat, with extra-virgin olive oil as your main cooking oil.
Andrew Weil, M.D.