Dr. Azhak, I want to thank you for this post. As an Internist, I must tell you that this is one of the best, clearest, most educational posts regarding CT Ca scans and CAD that I ever seen, ie including textbooks and reference papers. Beautiful work integrating history, symptoms, findings and pathophysiology. It should be read by every PCP, probably every cardiologist, and any/all patients getting a CT Ca scan. Thank you.
This is interesting. I had a 0 calcium score but since menopause my Lp(a), ApoB and ldl are all elevated although I have low triglycerides and high HDL and 0 inflammatory markers. I am opting for a CT angiogram with a pre protocol for allergies to contrast: I am nervous! My mother had low cholesterol and had a 90% LAD blockage and massive heart attack at 75 and my grandmother had cholesterol in the 400’s with zero calcium score lived to her mid 90’s!
Debbie thank you for sharing your story. I have had a substantial number of patients with similar characteristics to your numbers. Your concerns are valid and I would say the science is not clear on the CNS effects yet. Officially based on studies out there I would start by saying... The large controlled studies do not show that statins cause dementia or progressive memory decline. A small number of people do report brain fog or forgetfulness after starting one, and I take that seriously because it can be real and usually improves after changing or stopping the medicine.... having said that upfront....From a risk / benefit standpoint, a calcium score 100 or higher classifies someone in a significantly higher category of cardiovascular event risk than a calcium score of 0. So when looking to lower cardiac risk statins enter the conversation of course, but there are alternatives to statins in this day and age- namely the PCSK9 agents like repatha, leqvio and now lipfendra. But before all of that.... i would say, what the lipoprotein a, fasting insulin, uric acid, homocysteine, hba1c are all factor in to cardiovascular risk assessment And the foundation of modifying cardiovascular risk is an anti inflammatory diet and lifestyle. (We havent even discussed exercise yet). The truth is, with all of these case reports of patients reporting neurological side effects from statin therapy, we have no idea what the baseline metabolic health and neuro-inflammatory status of these people are. When I counsel my patients about this I spend a lot of time educating them about the Neuro inflammatory effects of pesticides, and why they need to be vigilant about eating organic pesticide, free foods, make sure they incorporate regular amounts of cooked Asian mushrooms in their diet for the ergothioniene content and be vigilant about not consuming excessive sugar, etc. all things known to contribute to excessive inflammation in the brain, which is the root cause of neurodegenerative diseases in general- on top of which we don't know what the effects of statin therapy or any medication for that matter is on top of that baseline. the issue might be statins as a drug per se, but the issue may also be lower cholesterol, etc. in an already compromised brain so you can see the nuance in a case when factoring in all of these factors, so no one approach works for any given patient. It's a cumulative assessment of all of the risk factors at play followed by an educated measured decision that is shared between patient and their treating practitioner. This is the general roadmap I follow with my patients and I hope my response has been helpful.
Sounds interesting, I plan to read in full and report back. I love learning the nuances applied from other experts.
Dr. Azhak, I want to thank you for this post. As an Internist, I must tell you that this is one of the best, clearest, most educational posts regarding CT Ca scans and CAD that I ever seen, ie including textbooks and reference papers. Beautiful work integrating history, symptoms, findings and pathophysiology. It should be read by every PCP, probably every cardiologist, and any/all patients getting a CT Ca scan. Thank you.
This is interesting. I had a 0 calcium score but since menopause my Lp(a), ApoB and ldl are all elevated although I have low triglycerides and high HDL and 0 inflammatory markers. I am opting for a CT angiogram with a pre protocol for allergies to contrast: I am nervous! My mother had low cholesterol and had a 90% LAD blockage and massive heart attack at 75 and my grandmother had cholesterol in the 400’s with zero calcium score lived to her mid 90’s!
Female here, 69, with a calcium score of 151. The LAD has 129 of the 151.
Hs-CRP of 3.4. ApoB of 91.
(I’m normal weight and my metabolic numbers are excellent including BP, glucose, and A1C. I walk and exercise every day.)
My doctor keeps mentioning statins but I have read many studies about the effects on brain health due to statins.
I see that you are prescribing them. What, if any, are your concerns about statins? Do you think the studies are flawed?
I would appreciate your opinion. Thank you.
Debbie thank you for sharing your story. I have had a substantial number of patients with similar characteristics to your numbers. Your concerns are valid and I would say the science is not clear on the CNS effects yet. Officially based on studies out there I would start by saying... The large controlled studies do not show that statins cause dementia or progressive memory decline. A small number of people do report brain fog or forgetfulness after starting one, and I take that seriously because it can be real and usually improves after changing or stopping the medicine.... having said that upfront....From a risk / benefit standpoint, a calcium score 100 or higher classifies someone in a significantly higher category of cardiovascular event risk than a calcium score of 0. So when looking to lower cardiac risk statins enter the conversation of course, but there are alternatives to statins in this day and age- namely the PCSK9 agents like repatha, leqvio and now lipfendra. But before all of that.... i would say, what the lipoprotein a, fasting insulin, uric acid, homocysteine, hba1c are all factor in to cardiovascular risk assessment And the foundation of modifying cardiovascular risk is an anti inflammatory diet and lifestyle. (We havent even discussed exercise yet). The truth is, with all of these case reports of patients reporting neurological side effects from statin therapy, we have no idea what the baseline metabolic health and neuro-inflammatory status of these people are. When I counsel my patients about this I spend a lot of time educating them about the Neuro inflammatory effects of pesticides, and why they need to be vigilant about eating organic pesticide, free foods, make sure they incorporate regular amounts of cooked Asian mushrooms in their diet for the ergothioniene content and be vigilant about not consuming excessive sugar, etc. all things known to contribute to excessive inflammation in the brain, which is the root cause of neurodegenerative diseases in general- on top of which we don't know what the effects of statin therapy or any medication for that matter is on top of that baseline. the issue might be statins as a drug per se, but the issue may also be lower cholesterol, etc. in an already compromised brain so you can see the nuance in a case when factoring in all of these factors, so no one approach works for any given patient. It's a cumulative assessment of all of the risk factors at play followed by an educated measured decision that is shared between patient and their treating practitioner. This is the general roadmap I follow with my patients and I hope my response has been helpful.
Yes, very helpful. Many thanks for your prompt and thoughtful answer. I really appreciate you taking the time to give me your thoughts and opinions.