To better assess my own cardiovascular risk, this year, I had my own coronary calcium scan and carotid ultrasound. Thankfully, both studies were unremarkable (meaning not showing any concerning features). My coronary calcium score was 0. This means that there is no calcified plaque detected in the arteries of the heart.
For fifteen years, I have been counseling my patients on cardiovascular risk prevention. Family history, blood pressure, lipid panel (including more in depth components such as ApoB and Lp(a)), inflammatory marker hs-CRP, fasting blood glucose, hemoglobin A1c, insulin, and other metrics of metabolic health, such as visceral fat, waist circumference and body mass index, are all important factors in risk assessment. Imaging is a powerful modality for risk stratification that can be added to this assessment. It allows us to visualize plaque in the arteries of the heart, but also the carotid arteries (arteries of the neck). I typically recommend this screening modality when my patients are in their 40s to early 50s, but if they have certain risk factors, such as family history of premature heart disease, elevated Lp(a), or others, the screening may be recommended earlier. Imaging of the heart can provide information about calcified plaque alone (CAC) or about calcified and soft plaque (CCTA).
Knowing your risk helps you make informed decisions about managing your personal risk of developing cardiovascular disease, whether it’s lifestyle and nutrition alone, or adding medications to more aggressively control lipid levels.
I hear a hesitation from a lot of my patients to go on medications. There are many concerns people have about cholesterol lowering medications – is this going to cause muscle aches, affect my liver, affect my ability to exercise, etc? I hear and acknowledge that with medications, there are potential side effects and risks. I also know that for certain individuals, who have a higher risk of cardiovascular disease (especially those with intermediate to high 10 year risk), these medications can be life saving and can prolong meaningful, functional life. I will never forget many of the patients we treated in the coronary ICU for heart attacks and heart failure, and patients who came in with strokes, during my residency training. Many of these events could have been prevented or delayed with lifestyle, nutrition and appropriate, timely screening and medications.
My call to action: know your risk, so you can make an informed decision with your trusted physician or healthcare provider, about the best course of action for you. Will it be nutritional modification and lifestyle alone, or adding medications?
February is American Heart Month, a time to bring awareness to the health of our hearts and the everyday choices that influence cardiovascular risk. Heart disease is the leading cause of death among adults in the United States (Centers for Disease Control and Prevention). Despite its prevalence, many risk factors for cardiovascular disease are modifiable through lifestyle and medications.
I would also encourage reviewing our prior articles on this topic:
- Cholesterol: Why Is It Important and How to Interpret Your Lipid Panel?
https://drbojana.com/cholesterol-why-is-it-important-and-how-to-interpret-your-lipid-panel/ - What Is Lp(a) and Why Is It Important?
https://drbojana.com/what-is-lpa-and-why-is-it-important/ - How to Determine Your Cardiovascular Risk
https://drbojana.com/how-to-determine-your-cardiovascular-risk/ - How to Maintain a Healthy Heart
https://drbojana.com/how-to-maintain-a-healthy-heart/ - How to Create a Plan for Reducing Cholesterol and Cardiovascular Risk
https://drbojana.com/how-to-create-a-plan-for-reducing-cholesterol-and-cardiovascular-risk/