#50 - AMA #5: calcium scores, centenarian olympics, exercise, muscle glycogen, keto, and more
Peter Attia, joined by Bob Kaplan, discusses interpreting coronary calcium scores, emphasizing that a zero score doesn't guarantee freedom from risk. He also touches on exercise protocols, diet, and the importance of biomarkers for assessing cardiovascular health.
Deep Dive Analysis
7 Topic Outline
Podcast's Purpose and Host's Obsessions
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Understanding Coronary Artery Calcium (CAC) Score
Interpreting CAC Scores: Zero vs. Non-Zero
Limitations of CAC Scores in Detecting Arterial Damage
Utility of CAC Scores in Different Age Groups
3 Key Concepts
Coronary Artery Calcium (CAC) Score
A CAC score is derived from a quick, non-contrast CT scan that identifies bright white areas, indicating calcium deposits in coronary arteries. This scoring system provides anatomic detail about calcification in specific arteries and ranks it against a percentile, serving as a marker of advanced arterial damage and increased risk.
MACE (Major Adverse Coronary Event)
MACE is a term used to describe significant cardiac events such as a heart attack, stroke, or cardiac death. A lower CAC score at the population level is actuarially associated with a lower risk of MACE, but a zero score does not eliminate risk entirely.
Soft Plaque
Soft plaque refers to arterial damage that has not yet calcified. This type of plaque is not detected by a CAC score but still represents an enormous marker of risk for coronary events. A CT angiogram is needed to identify the presence of soft plaque.
5 Questions Answered
A CAC score is obtained from a quick, non-contrast CT scan that detects calcium deposits in the coronary arteries, which appear as bright white areas. These deposits are then scored and ranked to indicate the amount and location of calcification.
A zero CAC score actuarially means a lower risk of a major adverse coronary event (MACE) at the population level, but it does not mean the risk is zero. It indicates no calcified lesions but does not rule out the presence of soft plaque or future arterial damage.
No, a CAC score only detects calcified plaque, which is a late-stage repair of arterial damage. It does not pick up soft plaque, which can still be an enormous marker of risk and can lead to nearly 50% of fatal heart attacks.
Calcification in a coronary artery is an incredibly late-stage repair process, indicating that real damage has occurred and been repaired. It serves as a marker of risk, suggesting the need for more aggressive management of the patient's cardiovascular health.
CAC scores are often most helpful not in young people, but in older individuals, as the presence or absence of calcification can provide more definitive guidance on risk stratification in this demographic.
8 Actionable Insights
1. Aggressively Manage Non-Zero CAC
If your coronary artery calcium (CAC) score is anything other than zero, it indicates advanced lesion and repair, serving as a marker of risk that suggests you need to be more aggressive in managing your case.
2. Don’t Misinterpret Zero CAC
Do not assume a zero coronary artery calcium (CAC) score means you are ‘scot-free’ from coronary events, as this is categorically untrue and can lead to complacency, given that plenty of soft plaque can exist without calcification.
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3 Key Quotes
My problem is not with the calcium score. It's with sort of a school of thought that says, well, a calcium score, if it's zero, means nothing matters. You know, you're sort of scot-free. And that's, you know, unfortunately, that's just categorically untrue.
Peter Attia
The way I think of calcification is it tells you how many times you've been broken into and what kind of repair you've done.
Peter Attia
I'm not sure how you could trust me if I'm telling you about something when you know I'm being paid by the company that makes it to tell you about it.
Peter Attia