Silent coronary atherosclerosis: What tests may not reveal

If you’ve been to your doctor lately for a yearly checkup, you may feel confident that your risk of a future heart attack is low, or even better — zero.

That’s because doctors are now widely using an imaging test called a cardiac CT scan.

The scan creates tiny, cross-sectional images of the blood vessels that go to your heart to measure the presence and density of calcium-containing plaques.

Using information from the scan, your doctor determines what’s known as a coronary artery calcification (CAC) score, which estimates your risk for and extent of coronary artery disease on a scale of 0 to over 400.

If you get a score of 400 or above, you’re at high risk of having a heart attack, stroke or dying from either one within the next 10 years.

A zero score and your doctor will tell you your risk is low, especially if any other risk factors you may have are considered intermediate, according to the current American Heart Association/American College of Cardiology guidelines for the prevention of heart attack.

So, once you get that zero score, it’s all roses now, right?

Not so fast!

Those CT scans that we’ve all been relying on to tell us our heart and blood vessels are in good shape are now coming under fire. According to a study of over 25,000 adults in Sweden, they’re not supplying a complete picture of what’s really going on in our arteries.

A hidden epidemic of silent coronary atherosclerosis

So what exactly is the problem with those scans and CAC scoring?

According to study author Göran Bergström, M.D., Ph.D., professor and senior consultant in clinical physiology in the department of molecular and clinical medicine at the University of Gothenburg’s Institute of Medicine in Gothenburg, it all has to do the original basis of that CT itself.

“Measuring the amount of calcification is important, yet it does not give information about non-calcified atherosclerosis, which also increases heart attack risk,” he says.

When he and fellow researchers used a more detailed imaging technique — coronary computed tomography angiography (CCTA) scans — the results were shocking. In the group of 25,000 adults, aged 50 to 64 with no known prior heart disease, 40 percent were found to have some degree of atherosclerosis — specifically silent coronary atherosclerosis.

Within that group, among people who’d previously received a zero CAC score, 9.2 percent of them were found to have atherosclerosis visible by CCTA scan.

In other words, many of us, and our doctors, could be operating under a false sense of security if our CT scans and CAC scores show we’re in the clear, simply because they don’t see the bigger picture.

What is non-calcified atherosclerosis?

You see, unlike the calcified plaques that a cardiac CT scan can see, non-calcified atherosclerosis is a buildup of fatty deposits in your arteries.

You can almost think of it as the fat line in a steak — but lining your blood vessels.

Just like those calcified plaques, these fatty deposits narrow your arteries, reduce the function of their endothelial lining and restrict blood flow.

But even worse, non-calcified atherosclerosis is believed to be more prone to cause heart attacks compared with calcified atherosclerosis.

According to Bergström, “It is important to know that silent coronary atherosclerosis is common among middle-aged adults, and it increases sharply with sex, age and risk factors. A high CAC score means there is a high likelihood of having obstruction of the coronary arteries. However, more importantly, a zero CAC score does not exclude adults from having atherosclerosis, especially if they have many traditional risk factors of coronary disease.”

Keeping your arteries healthy

When you see your doctor next, make sure you talk with them about what you’ve just read and see if it’s possible to receive the detailed CCTA imaging for your arteries — especially if you are at high risk for heart problems.

And get to work protecting your arteries…

According to the American Heart Association (AHA), many scientists believe plaque begins when the endothelium becomes damaged. How can you cut down on that happening?

People who followed at least six out of seven of Life’s Simple 7, lifestyle habits devised by the AHA, were 10 times more likely to have healthy blood vessels as they age. 

On that list is smoking. Ditch that death habit right away. Smoking makes fatty deposits more likely to form. If that’s not bad enough, smoking accelerates the growth of plaque.

What else?

#1 – An artery-supporting cocktail

One important study found that including a combination of fish oil, cocoa extract and phytosterols in your diet has the potential to help stop atherosclerosis progression.

#2 – Cut down on artery-damaging inflammation by eating cruciferous veggies.

Vegetables like broccoli have been shown to help reduce the inflammation that can damage your blood vessels and the risk of heart disease along with it.

#3 – Support pliable arteries and healthy blood pressure

Certain nutrients have been found to support the arteries and their functions, like:

• Vitamin K increases arterial elasticity. When arteries get stiff, it’s harder for them to facilitate healthy blood flow.
• L-Arginine helps the body make nitric oxide (N-O). N-O is a vasodilator and signaling molecule important to the endothelium. It’s involved in the function of dilating blood vessels for blood flow and blood pressure.
• Nattokinase is an enzyme found in a Japanese food called natto made from fermented soybean. Research has found nattokinase supports smooth blood flow.
• Coenzyme Q10 is important for cellular energy and reduces inflammatory biomarkers.

Sources:

More than 40% of adults with no known heart disease had fatty deposits in heart arteries — ScienceDaily

Growing evidence of vitamin K benefits for heart health — ScienceDaily