Cholesterol trumps heart scan?

Lela's heart scan score: 449--very high for a 49-year old, peri-menopausal woman. Her score placed her flat in the 99th percentile, or the worst 1% of women her age.

Lela first consulted her primary care physician. Her doctor looked at the result puzzled. "Now wait a minute. Your cholesterol numbers have been great." After a pause, her doctor (a woman) declared the heart scan wrong. "Tests aren't perfect. The heart scan is simply wrong. I'm going to believe the cholesterol numbers and there's no way you have heart disease."

Is that right? Can cholesterol numbers trump your heart scan score? Can the heart scan simply be wrong?

The answer is simple: NO.

The heart scan is not wrong. The heart scan is right. What is wrong with this picture is that standard cholesterol testing commonly and frequently fails to identify people at risk for heart disease.

What if this woman smoked? That wouldn't be revealed in her cholesterol panel. Or had high blood pressure, increased inflammatory responses like C-reactive protein, had increased small LDL or lipoprotein(a), was severely deficient in vitamin D? None of that would be revealed by cholesterol numbers.

So, no, the heart scan is not wrong. The cholesterol numbers are not wrong. The doctor's interpretation of the data is wrong.

Please do not allow false reassurances offered by those who do not understand the technology steer you wrong.

This woman proved to have an entire panel of hidden causes of her coronary plaque uncovered. No surprise.

Comments (4) -

  • Anonymous

    8/28/2007 5:15:00 PM |

    How would those of us who have had valve repair and bypass surgery track our plaque if blood tests don't provide the whole picture ?

  • Dr. Davis

    8/28/2007 6:34:00 PM |

    This is a problem area. One possibility is carotid ultrasound. Though less precise and an indirect measure of the body's burden of atherosclerotic plaque, it's the best that I am aware of once the heart's arteries have been changed or distorted by bypass.

  • Anonymous

    8/28/2007 10:40:00 PM |

    I've been wondering about heart scans and plaque burden.  I have a  vested interest in this as I have a strong family history of early CHD. (FWIW, my CCS is 29 at age 41; not dramatically bad, but I believe that places me somewhere around the 90th percentile for my age; or potentially with the plaque burden of a 54 year old).

    Once a person is old enough -- or has sufficient calcification of the plaques -- then there is a very good correlation between plaque burden and CCS.  That is my understanding as to why heart scans are not generally recommended for people under 40 and to some degree even for people in their early 40s.

    So, in my case I worry that my low score may actually be an under indication of my burden.  The only way to figure that out though would be angiography or maybe carotid IMT, right?

    Which leads me to my second questions: I think what you are doing here is fantastic, but have wondered, is the reduction in CCS a reduction in the plaque burden?  Or is it simply a reduction in the calcium in the plaques?  And how does that impact the stability versus the instability of the plaques?

  • Dr. Davis

    8/29/2007 1:58:00 AM |


    Unfortunately, too much to cover in a Blog. That's why we have an entire website devoted to this topic. You are invited to go to to read further. You raise important issues that simply cannot be covered in a few sentences.