Next steps after your CAC scan
I’ve spoken at length about why you should schedule a preventative CAC scan, plus the details you should know so you can go into it with confidence.
But what we haven’t yet discussed is what to do after your CAC — particularly if you have a score above zero.
Step 1: Is your CAC score bad?
It’s normal for your CAC score to climb above zero as you age. However, this number should stay within a reasonable range (under 100 if possible). More and more people are experiencing heart attacks under 40, so getting your score now can help you better understand your risk factors later.
Here’s a quick ‘normal’ score breakdown by age:
Under 40: 0 - 10
41 to 50: 0 - 30
51 to 60: 0 - 40
61 or older: 0 - 50
If you’re any age over 40 and have a score of 101+, you may have a high risk for heart disease.
The good news is, you’ve likely caught it early enough to make a difference.
Here’s a quick rundown of your options.
Step 2: Do you need a second opinion?
CAC scans are incredibly accurate, and studies show false positives are very uncommon.
The only reason I would request a secondary scan is if the initial test failed (such as if your heart rate was too high or you were unable to comply with scanning protocols).
That said, CAC scans can be difficult to interpret, and your doctor may have a different idea of treatment than you do. Post processing can be challenging, not all doctors explain nuance well, and there may be other anatomic or incidental factors your physician doesn’t consider.
You’re always welcome to take your results elsewhere and get a second opinion on the severity of your score. I offer a telemedicine service where I walk patients through their CAC results so they can better understand next steps to take.
And speaking of next steps:
Step 3: Choose a pathway to address a high CAC score
If you’ve received a suboptimal CAC score, your next course of action should be choosing a treatment method.
Most conventional cardiologists will prescribe statins right away. But after 20+ years as a heart surgeon, I can tell you medication isn’t always the right approach.
It could even make the situation worse and put you at higher risk for heart disease.
Statins may induce new-onset diabetes, which worsens other factors for heart disease.
High statin intake can cause myopathy and rhabdomyolysis (essentially the weakening and wasting of muscle tissue).
Evidence suggests a risk for gut dysbiosis, nutritional deficiencies, and even Alzheimer’s disease.
To summarize: if you have significant heart plaque, you might not want to just take a statin. You’d be far better off correcting the root causes first by making lifestyle changes that last the test of time — like slowing and reversing heart plaque by addressing root cause factors like insulin resistance and inflammation.
The most holistic way to stabilize and lower CAC scores
Many patients in my practice have stabilized their CAC scores without the help of statins. Others have lowered their CAC scores, ultimately eliminating statins from their existing routine.
Here’s a high-level overview of what they’ve done so you can take similar steps after your CAC scan.
Adopting a low-carb diet
Many of my patients have seen dramatic results following a low carb, ketogenic, or carnivore diet.
These stabilize blood sugar, improve insulin sensitivity, and improve cardiovascular risk factors such as your triglyceride to HDL ratio.
Ultimately, I just want you to eat more whole, real food and less processed, near-food objects with added sugar, seed oils, and preservatives.
You can learn more about my thoughts on low-carb diets and heart plaque in this recent podcast appearance:
Incorporating more daily exercise
Studies have shown that regular exercise can have a positive effect on blood lipid and plaque content. But that doesn’t mean you need to commit to 60-minute gym trips. Even gentle walking on a regular basis can have a substantial impact on your heart.
For example, one 15-minute walk per day can help reduce inflammation, lower blood pressure, and boost insulin sensitivity. It can also slow your CAC progression, which reduces your risks for heart diseases.
Keep in mind cardio exercise is only one small piece of the puzzle. Building more muscle, which is the most metabolically active tissue in your body, will have a dramatic effect on long-term heart health.
See for yourself:
Skeleton muscle mass is inversely associated with atherosclerosis, meaning the more muscle you have, the lower your risk of heart disease.
Resistance training such as weightlifting can have more of a protective effect on the heart than cardio exercise alone.
Regular weight training can drop your risk of mortality by 15% and your risks for heart disease by 17%.
Now, I’m well aware there are a few recent studies associating high levels of exercise with higher CAC scores. But there is plenty of evidence to suggest that higher CAC levels in these cases indicate calcified plaques, which may offer more protection against plaque rupture.
In my opinion, there’s no need to panic. The risks of not exercising are far higher than worrying about doing ‘too much’ (which you’re probably not).
Scheduling set rest hours
Research suggests even one extra hour of sleep per night could decrease your risks of plaque calcification by an extra 33%. The less you rest, the higher your calcification rate may be, and the greater your risks for coronary heart disease become.
You can combat this by setting a nighttime routine and establishing a bedtime you can follow regardless of day (including weekends). Most people aim for seven to nine hours per night. Your mileage may vary, although getting less than seven isn’t recommended.
Take the first step after your CAC scan
It can be scary and overwhelming to receive a CAC score that’s anything less than perfect. The good news is, there’s still a lot that can be done.
You just need to find a doctor who ‘gets’ it.
And if you don’t currently have one, check out my guide to firing your doctor.