EP89: High Calcium Score May Not Be All Bad

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Episode Summary Dr. Warrick Bishop, a practicing cardiologist and patient educator, shares an intriguing case study of a 60-year-old fit and active man who experienced an alarming heart rhythm abnormality during a stress test. Despite having a high coronary calcium score, advanced imaging revealed an unexpectedly positive clinical picture that challenged conventional risk assessment interpretations. Key Takeaways: Lipoprotein(a) or "Lp(a)" is a cholesterol carrier in the bloodstream that is more likely to cause inflammation, blood clotting, and arterial calcification, and can run in families. Nicotinic acid (a B-group vitamin) and statins are used to lower lipoprotein(a) levels and manage high cholesterol in at-risk patients. During stress testing, the patient developed ventricular tachycardia (VT), a broad complex tachycardia that is considered a cardiac emergency and can be potentially fatal. A calcium score over 1,000 in the 90th percentile would typically indicate very high risk, but this patient's CT angiography showed no soft, cholesterol-dominant plaque. The absence of soft, non-calcific plaque is significant because this type of plaque is most likely to rupture and cause heart attacks, whereas calcified plaque is more stable and inert. Long-term statin therapy, exercise, and niacin treatment likely converted the patient's soft plaque into stable calcified plaque, stabilizing his arterial condition. The patient's rhythm abnormality during stress testing was more likely caused by minor electrical dysfunction rather than poor blood flow to the heart muscle. Comprehensive CT imaging with both calcium scoring and contrast-enhanced angiography provides more complete diagnostic information than calcium scores alone.