Patient No 1 :
“Doctor, you had put me on high dose statins since my CAC score was high. Now, my CAC is increased further. What is this ? should I not get anxious ?”
“No.Not at all . It is a good sign and it indicates your plaques are getting stabilised”
How is that possible ?
It is a therapeutic paradox. We start statins based on a CAC score in a low-risk population only to find the CAC score increase further. In multiple analyses, we have seen the CAC score consistently increase up to 30 % . We feel happy about it, as we presume it is a sign of plaque stabilization.
That’s interesting Doctor. Now,.. Doctor, my dad has already has a CAC of 300 , without statins he should be lucky , is it not ?
No you are wrong. “Natural CAC score is a marker of plaque burden, and we can never consider it as an index of stability, while the statin-induced high CAC score is an an absolute bliss & an index of pure stability“
Patient no 2 : My CAC is not increasing with statins , what to do ? Is it sign of statin failure ?
May be yes. I am not sure . It may indicate a poor response to statin and inability to take the plaques to its logical destination ie hardening and micro calcification
Final message
Most coronary calcification whether God or statin made , imply that plaques are stable biologically. (Except the nodular /eruptive ones or those in the shoulder region of the plaque, which can make a plaque physically stressed . We hate calcium essentially because, it is a hinderance to deploy a stent.)
We rarely realise , how often we formulate important concepts in cardiology based on very superficial or incomplete knowledge
Reference
Dr.S.Venkatesan MD 