Scan looks for calcium in the arteries

Dear Dr. Roach: You mentioned checking a calcium score to help determine risk of having a heart attack. Please explain what that is.

J.S.

Answer: A coronary artery calcium score is a special kind of CT scan that looks for the presence of calcium in the arteries providing blood to heart muscle. Blockages in the arteries are usually calcified, and the scan can calculate the total amount of calcium found in the walls of the blood vessels. The higher the calcium score, the more likely a person is to have blockages in the arteries.

I most often use the calcium score when I am not sure whether my patient would benefit from medication therapy to reduce their risk of a heart attack. If the calcium score is zero, then treatment may be safely deferred for five years.

Exceptions would be if a person is at high risk, such as from diabetes, strong family history or smoking. In people whose heart disease risk puts them on the border of a recommendation for medication treatment, a calcium score above zero would tip the scales.

Dear Dr. Roach: I am a primary care provider and read your recent column on red yeast rice. I agree with your comments but would add the concern I have: the presence of citrinin in red yeast rice products that is toxic to the kidneys and noted in 80% of sampled products. Experts strongly advise people NOT to use it.

C.J.

Answer: Many studies have confirmed the frequent presence of citrinin in red yeast rice products. In Europe, where there is better regulation of over-thecounter products, citrinin has become a less frequent contaminant, but the most recent data I can find confirms Dr. Jackson’s concern about citrinin.

Since red yeast rice seems to work primary through monacolin K, the active form of lovastatin, I recommend against red yeast rice. I strongly recommend using a statin when medication treatment is necessary to lower the risk of heart attack and stroke. They are purified and free of toxic contaminants, and the dosing is exact.