Calcium in vessels suggests blockages

Dear Dr. Roach: Iama 71-year-old woman who’s physically active and of normal weight.

I’m currently on 20 mg of simvastatin and have started taking aspirin, 81 mg three times a week.

I have white coat hypertension with home blood pressure measurements around 125-130/80. I have no diabetes, and my cholesterol is 194 with HDL of 92 and LDL of 92.

An incidental finding on a recent X-ray notes calcium on my aorta.

Is further testing, such as a CT angiogram, warranted?

M.P.

Answer: The aorta is the largest blood vessel in the body, and calcium, which blocks X-rays, can be seen in large blood vessels.

People with calcium in blood vessels are more likely to have plaque and blockages in those blood vessels. Healthy cholesterol levels do not rule out the possibility of coronary artery blockages.

For a person with no symptoms but who is suspected to have blockages in the aorta or coronary vessels, the doctor generally has two options: do further diagnostic testing to increase the certainty of the diagnosis, or treat the patient medically as though she has coronary artery disease.

That would mean prescribing a statin drug — more commonly a higher-potency drug like atorvastatin or rosuvastatin nowadays — and aspirin. Beta blockers and ACE inhibitors are also commonly used, but your blood pressure is nearly optimal as it is now. Still, many cardiologists would still use a low dose of a beta blocker like metoprolol.

Since more aggressive therapies like surgery or angioplasty and stent placement are unlikely to have a beneficial effect on your life expectancy, proceeding with treatment as though you already had coronary disease makes a great deal of sense to me.

Nonetheless, a CT angiogram is an excellent test to make the diagnosis of coronary artery blockages. It has the disadvantages of cost, radiation exposure, and dye load (which might damage your kidneys), but the advantage of providing more certainty about the diagnosis.