In this patient‑education video Dr. A, a naturopathic and integrative‑medicine clinician, explains coronary artery calcium (CAC) scoring and its relationship to arterial calcification. He first distinguishes two forms of calcium buildup: arteriosclerosis (hardening of the arterial wall itself) and atherosclerosis (calcification within the lumen where blood flows). The CAC test uses imaging to detect calcium in the coronary arteries because calcium is radiopaque, providing a numeric score and a percentile rank compared to population studies. Dr. A outlines how the score is reported, what a high percentile means, and notes that the test primarily captures late‑stage calcified plaque, missing the earlier inflammatory phase of atherosclerosis. He discusses the paradox that effective anti‑inflammatory treatments (e.g., statins, dietary changes, omega‑3s) can accelerate the calcification step, causing CAC scores to rise even as blood‑borne inflammatory markers improve. This rise is generally not worrisome if it occurs alongside proper treatment, but an unexplained increase without therapy signals higher risk. He emphasizes the need to interpret CAC results in context—considering inflammatory markers like ApoB, lipoprotein levels, and working with a cardiologist or integrative cardiologist who understands the underlying inflammatory arteriopathy. The video concludes with a call to action for viewers to subscribe and share.
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So today what we want to cover really is the coronary artery calcium score, arterial calcification, how they relate, and basically what that means. Hey, I'm Dr. A. Welcome to the channel. I've been teaching and researching in the naturopathic and integrative medicine world for 30 years now. I use this channel to answer questions, do patient education. So the first thing I just want to point out is there are 2 ways that calcium can build up in your arteries. Now, we've all heard of, you know, maybe some kind of old-fashioned terms like hardening of the arteries or calcified arteries. But one of the things that I want to make a distinction off the top here is that you can have a— inside the blood vessel, inside the artery— calcium that builds up that is called arteriosclerosis, and that is literally hardening of the arteries. And it's calcification within the artery itself. Doesn't have anything to do with your blood flow. Well, it does because it makes the artery harder, but it doesn't change the inside of your blood vessel. The one we're talking about largely is calcification inside the blood vessel where the blood is trying to be. And then that is called atherosclerosis. So we're gonna limit this talk to atherosclerosis, the inside where the blood's supposed to be stuff. Now here's the thing. They invented this coronary artery calcification score as a way to look and with imaging at And say, well, that artery on your heart has this much. This artery has twice as much. This artery doesn't have any calcium. Now, why they pick calcium? It's because calcium's easy to see with imaging. If you think about, you know, take an x-ray of your bones, it's the minerals that you see in the bone, and a lot of that's calcium. Well, if I have a special procedure done, the CAC, it's tuned to the heart and especially the heart blood vessels, and then that will tell the imaging software how much calcification I have in very important blood vessels that are feeding my heart. And what we don't want is we don't want like completely hardened, brittle blood vessels, coronary arteries feeding our heart, because then our heart needs lots of blood going through it and it might not be getting any in that area when we have a myocardial infarction or many other bad things happen. So a couple things about the CAC score. The first thing is, is that it's on a scale of essentially 0 to as high as you want to go, and that scale is based on how much calcium signal comes back, hence the name of it. But then your report usually You will get, and it will say you are in the something percentile. And what that means is if it says you are in the 75th percentile, that means for all of the studies that have been done on humans in the past, you are at the upper quarter, at the upper quarter cutoff for calcification of that artery, meaning 74% of people in studies had less calcium than you did. So you'll be reported a numeric value and a percentile value usually. He'll be explained to you, etc. Now, those of you who are listening to the earlier part might say, "Well, is that also looking at arteriosclerosis, the hardening of the arteries?" And it will pick that up definitely. But because the imaging is tuned to looking at this more gross atherosclerotic calcification, that signal, if it's there, will sort of almost overwhelm the arteriosclerotic signal. Now, just as a little passing side, where can your doctor? See arteriosclerosis directly, and they look in your eye. So you can see arterio- and atherosclerosis in the eye by the way that the arteries look, because of course there's no skin in the back of your eye, so the arteries back there are just laying there being arteries. And if you look with the ophthalmoscope, you'll be able to see, you know, is there a small, medium, large amount of calcification back there, etc. But anywhere else in your body, there's skin covering it, so you need imaging like this. And because the heart is what we're most interested in, coronary artery calcium score comes up. Now, what are limitations And I'll just say category of the CAC score. And this has been published since at least 2014 or 15 in the cardiology literature, maybe probably earlier, but it came to my attention back around that time. And that is because this image is looking at calcification. If you know atherosclerosis was only calcification, it would be a perfect instrument, a perfect test. The problem is that atherosclerosis is normally a very long process that involves multiple. Steps, and it kind of ends with calcification. So your coronary artery calcification score is looking at the end of a disease process. That's fine because it's a measurement we can have, but is the rest of that disease process also dangerous, and will the CAC score tell me about that? Well, the short answer is no, it's not going to. Why? Because the time period between starting atherosclerosis and getting calcified is made up of generally non- calcium-containing inflammatory molecules. So that means that the whole first part of my atherosclerosis journey may not have any calcium in it at all. Now, that might be a problem if I have a coronary calcium score of 0, high 5 and all around, and I've got wicked amounts of inflammatory atherosclerosis building all over the place. So this is one limitation. The next thing is, and there's different ideas, theories about this, the first part of atherosclerosis is very bad. It's full of inflammation, full of immune cells that It can be inside of your blood vessel walls. And so one of the ways that the body tries to calm it down is to send calcium and other molecules there to build a hard plaque that's like a bandage and says, let's cover this inflammation up. So then some people will say, well, okay, so that means then the calcium is actually good because it's like a bandage covering up a wound. Well, yes and no. The goal would be to deal with your coronary artery calcification and inflammation Before we get to the calcium bandage part, so that we don't have to build up all of this calcium. Because then the other group of people would say, well, no, the calcification is not a good sign because high coronary artery calcification scores are associated with worse outcomes. And that makes sense because if I have a high CAC score, yes, got a nice calcium bandage there on the side of the blood vessel wall, but it means that there and in other places in my arteries, I still have lots of inflammation. And what it took for For me to get all of this calcium onto the wall of the artery required a lot of inflammatory activity in my blood vessels. It should have never been there. That's the part that's very dangerous. So then by the time I go in and I get a CAC score done and it's super high, no wonder that's associated with worse outcomes. It's because I not only have the end of the trail being calcification, but I have the whole lead up to it, which is actually inflammation in my arteries that shouldn't be there. Immune activation gone wrong. Now, there's another twist to this that people find interesting, and that is that if you're on the trail— and there's a number of pathways this can take, so I'm only going to describe one, keep that in mind— but well-published, if you're on the trail towards calcification and then somebody comes along and says, oh, you have high markers of inflammation in the blood, you know, like ApoB and lipoprotein and these inflammatory markers that we look at, and they've been unchecked, and then somebody aggressively changes your diet, And they put you on treatments to deal with these inflammatory markers and it works. There's a phenomenon that was first seen with statin drugs that leads you towards less inflammation in the blood vessels, but it speeds up that calcification step. So there's actually a phenomenon where appropriate treatment will take you from a lower CAC score to a higher CAC score. And this blows people's minds since people research it and have to explain it. And it's It's like, wait a minute, my CAC score when we started was 200, and I didn't know I had all these problems. And then my, you know, my ApoB was high, my Lp, and all the things. And then you treated it very aggressively. Great. They all, you know, the blood markers are looking better. But here a year later, my blood looks better, but my CAC score now is 280 or 300, 80 to 100 points higher. That doesn't seem like the right direction. Well, it's because in trying to aggressively undo the inflammatory component, you had already tipped over. This tends to happen in people who already have a noticeable CAC score. Generally doesn't happen if you have a 0 or something like that. But if you got, you know, a 200 or something, or 250, you may wind up after 1 or 2 years of treatment with a 300 or 350. And the important part about that is the treatment is still warranted, whatever they did. And it's beyond the scope of this to get into whether it was done with, you know, just diet, or diet and, you know, omegas or statins, or whatever mixture they did for you. Whatever they It worked, but it made your CAC score go higher. Now, we don't have great data on this, but generally what I have seen is if that's the change and you did all the right things to lower all the bad markers in your blood, decrease the inflammation, and you just incidentally raised your CAC score, it doesn't really increase your outcomes that are negative. If your CAC score went from 200 to 300 and you were doing no treatment, then your risks of future coronary events is definitely higher. So the CAC score is a great tool. It's got lots of reasons why it's there. It's a part of a continuum, and appropriate treatment can actually affect it in a way that might make it a little bit higher if you already have a high CAC score. So you have to take this all into account. The part about the CAC score going up, certainly with statins, is well known in, in the cardiology literature. And again, I guess what I'm saying is if the So if the score went up, but you also aggressively treated the underlying problems, that's probably not going to be a huge deal as far as disease effect of the score going up. If the score went up 100 points and you weren't treating anything and you're super inflamed, that just means that the inflammatory cascade and process is on this sort of out-of-control train. And the higher the CAC score goes, the more risk you have. So the bottom line is you want to work with cardiologist, integrative cardiologist, somebody who understands these things. And can look at it from multiple points of the compass and really can deal with the underlying problem, which is the inflammatory arteriopathy that's going on underneath. And again, that's beyond the scope of this. This was just answering question about CAC scores going up with treatment. All right, we're going to do more on this. I'm Dr. A. Thanks for listening. Thanks for subscribing. Like, share, subscribe. Do hit the notification bell. And thank you for watching. Thank you for telling your friends about us. We really do appreciate it. I'll see you all on the next one.
