Coronary Calcification, Not Cholesterol

Coronary Calcification Predicts Future Heart Attacks and Coronary Death. Cholesterol Not Found to be a Significant Risk Factor

by Bill Sardi by Bill Sardi


A striking report just published in the New England Journal of Medicine indicates the accumulation of calcium in coronary arteries, and not cholesterol, more accurately predicts a future heart attack or other heart trouble, far more than cholesterol or other standard risk factors.

This report gives evidence of a major misdirection by modern medicine — the creation of cholesterol phobia in the population at large. Prior studies show use of cholesterol-lowering drugs does not reduce mortality rates for coronary artery disease. This report follows a front-page report in Business Week magazine declaring cholesterol-lowering drugs to be of marginal value.

The study involved 6722 men and women, ~age 60, who were studied for a period of 3.8 years (median). None had coronary artery disease at the beginning of the study. Subjects who experienced an adverse coronary event (heart attack, angina, placement of a stent, coronary death) were more likely to be taking cholesterol-lowering drugs (~28%) than those who did not experience such an event (~16%). Furthermore, subjects who experienced a heart attack or angina had about the same total cholesterol (~199) as subjects who did not (~194). Cholesterol barely met statistical significance whereas calcium was a highly predictive factor.

Traditionally-used risk factors, such as C-reactive protein (a marker of inflammation), triglycerides, HDL cholesterol and greater body mass, were not predictive for a future coronary artery event.

Among subjects whose coronary artery calcium score was zero, their risk for any adverse coronary event was only about one-half of 1% (0.0044), or less than 1 in 200, whereas those with a coronary calcium score over 300, about 8.0% experienced an adverse event involving coronary arteries (0.0804), or about 8 in 100, an 18-fold difference (1800%!), over the 3.8-year period.

This study shows the risk for a future heart attack is nil for those with a calcium arterial score of zero. This data helps to explain why hundreds of thousands of Americans experience a sudden-death heart attack with low-to-normal cholesterol. Most heart attacks emanate in the four coronary arteries that supply the heart with oxygenated blood. About 50% of arterial plaque is calcium and only 3% is cholesterol.

Arterial calcium can be measured by use of a CT scan (called an Agatston score, for Dr. Arthur Agatston, South Beach Miami, Florida cardiologist). About 70% of white males, 52% of black males, 57% of Hispanic males and 59% of Chinese males, have coronary calcium scores greater than zero. The calcium arterial scores for women are about half that of males owing to the fact they donate calcium to their offspring during pregnancy and lactation and control calcium via estrogen throughout their fertile years.

Calcium begins to accumulate in coronary arteries in males as soon as full growth is achieved, around age 18. Women begin to accumulate calcium in their arteries with the onset of menopause or early hysterectomy. It was recently reported that postmenopausal women who take calcium supplements increase their risk for a heart attack by about 45%. [British Medical Journal 2008 Feb 2; 336 (7638): 262—6]

In the early 1990s British cardiologist Stephen Seely noted that countries which consume that highest amount of calcium (New Zealand, Ireland, North America, Scandinavian countries), mostly from dairy products, have the highest rates of cardiovascular disease. [International Journal Cardiology 1991 Nov; 33(2):191—8]