Heart Disease Risk Calculator: CAC and MESA

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This fall, my annual cholesterol screening showed an alarming increase in all the cholesterol markers: Total Cholesterol, HDL (‘good’) cholesterol and LDL (‘bad’) cholesterol.

Both my Primary Care Doctor and I whipped out our phones and opened the ASCVD risk calculator app. I was relieved to find that although my 10-year risk of heart disease had increased versus last year, it still showed a low enough risk that statin medication was not required.

BUT THEN she told me about someone who eats well and exercises and also had a low 10-year risk of heart disease according to the calculator – and yet a CT scan (for an unrelated issue) showed a blockage. These 10-year heart disease risk calculators are useful but they are NOT perfect.  So she suggested a consult with my cardiologist and another Coronary Artery Calcium (CAC) scan.

If you’re not familiar with CAC scans, it’s a quick, easy, inexpensive X-ray test that illuminates your heart and measures the amount of plaque — which is what can block or restrict blood flow, which can cause stroke and heart attack. The CAC scan can help your doctor decide if your risk is truly low or if you might need a statin.

Luckily, my CAC test result was the optimal zero, same as 5 years ago. Then I went to see my cardiologist. While he agreed in principle that with a CAC score of zero I didn’t need a statin, he pulled up ANOTHER heart disease risk calculator that I’d never heard of: the MESA calculator.

MESA is a more refined measurement tool as it uses the same inputs as the ASCVD risk calculator, but then it adds in your CAC score. Happily, my MESA score aligned with the ASCVD score – so I can continue with eating healthily and exercising to control my cholesterol and heart disease risk.

The CAC test is becoming more prevalent but you might need to ask your doctor about it. Here’s some further info:

If your 10-year risk of heart disease is increasing or places you at ‘borderline’ for starting a statin like Lipitor, a Coronary Artery Calcium (CAC) scan can really help clarify your risk level. While my insurance didn’t cover it, it was around $100 and that is a small price to pay for the peace of mind of knowing that my lo-co diet and exercise plan is the right track for right now.



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