Reviewed on 4th Dec 2024

Calcium scores and what to do with a high value

[I am not medical doctor. I have no medical training. However, I have 7 cardiac stents so my interest in Coronary Heart Disease is not purely academic.]

Once upon a time there was homocysteine, a sulfur-based amino acid. According to WebMD, "You get it mostly from eating meat. High levels of it are linked to early development of heart disease." The question, then, was to determine whether homosysteine was a like a car's accelerator or its speedometer, that is, was lowering homocysteine like taking one's foot of the brake, or was it like trying to stop a car by grabbing onto the speedometer? Again, from WebMD, "Research has shown, however, that getting your homocysteine levels down with vitamins doesn’t reduce your chance of having heart disease." Oh, well,...

Then, there was C-reactive protein, a measure of inflammation. It was thought to be a mediator of Coronary Heart Disease and the next big thing in assessing cardiac risk. And then...nothing. It felt like CRP went from being assessed on almost everyone thought to be at risk to almost no one. Maybe it's because so many things other than heart disease can lead to high levels.

Now, we have calcium score. The higher the calcium score, the greater the risk of a serious coronary event. But what is one to make of a high calcium score? I know someone with a score of 300 who was told not to do any exercise until he was given a stress test, which he passed. (And, yes, there are may tales of those who have suffered serious events after having passed a recent stress test.) Is a calcium score a real advance or is it merely the latest in a string of false leads?

The calcium score itself is not controversial. The question is what to do with it other than a stress test or a statin if the score is high. And might it turn out to be another homosysteine or CRP?

The value of Dr, Bishop's book is its suggestion of a next step after a high calcium score--a scan with contrast to determine the location of the deposits are that are behind the high score. He provides evidence to support his recommendation. I found it compelling enough to start a conversation with my cardiologist if I had a high score, myself. (This is not an option for anyone with stents because the stents would interfere with the scans.)

Those concerned with their risk of having a coronary event, perhaps due to family history, should read this book to prepare for an intelligent conversation with their own cardiologists.

Other comments:

Others have commented on the book's use of mmol/l instead of the mg/dl used in the US. It can be confusing. However,

(Bishop) mmol/l *38.7 = mg/dl (US)

Ratios are unaffected by the choice of units.

Try to avoid the audio version alone. I like audio books, but the information and message do not lend themselves well to an audiobook.

[Disclaimer: I was given a copy of the book in exchange for my honest review. Review copies of books are permitted by Amazon. I have no problem with my review. However, I've spent too much time agonizing over how many stars to award.

5 stars: I have seen first person someone with a high calcium score who was not offered the followup suggested by Dr. Bishop. The book is well worth the price if it prevents or postpones a serious coronary event, especially if it's yours. The information is presented in a way that anyone reading the book could have an intelligent conversation with his/her cardiologist about calcium scores and what should be done with them.

4 stars: A bit pricey, although much less expensive than having an MI. The choice of mm/l with no instructions for conversion to mg/dl was a huge distraction. A fear that I might be influenced to go higher (5 instead of 4) for having received a free copy. Note: fear of unconscious bias applies to the number of stars, not to the review itself.

When I started writing this disclaimer, I knew I'd award 4 stars because "If you have to think about it..." However, after reading what I've written about my quandry...]

Reviewed on 4th Dec 2024

Reading about heart

Although a lot of this book is hard to comprehend i believe that i did benefit from reading this book. Thank you for the oportunity.

Reviewed on 4th Dec 2024

Prevention Is Better Than Cure - Easy Read

The book is clear, concise, and lays out a plan to be proactive in preventing a heart attack. It was quite easy to follow and understand. This comprehensive book will not only serve as a wake-up call for many but also save lives. I now have an interest in a CCTI where I didn't before.

The book explains the functions of the heart and how plaque is formed in the arteries and then how to detect and treat it. His primary focus, of course, is on prevention of heart disease and how you can accomplish that.

I feel much more comfortable talking to my doctor about this subject. I am much more prepared to hold an honest and informative discussion.

I also think that he didn't write to his potential reader base. Americans will not comprehend most of the notations for the lipid panel values. Might have noted American notations as well. He lost me there throughout.

Disclaimer: I was offered this book in exchange for my honest opinion of it.

Reviewed on 4th Dec 2024

An easy to understand proactive approach to prevent cardio problems

This book is a must for anyone who has a history of cardio problems in their family or are experiencing problems of their own. In fact, if you aren't sure, you need to read this book anyway. I learned more about my heart, various tests and results than I would ever have imagined in this short and concise book. I am not a doctor and all the details and test results seem to blur for me. In this book Dr. Warrick provides cases and outlines test results compared to what would be ideal. I can now use this book as a guide when I review my results. More importantly though is that Dr. Warrick lays out a path to using CT scans to proactively prevent heart attacks rather than just treating the disease after you have one. Ironically, after I started reading this book, I developed a (non-heart) medical issue based on traditional medical test results in which a CT scan was used to further determine whether there was an actual issue. If works for one part of the body, why not for cardio as well? This is a great read presented in a very easy to understand format. I am grateful for having had the opportunity to read this book. It is a great reference book to have on hand.