Is a CAC a good place to start if lipid particles large?

Posted by baguette @baguette, Jul 5 11:13am

My NP suggested a CAC because my total cholesterol went up to 194, and my LDL is higher than recommended. She also ordered a particle test, and the particles are in the high range. She wants to check for plaque buildup.

My question is that I have read about two tests. One is the CAC, which appears to be the go-to test.

However, my sister and her husband had echocardigrams, and their doctor said that while the test doesn't look for plaque, if it signals something abnormal about the heart, a CAC then would be done.

I also read about a cardiac CT angiography , where you still use a CT scanner but dye is injected. It requires a newer version of the CT scanner, and is used more in Europe than in the US. https://www.health.harvard.edu/heart-health/a-safer-way-to-diagnose-coronary-artery-disease

I am trying to get the biggest bang for the radiation exposure. Would it make sense to track down the CT angiography, or stick with the plain vanilla CAC?

Or should I start with the non-radiation echo and see if that signals more testing needed?

Interested in more discussions like this? Go to the Heart & Blood Health Support Group.

gloaming | @gloaming | Jul 5 6:19pm

My understanding is that the more dangerous LDL is the 'small' and the 'very small'. Perhaps I am mistaken.

The angiogram I had did not require a CT scan, but I was on a table with a flouroscope that allowed the gentleman surgeon inserting the catheter into my wrist to see where the detector was located as he manipulated it around the various blood vessel ostia inside my heart. And yes, they inject dye each time they insert the probe into the blood vessel to see if the flow pinches anywhere. If there's a narrowing, there is plaque.

On the other hand, prior to being referred to an electrophysiologist for a catheter ablation (for atrial fibrillation), my cardiologist had me do two MIBI stress tests with contrasting dye. Each one was the equivalent of 500 chest x-rays. What're ya gonna do? They need to check for ischemia, since fixing a fibrillating heart is back asswards when it has severe stenoses. They didn't find any narrowing. even during the angiogram....but I'm still told to take a statin. No ischemia, even at 70, and male, ex officer in the armed forces (stress), but I have to take a stain for life. 🙁

Your CAC is merely and indication of your recent blood chemistry. It's like feeling a garden hose for cool to tell if the water is running inside it and not hot from the sun. In my mind, the gold standard is an angiography....or a 'look-see'.

baguette | @baguette | Jul 6 8:33am

In reply to @gloaming "My understanding is that the more dangerous LDL is the 'small' and the 'very small'. Perhaps..." + (show)

My research agrees that the angiography is the gold standard, but my understanding is that my blood labs don't justify that test yet. The first step is the CT, non-invasive. I just wondered if it's necessary, or if I should find a place that does the CT with one injection of dye. Or if an echo is a good first step, with no radiation.

I didn't remember correctly about the lipid particles. You are correct, it is the smaller size that is the issue. So the smaller size of my particles raised concerns. Thanks for catching that. I am not that versed in heart tests, yet. You forced me to go look up my test results instead of relying on memory!

Good luck with your journey. I wish you well.

gloaming | @gloaming | Jul 6 1:32pm

I see what you mean. Why not ask for a Doppler ultrasound of your carotid arteries? If they show modest or low deposition, you should be good for a few years yet, and probably do somewhat better with diet changes/improvements, or maybe a statin.

baguette | @baguette | Jul 6 5:46pm

I think I need to consult with a cardiologist. My NP I would guess never heard of a Doppler ultrasound. I don't know if there even is one where I live. Thanks for throwing out that option.

mayoconnectuser1 | @mayoconnectuser1 | Jul 7 9:16am

CAC uses a CT to count calcium ... https://www.heart.org/en/health-topics/heart-attack/diagnosing-a-heart-attack/cac-test - it will provide a summary of cakcification it sees. It is very inexpensive.

I am not a medical professional.

IMO, since it is both cheap and extremely accurate, it should be done first. Of course, one's age, lipid panel (including an advanced lipids panel), pre existing conditions like BP must be considered.

Depending on outcome, next would be a stress test with echo, then PAD ultrasound, perhaps nuclear stress test - by this point it should be clear whether or not a cath is needed. If you are having any heart discomfort or pain, you should probably be cathed.

Please sign in or register to post a reply.