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Protect arteries like retirement savings
Treating early
The medications are inexpensive and have minimal side effects. A small percentage of people can't take them, and other agents exist with less cost and fewer side effects. Cardiologists now treat high cholesterol sooner, even starting in the 30s, which can significantly reduce lifetime risk of a heart attack or stroke. New blood pressure guidelines are also more aggressive, partly because lowering pressure decreases the risk of dementia.
The calcium score
A coronary artery calcium score is a simple test with very little radiation, no IV, and a modest price. It shows whether even the very beginning of plaque is present, which makes it an early, sensitive way to sharpen a risk profile.
When it is considered
It is considered for anyone with concerns or risk factors, though with very little risk it is probably not needed before 40. Women with pregnancy-related complications benefit from it in their 30s, and so do those with a family history or even mild diabetes, because it gives a baseline for how aggressively to manage everything else.
Why does early exposure to LDL matter?
Plaque builds up over years, so the total amount of LDL an artery has seen counts as much as the current level. A 2012 study by Brian Ference and colleagues in the Journal of the American College of Cardiology used gene variants that lower LDL for life. People carrying them had far larger reductions in coronary risk per unit of LDL than statin trials produce in people who start treatment later. The finding gave support to the idea of cumulative exposure.
How does a calcium score reveal plaque?
A coronary calcium scan is a CT scan that detects calcium deposits in the walls of the heart's arteries. Calcium builds up in plaque as it matures, and it blocks X-rays more than the surrounding tissue does. The total is reported as an Agatston score, named for Arthur Agatston, the Miami cardiologist who developed the method in the 1990s. A score of zero means no calcified plaque was found.
Why would lowering blood pressure cut dementia risk?
High blood pressure damages the small vessels that feed the brain's white matter, leaving lesions that show up on MRI. The SPRINT MIND study, published in JAMA in 2019, found that intensive blood pressure control lowered the rate of mild cognitive impairment compared with standard control. Reduced blood flow and damaged vessel walls are thought to play a part in many forms of dementia.
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