Our approach to CT calcium score

March 26, 2022 Andrew To

MESA calculator - probability of non-zero calcium score

In primary prevention, CT calcium scoring has been suggested to help decision making surrounding statin use.

Some of the underlying concepts are somewhat complex, but the screening paradigm remains that of matching the intensity of preventive efforts with the individual’s absolute risk.

The appropriateness of CT calcium scoring in an individual patient therefore depends

patient’s pretest probability of atherosclerotic cardiovascular risk
potential benefits of preventive therapies
negative aspects and risks of preventive therapies
patient preference

My approach to chest pain

September 7, 2019 Andrew To

Severe coronary non-calcified atherosclerosis with severe stenosis, on CT coronary angiography

Chest pain presentations are common, but management can be variable and difficult to understand. Here is my approach:

Lifestyle changes for hypertension – exactly how effective is it?!

April 19, 2018 Andrew To

In general practice (and in secondary care), we discuss at length lifestyle modifications that aid blood pressure lowering. But exactly how effective are the various strategies?

There are 5 things we could do to reduce our blood pressure, without medications.

“My cholesterol is almost normal – why do I need statins, doctor?”

January 31, 2018 Andrew To

Baja hiramasa yellowtail, pineapple two ways, achiote infused agave @Topolobampo, Chicago, IL

Traditionally, we are taught that laboratory tests have “normal ranges”, such as in haemoglobin or creatinine. However, this concept of “normal”, when applied in cholesterol measurement, often creates confusion amongst some clinicians and certainly in most patients.

Individual risk assessment - a common scenario

September 4, 2016 Andrew To

1906 San Francisco Fire Sacramento Street; Photo from Arnold Genthe from the Library of Congress

A 40-year-old Maori man came for routine review concerned because his 38-year-old brother, who was a smoker, died suddenly of a heart attack. The patient was athletic, previously played professional rugby, without clinical risk factors.

- BMI 28

- LDL 4.9; TC/HDL ratio 4

His calculated cardiovascular risk on these parameters was low. A reasonable approach would include

1) reinforcing healthy living and reassessing in 5 years

2) reinforcing healthy lifestyle and starting a statin

3) reinforcing healthy lifestyle, getting a CTCA, starting a statin

4) all of the above