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 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.

Patient centered discussion of primary prevention statin therapy

September 5, 2017 Andrew To

The Mayo clinic has recently published an electronic tool called “Statin Choice Decision Aid”, which is immensely valuable in helping patients visualize cardiovascular risk, and the benefit of statin medications as applied to them.

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

Are cardiologists obsessed with statins?

September 4, 2016 Andrew To

Sam is a 60-year-old male heart attack survivor who had an unremarkable recovery after the successful coronary artery stenting in the middle of the night of his presentation. Now it is 3 months and Sam feels absolutely grand. At follow-up, his cardiologist insists that he should continue all the prescribed medications. He read on the internet some bad press about statin medications and thought, “surely, nothing will happen if I stop taking statins?!”

Vitamin D and stain myalgia

August 30, 2015 Andrew To

55M IHD with prior stents; prior myalgia with Simvastatin and Atorvastatin; but yet still more myalgia with Pravastatin. The treating physician decided to check his vitamin D level and his coenzyme Q10 level.

Which one, vitamin D level or coenzyme Q10 level, is relevant in statin myalgia?

Statin Intolerance - the 2015 Approach

August 30, 2015 Andrew To

Scenario = 55M IHD with stents, trialed simvastatin, atorvastatin and pravastatin, all causing myalgia, without CK rise

Question = what to do?