Trains, planes, and heart scans

A Heart Scan Blog reader posted the following question:

It is not clear to me why getting a cardiac scan is the necessary first step, if in fact the next step would be to bring down small LDL particles which is revealed on a NMR lipoprofile or VAP test. Why isn't the NMR or VAP test the first thing?

Good question. Think of it this way:

Lipoproteins, as measured via VAP (Vertical Auto Profile) or NMR (Nuclear Magnetic Resonance), provide a snapshot of risk from a metabolic viewpoint at that moment. Lipoproteins shift with the tides of age, menopause, weight changes, even what you ate last evening for dinner (especially small LDL). There are also other factors that cause coronary plaque, as well, not revealed through lipoprotein testing, such as vitamin D deficiency, smoking, high blood pressure, phosopholipase A2, lipoprotein(a), inflammatory factors, thyroid dysfunction, omega-3 fatty acid deficiency, etc.

A heart scan, providing a coronary calcium score, provides an indirect measure of coronary plaque that is the sum total of lipoprotein and other plaque-causing factors that have accumulated up to the time of your scan--regardless of the cause.

It means that two females, each 60 years old, with 70% small LDL, HDL 42 mg/dl, triglycerides 150 mg/dl, and mild hypertension, have identical markers for potential coronary risk, but can have widely different heart scan scores. One might have a score of zero, while the other might have a score of 300.

Why would the same panel of causes measured at one moment yield wildly different quantities of plaque? Several reasons:

1) The lifestyles, eating habits, and weight of each woman differed during their earlier years, not currently reflected in this moment's lipid or lipoprotein patterns. Perhpaps one experienced several years of extraordinary stress from a failed marriage, or suffered through two years of depression that caused her to smoke and overeat.

2) There are hidden factors that affect coronary plaque growth that we are presently not able to detect, e.g., vitamin D receptor genotype, cholesteryl-ester transfer protein variants, variation in inflammatory factors. If we can't measure it, we won't know whether it might influence coronary plaque risk.

With all the changes that occur over a person's life, with the uncertainties of yet-to-be-identified causes for coronary plaque, how can you possible know what your risk for heart disease truly is? Yup--a heart scan. Do it and you will know.

Comments (10) -

  • Anonymous

    9/6/2009 6:22:50 PM |

    So now the question is, how would your treatment differ for these two women?

    BTW I had thought the NMR/VAP were the lipoprotein equivalent of the HbA1c for blood sugar -- oh well!

  • Lou

    9/6/2009 10:38:43 PM |

    Hi Dr Davis

    I have just discovered your brilliant site.

    I saw on another post that you have some Track you plaque members from other countries. Do you have any idea if the blood tests you recommend are available to patients outside of the States (specifically in the UK or Europe)?


  • Anonymous

    9/7/2009 1:45:12 AM |

    Hi Dr. Davis,

    Do you find an earlobe crease to be a reliable determinant of coronary calcium?  I have one and notice you have one as well (on your pic).


  • Heart Scan

    9/7/2009 6:12:51 AM |

    Isn’t it natural for us to believe we are healthy and not suffering from any disease? I had a similar thought process until my physician asked me to get a heart scan done after he found that my basic cardiograms were not perfect. I discovered that there were calcium deposits in my coronary arteries and I was at a serious risk of a heart attack. I was shocked and went ahead with the Cardiologist's suggestion of an advanced diagnostic scan. Though it’s always tough to undergo such experiences, I was not at any kind of discomfort at the advanced heart scan facility. I am not an expert in medical appliance and machines but could feel that the equipment was world-class and I was in safe hands. That feeling is really very important for me and that’s how it actually went on. The facilities for Full Body Scan were as good as they can get.

  • Dr. William Davis

    9/7/2009 2:13:21 PM |


    Easy. A woman with a zero score might make some efforts to correct her lipid/lipoprotein patterns to less strict endpoints, though she should still supplement vitamin D, iodine, and omega-3 fatty acids. The other woman should follow our Track Your Plaque endpoints if her goal is to stop plaque growth.


    Sorry, but I am not familiar with the availability of lipoproteins worldwide. I do know that people from outside the U.S. have managed, but it differs in every country. Please let us know if you have any success.

  • Anonymous

    9/7/2009 3:21:15 PM |

    I had a heart scan 7 years ago at  Hopkins, how often should it be done? I didn't have any calcium- I  was 49 at the time but I have high levels of small particle LDL and HDL.

    Incidentally they called a week after reporting the results of the heart scan and said I had a bunch of 'spots' on my liver which requires CAT scans and Ultra sounds to further investigate. Turned out to be something rather normal- I forget what they are called- just it involved a bunch of tests during a four week period and a lot of worrying.

    Anytime you do a body scan be prepared to find other stuff- which may or may not be a good thing depending on your frame of mind and it you are the type of person who needs to know everything.

    C'est la vie

  • Anonymous

    9/9/2009 1:42:12 PM |

    Actually, I can think of at least one scenario where getting a VAP or similar test WOULD be the first step... youth.

    I am inelligible for a heart scan because of my age (female under 40), yet I have a strong family hx of heart disease and have already presented with some signs of risk.  IMO, a VAP test would be the best thing for someone under 40 who is concerned about heart disease.

  • Materialguy

    9/15/2009 5:21:02 PM |

    I'm looking at "The New Heart Disease Handbook" by Christopher Cannon MD and Elizabeth Vierck 2009. They mention calcium score and calcium scan a few times. Their wording focuses on the calcium scan being useful in identifying areas of plaque buildup. There are probably only a total of 300 words on the subject all totaled. Sounds like progress slowly inching along.

  • Carolyn

    9/23/2009 6:11:03 PM |

    Wheat bran and any other dry whole grain puts my digestive tract in acid overdrive.

  • Female heart attack

    9/24/2009 10:06:31 AM |

    We all have heard of heart attacks. Among women, menopausal women are more prone to heart attacks due to lower levels of estrogen. Some symptoms of female heart attacks are: pressure felt in the chest area, feeling weak, low energy, uncommon symptoms are: nauseous sensation, giddiness, etc. Women often put themselves in the last list because they have many responsibilities, but as soon as any women notice such symptoms, should go for checking.