Have you ever wondered if tiny calcium deposits can build up inside the main arteries that carry blood to your heart? It's like limescale in water pipes over time. This is what we medically call coronary artery calcification (CAC) . Sometimes, this can happen without any visible symptoms. But being aware of this is very important for the health of your heart.
What is Coronary Artery Calcification?
Simply put, this is when calcium builds up inside the walls of the two main arteries that supply blood to your heart, called the coronary arteries . This doesn't happen overnight. It usually takes about five years for the calcium to build up inside your arteries, after a period of time when you have a build-up of plaque (called atherosclerosis ). Think of it like a pipe that has a build-up of dirt and grime, and then that buildup gets thicker.
Calcium deposits in these arteries are an important indicator of coronary artery disease . This allows your doctor to assess your risk for heart disease.
When these fatty deposits build up inside the arteries, it reduces the flow of blood. You know, the coronary arteries supply the heart muscle with oxygen-rich blood. So, if the blood flow through these arteries is obstructed, you can get chest pain (angina) , or worse, a heart attack .
There are two main types of calcium deposits:
Doctors see this in two main ways, depending on the layer of calcium deposited in the artery wall:
1. Intimal deposition: This occurs in the innermost layer of the artery wall. This type is most commonly seen in coronary arteries.
2. Medial deposition: This occurs in the middle layer of the arterial wall.
What is the relationship between calcium deposits in the arteries and atherosclerosis?
There is a big connection between the two. The amount of calcium in your arteries can give you an idea of how much atherosclerosis you have, which is the buildup of fatty deposits in your arteries. Atherosclerosis is when fatty deposits build up inside your arteries, narrowing them. It makes it harder for blood to flow properly. Calcium can make this condition worse.
Who is most affected by this situation?
People with coronary heart disease usually see calcium deposits in these arteries.
- With age: If you look at people over 70 years old, more than 90% of men and 67% of women have this condition. Before menopause, women are somewhat protected from the risk of developing this (atherosclerosis) due to the hormone estrogen . That is why women develop this condition about 10-15 years later than men.
- Race/Ethnicity: Some studies have found that white people are more likely to develop this condition than other races.
- For men: Men are at higher risk of developing this (Coronary Artery Calcification).
What are the risk factors? (If you have these things, you may also be at risk)
Some people are more likely to develop this condition. See if you have any of these risk factors:
- If you have chronic kidney disease .
- If you have blood sugar problems like Diabetes Mellitus .
- If the level of bad cholesterol (LDL - Low-Density Lipoprotein) is high and the level of good cholesterol (HDL - High-Density Lipoprotein) is low.
- BMI (Body Mass Index) value, that is, if the body mass index is high (obesity).
- If someone in your family has a history of calcium deposits in the coronary arteries like this (hereditary predisposition).
- If you have high blood pressure .
- If you have a history of smoking or using other tobacco products.
- With increasing age.
- If there are abnormalities in parathyroid hormone .
- If the phosphate level in the blood is high.
- If the calcium level in the blood is high.
What does this do to the body? How does it affect it?
When calcium builds up in your coronary arteries, it causes them to become stiff . This reduces their ability to contract and expand properly. This increases your risk of heart disease.
Simply put, this calcium buildup reduces the amount of blood that reaches your heart muscle. Think of it like a motor that works non-stop. If it loses its blood supply, it will have problems, right?
Another thing is that when calcium deposits are present in the arteries, it becomes difficult for doctors to perform certain treatments, such as Percutaneous Coronary Intervention (PCI) , or as we all know , Angioplasty, because these calcium deposits can interfere with the proper deployment of the stent that is placed inside the artery.
What are the symptoms?
Most of the time, people with this condition (Coronary Artery Calcification) do not show any symptoms . That is the most dangerous thing. But over time, as this condition worsens, some symptoms may appear. They are:
- Stable Angina: This is chest pain or discomfort that usually occurs during exercise or when climbing stairs. It subsides with rest.
- Shortness of breath.
- A heart attack.
Important: If you have these symptoms, be sure to seek medical advice.
Why is this happening? What are the reasons?
Usually after the age of 40, calcium in our blood can start to build up in various parts of the body. In particular, the walls of arteries that have been damaged, inflamed, or are undergoing repair are the most susceptible to these calcium deposits.
This process can actually start as early as your 20s , but a doctor only sees it when it's large enough to be seen on an imaging test. And, many people in their 20s and 30s don't get these tests done regularly.
Calcium deposits start as very small particles (0.5µm - micrometers). Over time, as fatty deposits accumulate, these calcium deposits can grow larger than 3 millimeters. Researchers believe that these small calcium deposits (microcalcification) in the intimal layer of the artery wall begin with the death of smooth muscle cells.
How do you find this? What kind of tests are done?
There are special imaging tests that can detect this condition (Coronary Atherosclerosis), that is, fatty deposits in the arteries, before it becomes severe. One of the most important of these is the (Computed Tomography - CT) scan, or (Multidetector Computed Tomography - MDCT) .
A cardiac CT scan can clearly show the calcium deposits in your coronary arteries. This is called a coronary artery calcium (CAC) test . It mainly looks for:
- How much calcium is deposited?
- What is the density of those deposits?
- How big are they?
Using this information, your doctor calculates a value called the Agatston score . This score can range from 0 to 400 or even higher. The higher the score, the greater your risk of having a heart attack or stroke within the next 10 years.
Doctors have found that this (CAC) test can accurately predict future cardiovascular risk. However, you may have to pay for this test out of your own pocket.
What does the CAC score (Agatston Score) mean?
Here's how those signs are usually interpreted:
- Score 0: No medical condition.
- Score 1 to 99: Mild disease.
- Scores from 100 to 399: Moderate level of illness.
- Score above 400: Severe disease.
In addition to this (CAC) test, there are other less invasive tests that can check for calcium deposits in your coronary arteries:
- Cardiac Intravascular Ultrasound (IVUS): This uses an ultrasound device with a catheter (thin tube) attached to the end to look inside the arteries. The results are graded from Class I to Class IV, with Class IV indicating the most severe calcium deposits.
- Intravascular Optical Coherence Tomography (IVOCT): This shows how much calcium is deposited in your arteries and how thick it is. It uses near-infrared light to create images of the inside of the arteries.
What are the treatments for this?
Doctors don't yet have a standard treatment for coronary artery calcification. However, in severe cases, some doctors are using a new treatment called intravascular lithotripsy . This involves passing a device through a catheter into the artery and using it to deliver pressure waves to break up the calcium deposits in the artery wall. A stent can then be placed to keep the artery open.
Some other treatments used to improve blood flow in the arteries include:
- Rotational, orbital or laser atherectomy: This involves cutting away and removing fatty deposits (plaque) and calcium inside the artery.
- Cutting, scoring or high-pressure balloon angioplasty: This involves inflating a balloon to push the fatty deposits and calcium against the artery walls.
Can complications occur during treatment?
As with any medical treatment, some complications can occur with this treatment.
Complications of Intravascular Lithotripsy:
- Arrhythmia ( abnormal heart rate)
- Aneurysm ( bulging or weakening of a blood vessel)
- Bleeding complications
- Stroke
- Death (very rare)
Complications of Rotational Atherectomy:
- Artery dissection
- Heart attack
- Death (very rare)
- Emergency Coronary Artery Bypass Graft (CABG)
Coronary Angioplasty Complications:
- Heart attack
- Stroke
- Arrhythmia
- Bleeding
- Blood clots
These complications don't happen to everyone, but it's important to be aware of them. Your doctor will explain these risks when they recommend a treatment for you.
How can I reduce this risk?
The best thing to do is to control the problems that increase the risk of developing coronary artery calcification. These include:
- If you have diabetes, control it well.
- If your cholesterol level is abnormal, get it under control.
- If you have high blood pressure , control it.
- If you have kidney disease , get proper treatment for it.
In addition to these things, it is very important to follow a healthy lifestyle.
What happens if I have this condition? What can I expect?
If you are diagnosed with Coronary Artery Calcification, you are at increased risk of developing Coronary Artery Disease and Major Adverse Cardiovascular Events (MACE) .
However, when it comes to the success rate of treatment methods, Intravascular Lithotripsy has been successful in more than 92% of cases. Similarly, Rotational Atherectomy has also shown a success rate of 90%.
However, calcium deposits in the arteries increase the risk of failure of treatments such as balloon angioplasty . It can also be difficult to position a stent properly within the artery.
How can I take care of myself? What should I do?
If you have coronary artery calcification, it's important to follow a heart-healthy lifestyle. That means:
- Eat low-fat foods (reduce oil, fried foods, and fast foods as much as possible).
- Stop using tobacco products (cigarettes, beedis, etc.) completely.
- Exercise regularly (something like walking for at least 30 minutes a day).
- Keep your blood pressure and cholesterol levels normal (take medication as directed by your doctor and control your diet).
When should I see a doctor?
If you have high blood pressure and/or high cholesterol, see your doctor regularly to make sure those conditions are well-controlled. If you need a plan to improve your cardiovascular health, it's a good idea to see a doctor to talk about it.
When should I go to a hospital urgently (ETU) ?
If you experience symptoms of a heart attack, such as severe chest pain, nausea and vomiting, and severe shortness of breath , call 911 immediately or go to the nearest hospital . Time can be the difference between life and death at a time like this.
What questions should I ask the doctor?
When you go to see a doctor, it's helpful to ask these questions:
- Do I need to be tested for coronary artery calcification?
- How severe is my condition (Coronary Artery Calcification)?
- What treatment do you recommend for my condition?
- What are the risks and benefits of this treatment?
- What changes do I need to make in my lifestyle?
Let us remember in summary (Take-Home Message)
Knowing whether you have calcium deposits in your coronary arteries is important for your doctor to develop a plan to help you. You may need treatment to remove calcium from your arteries, or you may just need to incorporate some heart-healthy habits into your life. Even if you don't have cardiovascular problems, eating a low-fat diet, exercising, and staying away from tobacco products can help keep you healthy. Remember, a healthy heart is the key to a healthy life!
` Calcium in the arteries of the heart, coronary artery calcification, heart disease, cholesterol, high blood pressure, diabetes, heart attack, atherosclerosis
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