Researchers are revisiting their views on the relative dangers soft and hard
atherosclerotic plaque deposits pose to heart health.
Atherosclerosis is caused when plaque builds up in the arteries, narrowing and
‘Calcium score which indicates the deposit of calcium forming a hard plaque is
a greater danger to heart health than soft plaques, and may cause heart attack.
Having a calcium score of zero is like having a five-year warranty against heart
attack -- even with high levels of low-density lipoprotein, also known as LDL or
"We previously thought the lipid-laden soft plaque was more likely to rupture and
cause heart attacks, but based on our new research, it's more the calcified plaque
that appears to be associated with adverse cardiovascular events" said Brent
Muhlestein, MD, one of the study's authors and co-director of cardiology research at
the Intermountain Medical Center Heart Institute in Salt Lake City.
Intermountain Medical Center Heart Institute researchers had earlier teamed with
Johns Hopkins School of Medicine and National Institutes of Health scientists to
analyze the composition of plaque from 224 patients who had diabetes, but no heart
This new research reflects more long-term findings after patients were followed for
an average of nearly seven years to see if their plaque composition had predicted
whether they'd have a cardiac event.
Which Type Of Coronary Artery Plaque?
In this study, through careful quantitative evaluation, the composition of coronary
artery plaque identified in the subjects through CT coronary angiography was
stratified proportionately into amounts of soft, calcified, and fibrous plaque and
compared with future risk of unstable angina, heart attack or death.
Unexpectedly, proportionately higher quantities of calcified plaque best
predicted major adverse coronary events, while soft plaque did not
Dr. Muhlestein said further studies are needed to verify the findings, but results
from his team's research may represent a potential paradigm shift. "We need further
validation to gauge the importance of why the coronary calcium score is so
predictive," he said.
Although a build-up of coronary calcium doesn't go away, doctors can successfully
treat the patient aggressively with statins. They know no one gets coronary calcium
if they don't have plaque, even if it hasn't been seen, so anyone with coronary
calcium also has atherosclerosis.
"It's a disease marker, not a risk marker. And we think it's possibly a very
important predictor," said Dr. Muhlestein, who noted that having a calcium score of
zero is like having a five-year warranty against heart attack -- even with high
levels of low-density lipoprotein, also known as LDL or bad, cholesterol.
"The finding potentially could mean a lot of patients may not require statin
therapy, even though they have high cholesterol," he said. "Maybe we can find and
identify them. If there's no atherosclerosis, you're not going to have a heart
attack. So the coronary calcium score may allow us to much more effectively select
who we treat."
Using computed tomography (CT) images of the heart and other types of imaging,
build-up of dangerous coronary plaques--which restrict the flow of blood to the
heart can be detected. Coronary calcium builds up at the site of coronary plaque, so
a coronary artery calcium scan can be effective in detecting plaques.
- Brent Muhlestein et al., New study finds potential breakthrough in determining who's at risk for heart attacks, American College of Cardiology's 66th Annual Scientific Session (2017).