Dr. Roach: Cardiac calcium score is a screening test for artery disease
Dear Dr. Roach: A friend suggested I get a cardiac calcium score test to measure the amount of plaque in my heart. What is your opinion of this test?
He said since plaque is 20% calcium, the test just measures the amount of calcium in coronary arteries. Can you have coronary artery plaque without calcium? If so, would it make this test inaccurate?
Dear R.I.: The coronary calcium score is a screening test for coronary artery disease. It is not appropriate for everyone, but it is a useful test for men and women at higher risk. Doctors often order it when they are uncertain whether to recommend treatment to combat risk factors for blockages in the arteries, such as people with high cholesterol. I order a few such tests a year; some of my colleagues in cardiology order many more.
People with a calcium score of zero are at very low risk for developing a heart attack in the three years after the test. However, it is possible to have blockages in the arteries without calcium, as you have suggested. This is probably why there is a small risk of heart attack with a normal calcium score.
If a blockage is still suspected despite a normal calcium score, it may be diagnosed by cardiac catheterization and angiography. A CT scan with dye (computed tomography angiogram) can find blockages even without calcium. Finally, if the blockage is large enough, a stress test will be abnormal.
Dear Dr. Roach: My husband successfully completed 45 days of radiation for prostate cancer. His last PSA was non-detectable. He has to take medication for two years as part of the cure. However, it is causing him to have horrible hot flashes and night sweats. The usual over-the-counter solutions for women do not seem to be helping at all. Would you suggest something designed for a male?
Dear P.B.: The first effective treatment for prostate cancer was depriving the cancer cells of androgens, which was initially done surgically, by removing the testes. It is done now with medications that act like gonadotropin-releasing hormone. Although these initially stimulate testosterone production, their continued use causes lower levels of testosterone, and within a month testosterone levels drop to the same levels as in men who have had surgery to remove their testes.
Hot flashes occur in 80% of men and can be very disruptive. Treatments that are effective for women are often not effective in men, as you observed. The best-studied and most effective treatments in men were medroxyprogesterone (a hormone that opposes some actions of estrogen) and cyproterone (an antiandrogen available in Canada, but not the U.S.). It reduced hot flashes by 84% to 95% in men. Venlafaxine, normally used as an antidepressant, reduced symptoms by 50%, and gabapentin, used for epilepsy or for nerve pain, reduced symptoms by about 45%.
It's very important to treat the symptoms so he can continue this treatment, which is part of his best chance for long-term remission from prostate cancer.
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