Dear Dr. Roach: My primary care doctor prescribed a cardiac calcium test after seeing me breathing hard while climbing onto the examining table. I don’t feel a need for it, as I am over 72 years old and it is common in this age. I checked with another doctor and he asked: “What if you have higher cardiac calcium,” as I am already taking atorvastatin and enalapril. Since then, I have been avoiding the test. What is your advice?
J.M.
Shortness of breath with exercise is indeed common, but when people have difficulty breathing with pretty minimal exertion, I would be concerned that there is a problem. Blockages in the blood vessels to the heart muscle — coronary artery disease — is one common and treatable cause of breathing problems with exertion, and high cholesterol and high blood pressure are risk factors for coronary artery disease. I think a test to determine whether you have coronary artery disease is reasonable.
However, the coronary calcium score wouldn’t be my first choice. A coronary calcium score looks for calcium deposits in the blood vessels to the heart, and high levels do make CAD more likely. Since a coronary calcium score doesn’t provide information about whether (and how big) those blockages might be, a stress test would be my first choice, followed by a definitive anatomical test, such as a coronary angiogram, if abnormal.
If there are blockages and you have symptoms despite medical therapy, your cardiologist would consider treating those blockages with a coronary stent. If the blockages were severe and in the left main coronary artery, cardiac surgery would be indicated.
The coronary calcium score is best used for higher-risk asymptomatic people, especially when trying to get more evidence to weigh the risks and benefits of medical treatment.
Dear Dr. Roach: I am 68 and have been taking benazepril to control my high blood pressure for approximately 20 years. I often read that high blood pressure can put a person at risk for different issues, including complications with COVID-19. Since my blood pressure is within normal range with medication, am I still at risk for high blood pressure issues?
M.R.W.
High blood pressure does put people at higher risk for medical issues, especially stroke and heart attack. Reducing these risks is the major reason to treat with blood pressure medication.
Over many years and hundreds of studies, it is now generally accepted that the sooner the blood pressure is treated, and the closer the treated blood pressure is to normal blood pressure, the better the reduction in risk of complications. Most experts aim to get the blood pressure down to near-normal, if that is possible to do without too many side-effects. It is my belief that a person who is rapidly diagnosed with high blood pressure once it occurs, and who is treated aggressively and successfully, will be at no (or very little) increased risk for high blood pressure and stroke.
While it is true that high blood pressure seems to be a risk factor for bad outcomes in people infected with COVID-19, I can't say definitively that successful treatment completely removes that excess risk. However, I believe that is likely to be the case, and preliminary data suggest that benazepril, like other ACE inhibitors, may be particularly protective. There are many reasons to effectively treat high blood pressure.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers can email questions to ToYourGoodHealth@med.cornell.edu
