Question: After my triple bypass surgery, my doctor informed me that he had taken care of the damaged vessels. However, he said he saw signs of additional calcification in other arteries and that it was imperative for me to lose weight, exercise, and control my stress. Is calcification because of sodium intake or stress, or a combination of the two?

Dr. Hibberd’s Answer:

Screening for coronary artery disease is now done by a risk score that is calculated by a specialized cardiac vessel CTT scan that identifies the extent of coronary calcifications. While slow to be accepted in the United States, this method has been widely used in Europe as a screening tool for initial identification of patients who should be evaluated further for coronary artery disease. The reasoning goes: Increased calcifications equal increased coronary risk score, and elevated scores are associated with increasing amounts of existing coronary artery disease.

You know you have coronary artery disease, but only large vessels can be bypassed. Some patients, especially those with poorly controlled diabetes, have small vessel disease that often is not amenable to bypass or stents. Small vessel disease may be allowed to advance and will cause just as much or more cardiac disability as multiple large-vessel narrowings.

Your doctor is trying to tell you to reduce your other risk factors for progression of coronary artery disease, and you need to start yesterday! Be sure to bring your LDL “bad” cholesterol level to as close to 80 as possible, exercise regularly, do not smoke, and try to optimize your diet and achieve desired weight/fat/muscle ratios. Treat underlying conditions such as diabetes and hypertension aggressively.

Your sodium load does not directly affect the coronary artery disease process but does play a role in blood pressure management in some of us who are salt sensitive. These calcifications do not reflect your sodium or your stress levels but do reflect the presence of plaques and disease in your coronary artery vessels. Our diets are generally too high in sodium. Not adding salt to food is a reasonable habit for all of us to help maintain healthy blood pressure readings.