For many decades, doctors have used the traditional coronary disease “risk factors” to predict an individual’s risk of developing heart attacks or other major coronary events. These include smoking, diabetes, high blood pressure, and elevated cholesterol.

            These factors can be plugged into various formulas to predict the likelihood of a coronary event occurring in the next 10 years and are used to decide if a person should be started on lipid-lowering therapy.

            If the calculated risk is very low or very high, no other information is needed. Many people, however, fall into an intermediate risk range. In some instances, even those with high risk of coronary disease may not want to start a statin drug because of feared side effects (which are uncommon).

            Such situations suggest the use of a coronary artery calcium (CAC) score.

            As plaque (cholesterol deposits) builds up in coronary arteries, calcium is also deposited. A low-dose CT scan can measure the amount of calcium. Ideally, you would have a score of 0, and the higher the score, the higher the risk of developing symptomatic coronary disease.

            Who might benefit from this testing?

            If your doctor has recommended you start a statin, but you are hesitant, a zero score would allow you to postpone the drug while a score over 100 would strongly suggest you take it.

            If your calculated risk is intermediate, a zero score would suggest you do not need to begin cholesterol-lowering therapy while a non-zero score would push you to do so.

            If your cholesterol is not bad but you have other risk factors for coronary disease, a CAC score will give useful information. If several family members had early heart attacks, a non-zero CAC score suggests that even if your cholesterol is not high, a statin might be a good idea.

            If you have not tolerated a prescribed statin and stopped it, a CAC score may help you to decide whether to try a different statin or one of the newer injectable cholesterol-lowering drugs.

            Who should not get a CAC score done?

            If you are under 40, a zero score is expected and will not impact decision-making; use the traditional risk factors to guide your thinking. If you are over 80, and not on a statin, the results are unlikely to change recommendations to begin.

            If your risk for coronary disease based on the traditional risk factors is high, a CAC is a waste of money: take a statin. If you are on a statin and doing well, be happy and do not get a CAC test.

            Finally, if your score is zero, repeating the test can wait at least three and probably five years.

            Edward Hoffer MD is Associate Professor of Medicine, part-time, at Harvard.

What Does The Doctor Say?

By Dr. Edward Hoffer

            Spring comes in increments – each little note building up to a symphony. We bystanders are delighted by the show and feel ourselves come alive in this most resplendent of seasons. Birdsong and tiny flowers envelop us, brooks gush, buds swell, drawing us into this magnificent and mysterious rebirth.

            Are you ready? Then roll up your sleeves, pull on your garden clogs and get ready to review the remains of last year’s garden. Do not be too dismayed at the frayed looks – even if you did a thorough fall cleanup, the winter has left its mark. It is a daunting task, yet we take delight in the adventure. Before long, you will see a magical transition made by your own working hands.

            Where to begin? We know the script by now, having many springs before now. It starts with an earnest desire to create and a strong-working body that will get things going. And also knowing what the end result will look like. It may not always turn out exactly as you envision, but no matter – look at it as an adventure, an opportunity for personal growth and invention. Here are some ideas to help you begin:

            1. If you are starting out, create your new garden on paper with your own unique tastes and uplifting elements. Get to work digging the site and loosen the soil, careful not to over-till it, but allowing nutrients and oxygen in.

            2. Smooth out the battle scars of winter – withered leaves, twigs and branches, displaced pebbles and shells and uneven soil. Perfunctory tasks like these allow a preview of the show underway – buds and shoots marching toward the light. Pretty soon your labors will have you limbering up in sync with nature. I had one close call though while removing leaves. A bunny’s nest. I quickly piled the leaves back, thinking of their future bouncing shapes across the landscape.

            3. Think like a plant. If you are placing orders for plants online, remember to schedule the delivery for when the ground is warmer (above 40 degrees) and drier. A big mistake is planting in cold, muddy soil. Shoot for early May, which will give you time to do the prep work and read up on your forthcoming acquisitions.

            4. To safeguard your seedlings during the inconsistent spring night temperatures, invest in a cold frame. You can also use a garden cloche or an overturned bucket or pot to cover seedlings.

            5. Pruners and other gardening tools need to be sharpened and smoothed if you did not do it over winter. Old deciduous hedges should be hard pruned in spring where necessary and then fed well to encourage new growth. Keep off the spring-blooming trees – but prune roses when they bud out. It’s a good time to cut back fruit trees if you have not done so yet. Look for signs of frost damage – but don’t eject a plant that appears to be dead. It may revive in early summer and can be trimmed of any deadwood.

            6. Admittedly not the most exciting task, it’s time to turn the compost pile and burn the sticks and brush. Use dry fresh compost and seasoned manure to top dress your gardens. Not necessary to dig it in, as you’ll disturb precious ecosystems. Nutrients added from the top will work their way down.

            7. Feel the magic – plant some seeds. Use peat pots or egg cartons – that way you can install them directly into the ground when ready. Try something new like watercress – rich in antioxidants and more vitamin C and K than most vegetables and fruits. Popular in Victorian sandwiches, cress is among the lush greens available for salads, soups, sandwiches and stir-fries. Try out a fun flower like the easy-to-grow Mexican heirloom vine Cobaea scandens (aka Cathedral Bells) or violet-blue flowered Heliotropium arborescens (Marine Heliotrope) with its heady vanilla fragrance.

            8. Early spring is the best time to repair trellises and fences before vines and shrubs start leafing out. Amendments should be done now to pergolas, gazebos, balconies, patios and chicken coops where it applies.

            9. When the garden finally defrosts and the soil crumbles it’s time to plant early spring vegetables. Normally I plant peas on St. Patrick’s Day, but this year hasn’t been typical. It’s not advisable to plant in wet, compacted soil, as the reduced aeration will hinder. But soon I will put in some peas, spinach, lettuce and leeks.

            10. One must-do on my spring list is inventorying the contents of my shed and greenhouse. Time to pare down. Prepare the beehives and toss dysfunctional equipment. In the short window that is the growing season, we all need to keep organized. More time to smell the roses.

            “Spring is nature’s way of saying, ‘Let’s party!'” – Robin Williams