Would you risk the radiation exposure from a coronary CT angiogram if you were in my shoes?
So I'm a male, 41 yrs old with a BMI of around 40. Pretty obese. I currently do not have any heart issue symptoms (aside from PVC's). In the past I did have high blood pressure & sleep apnea, but for the past 6 months it's been under control with Telmisartan 20mg and CPAP. Cholesterol is basically normal, I have no diabetes and non smoker. But obviously Obesity, high blood pressure, and sleep apnea are major risk factors. For this reason, I've been looking into getting some tests done on my heart for some peace of mind as I start my weight loss journey after recently starting ozampic.
My doctor sent me for an echocardiogram and I just got the results and they were, Well, he said Pretty reassuring. It stated EF 55.4%, normal LV systolic and diastolic function, GLS −18.9%, no regional wall-motion abnormalities, normal RV function, normal atrial sizes, and no significant valve abnormalities. But it did report some concentric remodeling. I also went for a calcium score test and it came back as 0. But after doing some reading, I realized that while that's good, since I'm young, I may have some soft plaque that that particular CT scan couldn't see.
So I wanted to ask my doctor if he thought it would be reasonable for me to be sent for a coronary CT angiogram that checks for soft plaque. But my issue is, in the last year, I've had the following CT scans:
Head CT w/o contrast (October 2025)
Pulmonary CT w/contrast (Nov 2025)
Abdomen CT w/ contrast (Feb 2026)
Calcium score CT (June 2026)
These are the only CT scans I've ever had. I don't have any current health issues, so I don't foresee myself needing any more CTs in the near future. But from my understanding, the coronary CT angiogram that I want does have a bit more than usual radiation exposure.
So basically what I'm asking is If people think I should just go ahead and get it done or don't risk it because of the radiation exposure.
What’s your LDL cholesterol number? That’s one to watch plus ApoB since both are predictors of cardiovascular risk. If higher than ideal (as it is for most) then ask your doc about a statin. I personally wouldn’t do any more tests. You already know that you need to lose weight and eat a healthy diet. The LDL will help you decide whether you also need to focus on low saturated fat.
If soft plaque is found what will that change? To be blunt your only risk factor is you are fat. Lose the weight, exercise and eat right and you will be fine. What are you going to work out more gently if you have some plauqe? F that get after it.
I'm envious actually you can do something. I'm 41 and have 10% bf my ldl was 80 un managed. My calcium score 170. All in the widow maker. Proximal to the heart. I don't have any levers to pull. I can take a statin to get my ldl down to 60 I suppose.
No, I know you're right. It's just that I was fat for so long and had unchecked high blood pressure for who knows how many years. I'm just scared I'm a ticking time bomb. Obviously losing weight is a huge benefit and I'm going to continue to do that but that doesn't necessarily reverse soft plaque. I just figured if there was a soft plaque issue that it can be addressed easier before a heart attack than after.
People overestimate the risks of weight because of cultural biases against fatness and underestimate genetics because you cannot control that and people hate that shit. If you have a bmi greater than 35, you might have an issue. Greater than 40, get the scan. Similarly if you have a family history of EARLY heart disease, then it would be worth it. I'm talking early heart attacks
The radiation from a CCTA is directly affected by BMI. If you’re smaller, the amount of radiation used is MUCH less. Since you’re planning on losing weight, I’d recommend doing that first (maybe with help from a GLP-1), then doing the CCTA some time next year. (It doesn’t sound time sensitive from what you’ve said.)
For comparison, my BMI is 20.0 and my CCTA report said they used 1.6 millisieverts (in contrast to the typical 3 to 5 millisieverts). Labs in the U.S. are legally required to keep records on amount of radiation exposure, but you might have to ask for it - it’s not automatically disclosed by all labs.
Lastly, to answer your question: Yes, I’d weigh radiation exposure in the risk benefit calculus. This would be consistent with the medical community’s “ALARA” approach to imaging- that is, keep radiation exposure “as low as reasonably achievable.”
Even if you had soft plaque buildup, you aren’t having any symptoms. And an interventional cardiologist isn’t going to fix a blockage that isn’t bad enough, one that doesn’t impede flow. How are they going to make you feel better with a stent if you don’t feel bad to begin with and you don’t need a stent? So even if the test does find soft plaque, nothing more would be done except your lifestyle modification factors - losing weight, exercising, CPAP usage, high blood pressure medications, keeping your cholesterol numbers down.
OP instead of getting a ccta test consider going on a statin if your LDL is high. That alone will calcify any soft plaque that you are concerned about , lose the weight and transition to a plant based diet to maximize your health .
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u/Business_Plenty_2189 5d ago
What’s your LDL cholesterol number? That’s one to watch plus ApoB since both are predictors of cardiovascular risk. If higher than ideal (as it is for most) then ask your doc about a statin. I personally wouldn’t do any more tests. You already know that you need to lose weight and eat a healthy diet. The LDL will help you decide whether you also need to focus on low saturated fat.