Dear Dr. Roach: I’m an 80-year-old male who doesn’t drink or smoke, exercises regularly, and takes telmisartan for blood pressure and rosuvastatin for cholesterol. I’ve never had any heart issues except for a diagnosis of arteriosclerosis. Five years ago, my calcium score resulted in a left anterior descending artery at 92.9 Agatston units, while the other arteries were all zero. Now this same test shows my LAD artery at 91.6, with the left main coronary artery at 57.6 and the right coronary artery at 31.6.

Now, the total score is 180 compared to 92.9 five years ago. I’ve decided to reduce my daily saturated fats to 15 grams. Would this help maintain my condition rather than worsening it? I’ve been eating two eggs a day for about three years. Could this have contributed to a worsening score? — G.L.D.

Answer: The coronary artery calcium scan is a useful test in certain situations. I use it in my patients when it isn’t clear whether they need medication to reduce the risk of a heart attack. It isn’t particularly useful in people who are already on drug treatment, and repeat calcium artery scores don’t help with management. However, if a person has a low score, and drug treatment is deferred, a repeat scan can help identify whether a person would benefit from treatment now.

The natural history of coronary calcium is to go up over time. This doesn’t mean that your treatment has been inadequate. As far as your saturated fat intake, experts such as the American Heart Association recommend that no more than 6% of your total calories come from saturated fat. Fifteen grams daily is a reasonable goal for a person who consumes 2,000-2,500 calories per day. Most experts agree that reducing saturated fat in the diet, especially by switching red meat for plants or fish, reduces heart disease risk, so I’m in agreement with reducing saturated fat.

Each egg contains 1.6 grams of saturated fat, so you could omit one egg yolk or just switch to one egg per day to reduce your saturated fat intake further. There’s no agreed-upon amount of eggs for optimal health, but for my patients with arteriosclerosis, I recommend seven eggs (really, egg yolks) per week or fewer.

The dose of rosuvastatin, and whether additional drug treatment might be necessary, is based mostly on your LDL or ApoB level.