Do I Need a Coronary Calcium Score?
As with most technology, the cost of a coronary calcium score test (also known as a “heart scan” or the calcium score) is dropping, and doctors are more inclined to consider this useful diagnostic tool for women who may have a moderate risk for heart disease or whose heart disease risk is unclear.
When my high-risk patients are not taking their cholesterol-lowering statin medicine, the calcium score can be a very powerful motivator for them to follow my professional advice and prescription.
However, the heart scan is not without some risks, and it may not be appropriate for everyone. Because a computed tomography (CT) scanner is used to detect calcium deposits within the walls of the coronary arteries, there is some exposure to radiation.
What is a coronary calcium score test?
This non-invasive test uses a CT scan to measure the amount of calcified plaque in your coronary arteries. The test measures your “calcium score, which helps your doctor calculate your risk of developing coronary artery disease (CAD)-related events such as a heart attack or a stroke.
What does a calcium score test show that other tests do not?
The calcium score test shows the amount of coronary artery calcium that resides in the coronary artery plaque, which cannot be directly imaged non-invasively. In addition, the vessels of the heart are five times more likely than those of other organs to make plaque. So, if you want to get a good idea of whether or not you are a “plaque builder,” then a CT scan of the heart might predict other types of non-coronary diseases too.
How is plaque detected?
Arterial plaque is hard to measure non-invasively. Plaque takes up calcium, which CAN be detected and counted in a heart scan. The calcium literally sparkles on a CT scan and the specks of light can be counted. The amount of coronary artery calcium is a measure of coronary artery plaque. Coronary artery plaques can sit and grow slowly over time to produce an artery obstruction. This may lead to chest pressure or discomfort which occurs first with exertion. Plaques may also rupture suddenly, causing a blood clot to form which may totally obstruct a coronary artery — the cause of a heart attack.
What is the importance of the calcium score?
The greater the coronary calcium score, the larger the amount of plaque is in the artery wall, and the greater the risk of a heart attack. The calcium score is thus a good predictor of a heart attack.
Who will benefit from a calcium score?
Every person with a moderate risk of heart disease can benefit from a heart scan, but those with a low or high risk of heart disease may not. We define moderate risk as an atherosclerotic cardiovascular disease (ASCVD) risk score of 5-7.5%. However, you may be considered to be at moderate risk when your ASCVD score is classified as” low risk” AND you also have a family history of heart attacks at an early age.
Generally, a heart scan is not recommended for the following people:
- Men younger than age 40 and women younger than age 50, because few younger people have detectable calcium
- People who have low risk and no family history of heart attacks at an early age; these people rarely have detectable calcium
- People who already are known to be at high risk, because the heart scan is not likely to provide any additional information to guide treatment decisions
- People who already have symptoms or a diagnosis of heart disease, because the heart scan will not help doctors better understand the disease’s progression or associated risks
What does the score mean?
So, the first question is a yes or no question: Do you have plaque? If your calcium score is more than 0, then YES, you make plaque.
The next question is, How much plaque do you have compared to others of your age?
We use the following scoring system:
|Score||Presence of plaque and what it means|
|0||· No plaque is present
· Less than a 5% chance of having heart disease
· Very low risk of having a heart attack
|1–10||· A small amount of plaque is present
· Less than a 10% chance of having heart disease
· Low risk of having a heart attack
|11–100||· Plaque is present
· Mild heart disease
· Moderate risk of having a heart attack
|101–400||· A moderate amount of plaque is present
· Plaque may be blocking an artery
· Indication of heart disease
|400+||· A large amount of plaque is present
· More than a 90% chance that plaque is blocking at least one artery
The American Journal of Cardiology, Vol. 87, June 15, 2001
Are there any risks to this procedure?
The CT scanner emits about the same radiation as an x-ray machine for 10 x-rays. For this reason, a doctor’s written order is required.
What should patients expect about the scan?
Dye is not required for the heart scan.
During the heart scan, you will lie on your back on a table that slowly moves your whole body, except for your head, into the CT scanner (a hollow tube). The technician stands behind a glass wall and directs you while he or she takes the pictures. Usually, the procedure takes 10–15 minutes. After the scan, you should be able to drive yourself home and continue your daily activities.
At the touch of a button, the machine produces a print out of your results with the score calculated for your doctor. It is almost foolproof because it is automated by a computer.
How much do calcium score tests cost?
Currently, on the “open market,” a calcium score test costs about $150.
Are there any alternatives to this procedure?
A stress test, risk factor assessment, or cholesterol testing could be alternatives to this procedure. Your doctor can advise you about which tests are most likely to be useful for you.
My thinking is kind of black and white these days: If your body makes plaque, then the production of plaque needs to be suppressed.
For women with detectable plaque, cardiac risk factors should be aggressively managed. We generally recommend controlling blood pressure, reducing LDL cholesterol by using medications such as a statin, and a baby aspirin.
Until Next Time!
Stephanie Coulter, MD
Thank you to Jackie Ferrufino, Dr. Karla Campos, Dr. Briana Costello, Keri Sprung and Joanna Brooks for their assistance in this issue of Straight Talk.
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