HWN Suggests

Coronary Artery Calcium: Score? or No More?

Maybe it's not the $64,000 question, but increasingly cardiologists are asking: What is the role of coronary artery calcium (CAC) scoring... On the surface, it's not a tough question to answer. After all, CAC has been around since at least 1990, and we've seen dozens of studies trumpeting its predictive value...

And the Winner Is...

There's no mystery about CAC score's popularity as a high-tech screen. Cardiovascular disease stubbornly stays the leading cause of mortality worldwide—and now the new #1 cause of years of life lost—despite the fact that effective preventive methods exist.

Yet cardiovascular risk prediction remains an imprecise science.…

read full article

Featured

 Coronary Artery Calcium Scans Are Not the Answer

Medical tests can never be good or bad. The problem is always the humans who misuse the test. For now, though, I argue (again) against using CAC scans

 When Calcium Scoring Helps vs. When It Misleads

“CAC has revolutionised CV prevention...” - Peter Attia’s recent tweet caught my attention. He’s right that calcium scoring transformed risk assessment. I got to read extensively about coronary artery calcium over the last few weeks, and I can tell you the reality is more nuanced. When used in the right patients, CAC is the single best test we have for determining who actually needs aggressive heart disease prevention—it changes treatment decisions in nearly half of people who get it. But it doesn’t work equally well for everyone, and a zero score doesn’t mean you’re immune from heart disease.

Articles of Interest

Coronary Artery Calcium Score: What’s the Controversy?

In conclusion, evidence supports a high CACS as a strong positive predictor of cardiovascular events; however, it is still unclear which patient groups should undergo coronary artery CT scanning to guide clinical decision-making. Ultimately, the value of the CACS is both physician- and patient-dependent: only scores with the potential to modify pharmacologic therapy or risk- reduction strategies will prove useful. For physicians who widely encourage the use of statin therapy and aggressive risk reduction, the CACS may be of no added benefit. Conversely, for physicians or patients more averse to the potential adverse effects and cost burden of statins, the CACS may be useful as part of a risk-benefit discussion regarding their initiation

Coronary calcium scans: NYT article highlights value and minimizes limitations

The US Preventive Services Task Force (USPSTF) has found insufficient evidence (benefits vs. harms) to support CAC testing over traditional risk assessments for cardiovascular disease in adults without heart symptoms.

The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment

Although coronary artery calcium testing may slightly improve future risk prediction, this theoretical benefit is outweighed by its potential harms. Atherosclerosis is a complex lifelong disease, and wrongly simplifying it with coronary artery calcium testing helps the testers more than the tested.

This Test Tells You More About Your Heart Attack Risk

Coronary artery calcium scans can offer a more precise estimate of a patient’s chances for major cardiac events. Some cardiologists say it remains underused. “The test is used by more people every year,” said Dr. Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled between 2006 and 2017, his research team reported, and Google searches for related terms have risen even more sharply. Yet “it’s still being underused compared to its value,” he said. One reason is that although the test is comparatively inexpensive — sometimes up to $300, but often $100 or less — patients must pay for it out of pocket. Medicare rarely covers it, though some doctors argue that it should.

Why I’m Wary of Many Cardiac Screening Tests

We have been told for decades now that detecting cardiac disease early is better than waiting for symptoms to appear, which on the surface sounds reasonable. However, years of experience belies this supposed axiom, and in fact some screenings, in the guise of “early detection,” can be downright dangerous.

Call For More Calcium Screening Gets Pushback

But a zero calcium score can be useful to avoid statins, some argue.

Coronary Artery Calcium Scanning: Past, Present, and Future

Despite the remarkable mass of robust data supporting the prime role of CAC in risk assessment of the intermediate-risk population as well as several large subgroups, with the concept of atherosclerosis itself being a more potent predictor of CAD than risk factors for atherosclerosis having been validated in every study, CAC has not been incorporated into the mainstream of clinical cardiology and has been downgraded in the 2013 guidelines.

Coronary artery calcium score: Are we doing too many or too few?

The appropriate patient for CACS is still debated, and the answer to this question will likely continue to evolve as data accumulate. However, there is more agreement among experts in CVD prevention concerning patients for whom CACS is rarely indicated:

Coronary artery calcium score: current status

The CAC score is an independent marker of risk for cardiac events, cardiac mortality, and all-cause mortality. In addition, it provides additional prognostic information to other cardiovascular risk markers. The well-established indications for the use of the CAC score include stratification of global cardiovascular risk for asymptomatic patients: intermediate risk based on the Framingham risk score (class I); low risk based on a family history of early CAD (class IIa); and low-risk patients with diabetes (class IIa).

Could a coronary calcium scan help prevent a heart attack? Here's what you should know

The controversy surrounds what the coronary calcium scantest can, and cannot, reveal. In turn, this has led to criticism that the test may on occasion provide "false negative" results. A false negative is when a problem exists, but the test misses it and erroneously reports that all is well. Without getting too technical, coronary calcium scan testing may miss some clogging that exists in coronary arteries and not report it. Here’s why.

Could a Simple Test Have Saved Millions From Heart Attacks?

In 2013, the American Heart Association declared the coronary artery scan beneficial, but it still hasn’t taken off as a proactive route for all Americans – and many docs still don’t think it’s an effective solution to the problem of heart disease in the masses.

Expert lays out controversies for cardio care

This is one of the hottest controversies in cardiology. The test is non-invasive and can be performed without any contrast. If a study shows that you have no calcium in your coronary arteries, you are very, very unlikely to have a coronary event, whether you're symptomatic or asymptomatic. This makes the test very attractive for ruling out coronary disease. The problem is that if you do have a little bit of calcium in your arteries, you set the testing train in motion (a stress test perhaps followed by a coronary catheterization, etc.) and you may end up doing more harm than good by screening a lot of asymptomatic patients. The USPSTF [U.S. Preventive Services Task Force] doesn't think there's enough data to support coronary artery calcium scoring for asymptomatic individuals.

Heart Health Imaging 101: Calcium Scoring Test or CCTA?

While there are many reasons your doctor might order imaging of the heart, calcium scoring is primarily used to better define and diagnose risk in patients who may not be experiencing any symptoms or only mild heart health symptoms, while CCTA is primarily used in patients with acute or chronic chest pain.

Heart Scan Can Fine-Tune Risk Estimate for Patients Considering Statins

Advocates for the scan say it should be used to “de-risk” people. It can let those who do not want to take statins know whether their chance of a heart attack is actually extremely low.

Major Global Coronary Artery Calcium Guidelines

This review summarizes the framework behind global guidelines of coronary artery calcium (CAC) in atherosclerotic cardiovascular disease risk assessment, for applications in both the clinical setting and preventive therapy

One More Heart Test to Consider: A Calcium Scan

But measuring coronary calcium is not a surefire indication of a person’s risk. For one thing, the test measures arterial plaque that is hardened and firmly attached to the lining of coronary vessels. It does not measure the soft plaque that can rupture and travel through the coronary circulation until it reaches a narrowing it cannot pass, leading to a heart attack or stroke.

Should You Get a Calcium Score Test?

A calcium score test -- also called CT cardiac scoring -- can predict your risk for heart disease, but not everyone needs one.

Use of cardiac CT and calcium scoring for detecting coronary plaque: implications on prognosis and patient management

While risk factors can be used to identify individuals with possible CAD, CAC scoring and coronary CTA detect the actual presence of disease. In asymptomatic individuals without known CAD, knowledge regarding the presence or absence of CAC can lead to a more precise estimation of risk. Such information has the potential to match more aggressive therapies for those at higher risk while avoiding pharmacotherapy in those with no CAC. However, ongoing debate regarding incorporation of CAC among risk-based primary prevention strategies has limited the widespread use of this test. Among symptomatic patients, the results of coronary CTA can provide important prognostic information regarding a patient's future risk of major adverse cardiac events...

What Is a Worrisome Calcium Score

The test results are given as a number called your calcium score, which reflects the amount of calcium found in your arteries. A score of 0: No calcium is present. This result suggests a low risk of heart disease. A score between 1 to 10: Some calcium is present. There may be minimal signs of heart disease. A score between 11 to 100: Mild plaque build-up. Your risk of heart disease may be moderate. A score between 101 to 400: Plaque build-up is significant. Your risk of heart attack increases. A score above 400: There is extensive plaque in your arteries. This indicates a high risk of severe heart disease. A worrisome calcium score is generally considered anything above 100. However, risk can vary depending on your age, gender, and other health factors. Thus, it is best to discuss your calcium score with a healthcare provider who specializes in heart disease.

When Is Measuring a Coronary Artery Calcium Score Cost Effective?

Unlike measurement of traditional risk factors like blood pressure and lipids, however, CAC measurement has significant downsides...

Resources

The Widowmaker

A simple heart scan could save many of these lives, but THE WIDOWMAKER reveals that a hidden battle fought inside America’s medical establishment has pitted prevention against intervention keeping scans in the shadows while cardiac surgeries soar.