February is American Heart Month, a time when we can become more aware of our risks for cardiovascular disease, the leading cause of death for both men and women in America. A simple test may help assess those risks. According to Johns Hopkins Medicine, coronary artery calcium (CAC) screening trumps cholesterol levels, high blood pressure and other risk factors in predicting heart attacks and death.
In a study about CAC and other heart disease screening methods, lead author Dr. Michael G. Silverman, a cardiologist from Boston, said: “We showed that by using only the traditional risk factors, we miss a significant percentage of individuals at high risk. We may also be overtreating a large number of people who can safely avoid lifelong treatment.”
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The researchers found that CAC screening provides an accurate, personalized assessment for people who are either at high risk or low risk of a heart attack or death from coronary heart disease. The scan provides images of your coronary arteries that show existing calcium deposits. These calcifications are an early sign of coronary heart disease.
For the CAC screening, patients undergo a simple and painless 10-minute computed tomography (CT) scan in which pictures of the heart are taken. A score of zero means you have a very low risk of having a heart attack within the next 10 years.
For someone who has several risk factors for heart disease, the test can help determine how aggressive treatment should be, and what types of medications or interventions should be considered. According to Harvard Health, this test isn’t right for everyone but is typically most useful for people who don’t yet have symptoms of heart disease, but do have some risk factors. If your doctor is on the fence about your treatment, a CAC scan may help him or her determine the most appropriate treatment plan.
But a CAC score is less useful when a patient is at very low risk or high risk of heart disease because the score won’t change management recommendations or may lead to unnecessary testing.
CAC screening is now readily available and easy to perform, but there is some radiation exposure and out-of-pocket cost for the procedure. The screening may also reveal something either heart-related or unrelated but concerning that could lead to more testing, anxiety and cost.
A study published in JAMA Cardiology in October 2021 revealed more limitations of CAC scoring, particularly in younger patients.
“This study is getting a lot of attention because it highlights limitations of CAC scores,” said Dr. Ariane Coco Fraiche, a cardiologist at Harvard-affiliated Beth Israel Deaconess Medical Center.
The study looked at more than 20,000 people who had symptoms of arterial blockages. A large number of them got a score of 0 on a CAC scan despite the fact they already had plaque-related obstruction in their arteries. That’s because calcium may not get deposited into potentially dangerous plaques. This was particularly evident in people under the age of 40. More than half (58%) scored 0 on a CAC scan, compared with 5% of people over the age of 70.
This study showed that CAC scanning is not necessarily an accurate gauge of risk in younger people and in those with symptoms of artery obstruction, says Fraiche.
If you do undergo a CAC scan, you should review your results with your doctor, who can help you understand how the findings relate to your personal risk factors. Here’s how scans are graded:
• 0 (no plaque)
• 1-99 (mild disease)
•100-399 (moderate disease)
• 400 or higher (severe disease)
Unless your calcium score is 0 you may want to discuss lifestyle modifications with your physician, says Fraiche. However, an abnormal score does not necessarily mean you need to have more testing as long as you don’t have symptoms, say the expert, who adds that your CAC score is just one of several factors to consider when assessing cardiovascular risk.
“If you are concerned about your risk of heart disease or weighing the pros and cons of preventative therapies, I recommend talking to your physician about the potential role of a calcium score,” says Fraiche.
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