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Do cardiology societies endorse calcium scanning?

Does a coronary artery calcium scan predict risk for cardiac events?

Can a coronary artery calcium scan help patients to make lifestyle changes?

Can I rely on the traditional Framingham risk factors?

Who are the right candidates for a coronary artery calcium scan?

How is a coronary artery calcium scan performed?

How is the coronary artery calcium scan interpreted?

Do cardiology societies endorse calcium scanning?

Cardiology societies now endorse the calcium scan as an effective screening test for heart disease for the following reasons:

  • The "calcium score," calculated from the patient's coronary calcium scan, is a very strong predictor of his/her risk for developing a future heart attack or sudden death from heart disease.

  • A coronacry calcium scan is more accurate than the assessment of coronary risk factors for predicting an individuals risk for heart disease. The test may provide earlier treatment for heart disease than would otherwise be available with other screening methods.

  • The test provides you, the physician, with information to advise your patient on the most appropriate lifestyle modifications and/or medications they may require to prevent the development of overt heart disease.

Does a coronary artery calcium scan predict risk for cardiac events?

Epidemiological studies have consistently demonstrated a very strong, exponential relationship between the magnitude of coronary artery calcium and the likelihood of cardiac events. It is now well accepted that a coronary artery calcium scan is a very useful new technique for aiding in the prediction of long-term risk for cardiac events in your patients. Such information can be used to motivate your patients to make important changes in their lifestyles.

Can a coronary artery calcium scan help patients to make lifestyle changes?

Recent studies suggest that patients with higher coronary artery calcium scores become more compliant. Unlike risk factors, which often sound theoretical to patients, the demonstration of coronary calcium provides patients with objective evidence, which they can understand, that atherosclerosis is already taking hold in their coronary arteries.

Can I rely on the traditional Framingham Risk Factors (such as diabetes, hypercholesterolemia, hypertension, family history, tobacco use) to predict if my patient has atherosclerosis?

  • Traditional Framingham Risk Factors are helpful in predicting increased coronary disease, but in comparison to coronary artery calcium scanning, they are much more limited in their ability to do so.

  • Many patients with a normal cholesterol level or no family history of coronary artery disease have very substantial coronary artery calcium and conversely, many patients with high cholesterol and a family history for coronary artery disease have no coronary artery calcium.

  • Unlike risk factors which are only predictors of disease likelihood, coronary artery calcium is definitive if present, then so is atherosclerosis. Not surprisingly, therefore, recent epidemiological studies indicate that coronary artery calcium is much more powerful than all coronary artery disease risk factors combined for predicting future cardiac events.

Who are the right candidates for a coronary artery calcium scan?

Men and women who have one or more of the major Framingham Risk Factors, such as smoking, high cholesterol, diabetes, family history or hypertension. Patients with metabolic syndrome as well as those with a history of inflammatory disease processes (increasingly linked to heart disease) are also likely to benefit from calcium scans, as are those who are physically inactive. A coronary artery calcium scan is also a very useful test for triaging patients with atypical chest pain.

How is a coronary artery calcium scan performed?

Calcium scanning is a painless procedure that takes approximately 15 minutes to complete, including patient preparation. The test is performed with a CT scanner. The patient will lie on the scanner table and be asked to hold his/her breath for 10-15 seconds while the scanner takes a picture of their heart. There are no injuections required for the procedure and the patient does not have to hold their medications or fast. In summary:

  • No preparation is required. No blood is drawn and there is no treadmill exercises required.

  • The test is fast.

  • The test is safe.

How is the coronary artery calcium scan interpreted?
Coronary artery calcium scans are interpreted by a radiologist or cardiologist. A numerical coronary artery calcium score is calculated for each coronary artery calcium scan. The coronary artery calcium score increases with increased coronary artery calcium.

A normal coronary artery calcium scan, showing no evidence of coronary plaque

The interpretation of the coronary artery calcium score is dependant upon age and gender of the patient, however, certain guidelines can be used.
  • A CACS of zero indicates your patient has an excellent prognosis and is unlikely to have atherosclerosis.

  • A CACS 1-399 indicates calcified plaque is present and aggressive treatment of coronary artery disease risk factors is considered.

  • A CACS >= 400 indicates further cardiac testing (e.g., stress test) should be done to risk stratify patients relative to future risk for cardiac events.

An abnormal coronary calcium scan, with calcified plaque within one of the major coronary vessels (appearing white)

An abnormal coronary calcium scan, with calcified plaque in all three major coronary vessels

If you have questions about coronary artery calcium scanning, please call us at 212.636.1422.

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