Heart Calcium CT Scans: The Slow Crawl to Widespread Use While the “Walking Dead” Suffer
I will be succinct. After 30 years of cardiology practice, with an interest in the prevention of heart attacks and heart deaths, I think my medical community is doing a poor job. The concept that heart disease, specifically clogged heart arteries called coronary artery disease (CAD), has a long period without symptoms and warnings is well known. There is often a sudden change culminating in an emergency, heart attack, or death.
While there are screening prostate exams, colon exams, and breast exams, where in 2019 is the heart “mammogram” for individuals without symptoms? The “walking dead”, those with dangerous but silent CAD, are getting ignored in a busy medical system even though there is such an examination that is inexpensive, simple, and widely available.
The heart calcium CT scan, also known as the coronary artery calcium scan or CACS, is a radiologic procedure that is painless, takes under 1 minute, involves no needles or injections, and exposes a patient to about the same dose of radiation that a mammogram does (1 mSv). In most areas, the CACS costs around $100. The prognostic power of the CACS examination has been established for over a decade and has been confirmed in recent studies. I have ordered and interpreted thousands of these exams and have managed many patients with abnormal CACS results from around the world who visit my clinic. Yet, so few people have had this test, few primary care providers are recommending it, and many are suffering. The walking dead are not being identified. The slow adoption of the CACS examination into routine practice has been deadly for many. The time is at hand: Test Not Guess for silent CAD.
1. SHAPE Society
Over a decade ago a society was formed to promote testing for silent CAD using the CACS examination. The concept was introduced using the CACS test, those who had low risk could be reassured and avoid pharmacologic agents like statins. In contrast, those at high risk on testing would get more intensive and lifelong therapy and follow-up. The integration of this framework for detection of silent CAD into clinical practice has been at a snail’s pace.
2. 2019 ACC/AHA Primary Prevention Guidelines
Just this month the American College of Cardiology and the American Heart Association published comprehensive guidelines on preventing CAD that are worth reviewing. Although it was not the first time that CACS testing was mentioned in similar documents, one of the top 3 items that were recommended by this group was the ability of the CACS exam to reassign risk to low or high groups in asymptomatic individuals.
3. 2019 European Society of Cardiology Guidelines
The meeting of the European Society of Cardiology this month in Paris created a worldwide buzz over many new research studies. Included in this excitement were new guidelines for the management of cholesterol that included a prominent place for CACS testing
I suggest you share these references with your health care provider and ask for a Rx to go to your local hospital for the CACS exam. Call ahead to inquire as to the cost as it may range from a self-pay fee of $50 to $250 or more for the same exam. There is no preparation and there are no known risks other than the X-ray exposure. In my clinic, I rarely repeat the CACS exam so it may be a one time dose (unlike a mammogram). If your score is not zero, seek out experts in the field who evaluate and treatment persons with silent CAD with standard and natural approaches as I have outlined before.