The Biggest Heart Celebration: The Value of a Calcium Score of Zero

It happens every day, every week, even every hour. A 48 year old, a 63 year old, a 57 year old. Chest tightness, sweating, nausea and then collapse and likely death with no prior warning. It is such a common occurence that the vast majority of tragic cardiovascular events in young, loved, and productive persons who suffer an acute myocardial infarction (MI or heart attack) often complicated immediately by collapse and death do not catch the public eye. It takes a celebrity like James Gandolfini suffering this fate to capture the attention of an overloaded public. There must be a better way to identify and stop the number 1 killer of men and women, one I have been battling for 30 years.

I have written before about the rationale and scientific support for a new approach to heart care, one that says you get your heart checked by a simple CT scan revealing the health or silent deterioration of your heart arteries in under a minute and often for under $100. This is still one of the best kept secrets in medicine as it is rare for a practice or medical system to advertise the availability of this testing despite several thousand scientific studies supporting its accuracy. If you wonder why, please view the documentary The Widowmaker.

New data on the power of having this painless CT examination is now available from study tracking nearly 9,000 persons with chest pain being evaluated by their medical team. In this prospective evaluation, patients with chest pain where randomly selected for a stress test or a heart CT as the initial modality to determine the presence and possible severity of any undiagnosed heart disease. A coronary artery calcium scan (CACS) was considered normal if the score was a perfect zero. Even though these were a group of patients with chest pain, 35% had the perfect zero CACS score. In follow-up that extended beyond 2 years on average, those with a CACS of zero had an overall event rate of 1.4%, quite low. This compared to an event rate of 5.2% if the score was 100–400 and 6.4% when the score was >400. Those with CACS score of >400 had nearly 4 times the risk of a heart event, including death, of the normal cohort.

Why take the risk of not knowing your heart status? The CACS is a “low cost (typically <$100) and low radiation (<1 milliSievert) test which allows direct visualization of coronary atherosclerosis without needles, contrast or injection”. You do not need to wait until you are having chest pain to ask your health team for a Rx to have one done. I receive emails or phone calls regularly from individuals asking if they need therapy for a cholesterol of 220, 240, 260 and such. My first response is: what is your CACS score? A similar strategy has been promoted by others. Although the integrative approach to an elevated CACS score is beyond the scope of this article, there are even supplements that have been shown to reverse the process of calcification along with the ever present recommendations to follow a heart healthy lifestyle. Please, do not be the next statistic, never to see another sunrise, child’s small, wedding, or ball game. Test, not guess, and know if you can celebrate with a CACS score of zero.

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