A Tool for Detecting a Healthy Heart

Mark Horneffer, M.D., F.A.C.P, Internal Medicine, Columbia St. Mary’s

Posted: Feb. 1, 2008

Calcium scoring is becoming increasingly popular as a diagnostic test to aid in the early detection and risk assessment of heart disease. The heart scan is most often done using a multi-slice CT scanner, which takes high-speed, low-radiation images of the heart and counts the amount of calcium present. This noninvasive technique typically takes 10 to 20 seconds and patients remain in their clothes. There is no need for an IV or medication prior to the heart scan.

A calcium score is a measure of how much plaque has accumulated in blood vessels of the heart. The amount of calcium buildup is a good predictor of a person’s risk of a heart attack and can be used by primary care doctors as a guide for treatment. However, because calcium scoring is still relatively new and hasn’t been proven to save lives, the test is rarely covered by insurance. The cost of a heart scan typically runs patients $150 to $200 out of pocket.

Studies show a strong correlation between high levels of calcium buildup and a high amount of blockage in people’s arteries. Almost everybody accumulates some calcium buildup in arteries over the years. Heart scan results compare a person’s calcium score with the average score for other people of the same age and sex. Calcium scores can range from 0 to over 1,000.

No formal guidelines exist for determining who should undergo a coronary calcium scan. The presence of traditional risk factors such as diabetes, high cholesterol, high blood pressure, smoking and genetic predisposition remains the standard approach to evaluating a patient’s risk for heart disease, but a heart scan can be a more definitive tool for assessing someone at intermediate risk.

Ideally, a heart scan candidate might be a man in his 40s or a woman in her 50s who has borderline high cholesterol and a strong family history of heart disease. Scan results can help determine if the patient needs to incorporate medication and/or lifestyle modifications to lower his or her risk of heart disease.

When evaluation of risk factors does not tell the whole story, a heart scan can be helpful in identifying a person’s propensity for developing heart disease. For example, one of my patients was a 40-year-old woman who was in excellent health but had a strong family history of heart disease. As a result, she was advised to undergo a coronary calcium scan. Test results revealed that the woman’s calcium score was in the 99th percentile and she is now on a preventative regimen, which includes aspirin, cholesterol medication, vitamin D and fish oil.

The drawback of any heart screen test – whether it is a coronary calcium scan, stress test, or heart catheterization–relates to the unpredictability of heart disease itself. As calcium and cholesterol build up as plaques in the walls of arteries, some plaques are less stable than others. A person can have very little narrowing in the artery at one moment, but if the plaque ruptures, a sudden blockage occurs, and this is the cause of almost all heart attacks.

Still, the efforts that prevent plaque buildup are the same efforts that reduce the risk of plaque rupture. Evidence shows that the best way to avoid future heart problems is to consume a heart-healthy diet, exercise, avoid smoking, and take medications when appropriate.

Many centers recommend repeat heart scans to follow calcium buildup, but this practice has no proof of benefit. I tend to discourage my patients from getting repeat scans to minimize accumulated radiation exposure.

Patients who undergo a heart scan receive a preliminary report immediately following the procedure. The technician then sends a final, comprehensive report to the patient’s primary care physician within days of the scan.

Columbia St. Mary’s offers Dual Source CT Technology to produce calcium score scans. Before you schedule a coronary calcium scan, talk to your primary care doctor first to determine whether the test will benefit you.

Mark Horneffer, M.D.
Columbia St. Mary’s
414-326-1745

We Have Answers
Do you have medical questions or need help finding a doctor? The experts at Columbia St.Mary’s can help. Click here.