Monday, August 29, 2011

Coronary Calcium Screening -- Does Everyone Need One?

I watched Sanjay Gupta's special "The Last Heart Attack" yesterday.  I had eagerly awaited it because I knew he would be talking to Bill Clinton, Dr. Dean Ornish, and Dr. Caldwell Esselstyn about plant-based diets and heart disease. 

We heard from one woman with a prior heart attack who turned down bypass surgery and is doing well by taking her medications and following a plant-based diet.  And, Bill Clinton discussed how he's changed his diet to improve his health as well.

An interesting aspect of the show was the discussion of coronary calcium scans.  Sanjay Gupta interviewed Dr. Agatston, the physician who came up with the concept of the scan, and ironically is the author of The South Beach Diet.  Dr. Agatston states that coronary calcium scans are "the standard of care."

I would disagree strongly.

A coronary calcium scan looks for calcium in the arteries of the heart.  If the scan finds zero calcium, that would indicate that a person's likelihood of a cardiac event in the next four years is essentially zero.  However, if you have a score greater than zero, you do have some risk.  The higher the score, the greater the risk.

But, it's not a harmless test.  It comes with a significant dose of radiation -- 2 to 3 milliSieverts, or the equivalent of 8 to 12 months of environmental exposure.  Further, the test doesn't tell us how tight narrowings are, and can't accurately state that a patient needs angioplasty or bypass surgery.  For these reasons, your HMO insurance likely won't cover it either.

Stress testing is still the standard of care because stress tests identify functional abnormalities -- in other words, they identify portions of the heart that may not get enough blood with stress, and these areas when revascularized (with bypass surgery or angioplasty) will provide symptomatic relief.

I had a patient recently come to me with just about every risk factor imaginable -- he's diabetic, high blood pressure, high cholesterol, strong family history of heart disease, and a history of smoking.  He wanted a calcium scan.  He didn't need a calcium scan to tell me that he's high risk.

I think a coronary calcium score might be reasonable to better risk-stratify someone at intermediate risk, or to help motivate someone who otherwise would not make lifestyle changes.

But, the bottom line (as it often is):  If you don't want a heart attack, live clean -- eat healthy, exercise, maintain a healthy weight, and don't smoke.

5 comments:

Olinda Display said...

What is your opinion on the caroda artery test they did?

BZ said...

Read and do Dr. Joel Fuhrman's two-book set EAT FOR HEALTH. If one changes to eating a plant-based diet one reverses many diseases including heart disease and loses weight as a by-product.

Anonymous said...

I work with doctors who are put under legal scrutiny (by patients and their attorneys) for not using the very latest in technology to detect how severe a patient’s risk of heart attack is. What do you consider ‘intermediate risk’? Do you think this type of test should become ‘standard’ for certain types of patients?

Anonymous said...

Thank you, doctor for honestly evaluating the RISKS associated with this and many other screening procedures. So often patients are persuaded to undergo tests which are minimally helpful yet potentially harmful (most often relating to radiation levels). We need as patients to remain good consumers, trust yet question or physicians, and proceed with caution when considering every "new and improved" test offered in the medical arena.

Lady Bird said...

Living a healthy lifestyle is important, however people are dying who would seem to be very healthy individuals. Having a more reliable predictor for a cardiac event is important, and should be at the very least, an option for patients at all economic levels.