Heart Disease – a New Detection Test

A Coronary Artery Calcium test is better at predicting heart disease and cheaper to administer. Here's what it is and how this type of individualized screening is the future of healthcare.

Heart Disease – a New Detection Test
February was heart health month, and coincidentally, I have been reading up on an interesting test which is quick, painless, low cost, and provides an “individualized medicine” approach. The test is called a Coronary Artery Calcium (CAC) heart scan, which can detect heart disease earlier. By measuring the amount of calcium in the walls of coronary vessels, and the stability of the plaque, the resulting CAC score provides a very accurate screening. 

Current Diagnosis Standards
Currently physicians use risk factors to predict a patient’s heart disease probability, which include blood pressure, cholesterol, diabetes, weight, physical inactivity, smoking history, age, and gender. Unfortunately, this is an imperfect science, resulting in millions of Americans being prescribed statins who don’t need them. Plus, due to some negative side effects of these drugs, many patients stop taking them in just a few short months. With a quick screening test, patients would be able to determine if statins are appropriate for them, and whether the side effects are justified in their specific case. The medical community uses screening tests for breast cancer and colon cancer, why not for heart disease?

Here’s some disturbing heart disease statistics:

• In approximately 50% of all heart disease cases, the first time heart disease is discovered is when a heart attack occurs. 
• More than 300,000 Americans die every year with their first symptom of heart disease being sudden death. 
• In people with cholesterol levels as low as 180, heart attack is still the leading cause of death. 
• 10 million stress tests were performed in 2018, at an average cost of $1000 each. But studies have shown that the test will be normal 84% of the time in people who will eventually have a heart attack. In addition, 20% of these tests result in a false positive.  

The Coronary Artery Calcium (CAC) Heart Scan
The CAC scan is generally recommended for men 40+ and women 50+ who have no symptoms of heart disease but may be at risk for developing it. If there is a family risk of heart disease, it is recommended to start this testing 5-10 years prior. This test is not recommended for anyone who already has symptoms of heart disease or who has been diagnosed with heart disease, since the procedure would not help doctors better understand the disease progression and would not likely change previously set treatment decisions.

The extent of a patient’s Coronary Artery Disease (CAD) is graded according to the CAC score, ranging from 0 (no evidence of CAD) to over 400 (extensive evidence of CAD). About half the population will score 0. Those scoring between 1 and 100 typically can reduce their risk of heart disease through diet and moderate exercise. A score of 101-300 would indicate moderate plaque deposits, and anything over 300 would be cause for alarm.

An Easy Screening Test
The Coronary Artery Calcium (CAC) heart scan takes less than 15 minutes to conduct, there’s no preparation for the exam (like with a colonoscopy), no contrast injection needed, and the cost is about $250. Most facilities will ask the patient to stay away from caffeine and smoking for four hours prior to the test.

The amount of radiation exposure is equivalent to a mammogram. A nuclear stress test, in comparison, emits 17 times the amount of radiation.  Currently most insurance plans do not cover CAC scans, which seems odd to me. They are one-fourth the cost of a stress test, have better results without false positives and false negatives, the radiation exposure is 17 times less than a nuclear stress test, and could result in millions of Americans never having to fill a statin prescription. 

The Bottom Line
As medicine becomes more individualized, I believe tests such as Coronary Artery Calcium screening will become more mainstream. It seems we used to follow the “standards” blindly – if my cholesterol is over a certain level, just prescribe me the medication. But over the past decade, there has been a push back from patients with regards to prescriptions being an instant salve. I also believe that patients will start demanding these less invasive tests that will provide more clarity when determining treatment plans. 

​I love hearing about new “individualized medicine” tests that can point a patient in the right direction for their specific conditions. The future of medicine is here!