Coronary Artery Calcium Scan: Is It Right For You?
(Editor’s Note: we are pleased that we have a new columnist in the Health Matters column, Becky Montgomery. MD. She is a Davidson citizen and is Board Certified in the practice of Family Medicine, with many years of experience.)
Most people are aware that elevated levels of cholesterol, blood glucose, and blood pressure are risk factors for future heart problems. What you may not know is the same is true for coronary artery calcium (CAC) levels.
Calcium deposits in coronary arteries are an early sign of atherosclerotic disease (ASD), which is buildup of cholesterol plaque in blood vessels obstructing blood flow. However, not all arteries with ASD have calcium deposits. The presence of ASD increases your risk for problems like heart attack and stroke. Testing for CAC helps to reveal your potential risk of heart disease, often before other warning signs appear, such as chest pain or pressure, shortness of breath, or decreased exercise tolerance.
Coronary artery calcium can now be easily measured with a non-contrast low-dose CT scan of the heart. No IV infusion is required. The test takes about 10 minutes and provides images of your coronary arteries that have calcium deposits. A calcium score (sometimes called an Agatston score) is calculated based on the amount of plaque observed in the CT scan. The score range is:
Zero: No plaque. Your risk of heart attack is low.
1-10: Small amount of plaque. You have less than 10 percent chance of heaving heart disease, and your risk of heart attack is low.
11-100: Some plaque. You have mild heart disease and a moderate chance of heart attack. Your health professional may recommend other treatment in addition to lifestyle changes.
101-400: Moderate amount of plaque. You have heart disease and plaque may be partially blocking an artery. Your chance of having a heart attack is moderate to high with the predicted 10-year chance between 13-16%. Your health professional may want more tests and may start treatment.
Over 400: Large amount of plaque. You have more than a 90 percent chance that plaque is blocking one of your arteries. Your chance of having a heart attack is high with the predicted 10-year chance between 22-29%. Your health professional will want more tests and will likely recommend treatment to include a statin medication.
Unfortunately, despite the procedure’s proven benefit and relatively low risk, it is not covered by most insurances, including Medicare. The cost of the procedure can range from $100 to $400.
A CAC scan is not for everyone, but it can be a great way for those uncertain about their heart disease risk to make better decisions about treatment and medications. It is not recommended for routine screening, nor to be used as a diagnostic test for patients with symptoms of heart disease or heart attack.
An ideal patient population for CAC scan is asymptomatic adults 40 years of age or older at intermediate risk of heart disease. It can help identify those patients who may need more aggressive risk factor modification or treatment, who otherwise have been missed with routine screening (cholesterol levels, blood pressure, glucose, smoking, exercise, obesity).
Please talk with your health professional if you think this might be beneficial to your health.
Becky Montgomery, MD
Becky Montgomery is a Family Medicine physician who has practiced medicine over 25 years. She and her husband, Emmett, also a family medicine physician, had a private practice together in Mooresville before transitioning into Physician Assistant education in 2018. They have two adult daughters and live in Davidson.