Coronary artery disease (CAD) is often called the silent killer. While it’s the most common heart-related disease in both men and women, most people aren’t aware they have CAD until it presents in a catastrophic way, such as a heart attack.
Wouldn’t it be nice to be able to scan the body and find out if you have plaque building in your arteries? There is a procedure that allows for this, and it’s called a coronary calcium scan. A coronary calcium scan takes x-ray photos of the heart and determines the level of coronary calcification, or hardened plaque, in the heart’s arteries.
While a coronary calcification test sounds like a good idea, there are many things to consider when deciding if this is the right procedure for you. Namely, how will the course of treatment change once you’ve obtained the results of your heart scan?
Understanding the purpose of a coronary calcium scan
Coronary artery disease is dangerous. CAD occurs when fat, cholesterol, calcium, and other waste builds up in the arteries. Also referred to as plaque, this waxy build-up is the leading cause of atherosclerosis, a condition that narrows the arteries and blocks oxygen-rich blood from reaching the heart.
Narrowed arteries block vital blood flow to the heart muscle, causing it to weaken over time. Untreated CAD can lead to heart failure, a life-threatening condition in which the heart doesn’t pump blood as effectively as it should. Alternatively, it can lead to a heart attack.
While some plaque hardens, or calcifies, in the arteries, others remain soft. When plaque ruptures from the artery wall, it typically creates a clot. If this clot becomes lodged in the heart, blood flow is interrupted, and a heart attack occurs.
In an effort to quantify how much risk an individual has for CAD, the coronary calcium scan was developed. This short 10-minute procedure takes x-ray photographs of the heart through a CT scanner.
After the procedure, patients are given a calcium score, also sometimes called an Agatston score. This score is calculated based on how much plaque is visible in the arteries. Doctors then make recommendations based on the score severity.
Coronary calcium scan result recommendations
A coronary artery calcium scan estimates the likelihood of obstructive coronary artery disease. Depending on the results, cardiologists may make several recommendations, including:
Depending on the coronary calcium scan results, some physicians may recommend lifestyle modifications. For example, smoking is a significant risk factor for CAD, as are obesity, physical inactivity, and eating an unhealthy diet.
Doctors may recommend that individuals with low to moderate coronary calcification test scores make lifestyle modifications to lower their risk.
Medications, such as statin therapy
The primary use of coronary calcium scoring is to guide physicians to start patients on pharmaceutical drugs, such as statins. Approximately 35 million Americans currently take statins with the hope of reducing cholesterol levels and minimizing cardiovascular risk.
Unfortunately, evidence does not exist to show that statins are helpful. Not only do studies show minimal benefit to statin use, some research finds an increased risk of death for those who take statin drugs. Moreover, studies find statins increase coronary calcification rather than decrease it. As such, prescribing statins due to high coronary calcium scores is not beneficial.
Further testing, such as a cardiac stress test
Individuals who receive high coronary calcification test scores are sometimes referred to for a cardiac stress test. A cardiac stress test, also called an exercise stress test, measures the heart’s function and blood flow while it works hard.
While stress tests have value, they are best utilized for individuals with symptoms. For example, an individual who experiences chest discomfort while walking up a flight of stairs might benefit from a stress test. However, most people with abnormal coronary calcium scans are asymptomatic.
Cardiac stress test vs. coronary scan
A coronary artery scan is a passive test completed with the patient lying down. X-ray images are taken and viewed to evaluate for coronary calcification.
On the other hand, a cardiac stress test is a functional test typically performed on a treadmill or with drugs that mimic physical movement. During a cardiac stress test, individuals are connected to an EKG machine and a blood pressure monitor while the heart works progressively harder. Abnormalities in the blood pressure, heart rate, or any worsening physical symptoms point to the possibility of coronary artery disease.
It’s also important to note that stress tests are not always an accurate risk indicator. For example, in 2004, former President Bill Clinton passed his cardiac stress test and experienced a heart attack just weeks later. Countless others have had the same experience.
Invasive procedures such as cardiac catheterization and stents
In some cases, if the results of a heart scan show significant coronary calcification, it often leads to more invasive procedures, such as cardiac catheterizations and stents.
Unfortunately, studies show that stents do not reduce the risk of death, heart attack, or other major cardiovascular events. Research shows that stents are not necessarily effective in reducing symptoms or improving exercise tolerance in most patients. Stents are helpful only for those having an active heart attack.
According to a 2015 JAMA article, nearly 80 percent of stents placed for coronary artery disease are unwarranted according to current guidelines. While it seems counterintuitive, coronary artery blockages should not be fixed unless significant symptoms impact one’s life.
The best way to keep your arteries clean
Coronary calcium scans, stress tests, and cardiac catheterizations are diagnostic procedures often used in the medical field. While they may give us a small glimpse into the heart, they often don’t tell the whole picture.
Regardless of the outcome of these diagnostic procedures, the best way to keep arteries clean and running smoothly is to eat well and live well. Choose organic, whole foods. Move your body often. Spend time in the sunshine and nature. Get quality sleep. Find joy throughout your day.
If you’ve had a diagnostic procedure and want help determining the next best steps, consider working with one of our experienced health practitioners. Together you can review your results, discuss your risk factors, and make a plan to achieve your 100 year heart.
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