Coronary Calcium Scans for Heart Health. Worth It or a Waste of Money?
The unfortunate reality in the United States is that while the incidence of age-adjusted heart disease has dropped somewhat in recent years, it has trended upward over the past several decades. The reasons for this are clear and revolve around the trend toward less healthy lifestyles, including poor diets and sedentary lifestyles. The result is that, even in 2022, heart disease will be the leading cause of mortality in the US. It’s important to remember that this trend continues despite improved screening, patient knowledge, and earlier, more effective interventions.
Recently, there has been a trend toward novel screenings that may or may not serve an essential diagnostic purpose. Some of these scans target genetic markers that may be precursors for disease; others are sensitive enough to catch certain cancers earlier than ever. An exciting concept uses tried and true CT technology to check for plaque accumulation in the arteries. Known as a coronary calcium scan, they may be an excellent option for those with low or medium risk of coronary artery disease.
Why CT Scanning?
To understand why a CT scan makes the most sense for a test like this, it’s essential to know what atherosclerosis is. When excess fat (cholesterol) circulates in the blood, it can begin to stick to arterial walls. This accumulation slows blood flow to the area being served by this artery. Our blood is full of oxygen-rich red blood cells, which supply life-sustaining nourishment to every cell in the body. If this oxygen is depleted or compromised, muscles, nerves, and bone structures may begin to deteriorate.
When the peripheral arteries become occluded, this can lead to peripheral artery disease, pain, and dysfunction in the extremities, particularly the legs. When the coronary arteries are partially blocked, this can lead to chest pain or angina in its earliest stages. It can eventually lead to a heart attack when the heart does not receive oxygen and begins to fail.
Treatment for Atherosclerosis
This buildup on the walls of the arteries is often treated with balloon angioplasty while the plaque is still soft. A catheter with an inflatable balloon is threaded through the blood vessel. The balloon is inflated when it reaches the occlusion, pushing the soft plaque against the artery’s walls and opening the blood vessel. Typically, a stent is placed within the artery to maintain the opening and improve blood flow.
However, that soft plaque eventually hardens or calcifies. At this point, balloon angioplasty can no longer effectively push the plaque away, and nothing can be done to reopen the blood vessel short of an atherectomy (drilling through the plaque) or a bypass (CABG).
This calcification is considered a more advanced form of atherosclerosis and puts patients at significant risk for follow-on issues like a heart attack or peripheral artery disease. While a typical x-ray can see significant calcification, much like it shows bone, the more sensitive CT scan can catch arterial calcification sooner when less has built up.
Coronary Calcium Screening
We all know about cardiovascular screening and its importance, especially if we have a family history of the disease. Screening has saved millions of lives and continues to do so daily. Of course, screening does not catch every patient with the early signs of cardiovascular disease, and we may wish to be more proactive with some patients.
A coronary calcium scan targeting the coronary and peripheral arteries can give us a clear picture of any calcification in the arteries. These will typically appear as brighter, white cylindrical shapes, whereas the rest of the blood vessel appears as more of a gray outline.
The Benefits of This Form of Screening
Screening patients in this way can help us identify areas of concern in a person’s arteries. It gives us a head start in identifying and treating these problems and may allow us to slow the progression of occlusion in the affected arteries.
Potential Downsides of Heart Scanning
First and foremost is radiation exposure. A CT scan uses multiple X-ray beams to create a more comprehensive picture of the area’s bone and soft tissue structure. However, radiation exposure is cumulative over a patient’s life and should only be used when necessary. That said, CT scanning delivers a radiation dose equivalent to what the average person would be exposed to naturally over a year.
Second is simply a matter of cost. While calcium coronary calcium scanning is a legitimate diagnostic tool, insurance must approve the test. You will likely have a copay and out-of-pocket expenses. Your insurance company will probably not approve this test if you pursue it at an outpatient center with an order from your cardiologist.
The bottom line is that coronary calcium scans may be a valuable tool if you and your cardiologist agree that it is necessary to screen for coronary artery disease proactively. Feel free to call us and schedule a visit to discuss this and other screening options to maintain your cardiovascular health.