Feb 5, 2019
Artery buildups serve as silent danger signs of a heart attack. Discover how a coronary calcium score calculates patients’ risk by measuring the amount of calcium in their arteries through the use of a computed tomography (CT) scan.
Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.
Host: Thanks for joining us today. We’re speaking with Dr. Allen J. Taylor, Chair of Cardiology at MedStar Heart and Vascular Institute. Welcome, Dr. Taylor.
Dr. Allen J. Taylor: Thank you.
Host: Today we’re discussing coronary calcium scoring, which is a non-invasive heart scan that a cardiologist can use to help calculate a patient’s risk for coronary artery disease or atherosclerosis. Dr. Taylor, what are you looking for in a patient’s heart when you perform coronary calcium scoring?
Dr. Taylor: Great question. This is a very simple test that very accurately and easily detects the beginnings of atherosclerosis or what otherwise people call (quote) “hardening of the arteries.” It’s that development of plaque, cholesterol buildups and other things that are filling up the arteries as we age. And so, when we’re doing coronary calcium scoring, we’re looking for little pieces of calcium, like in your bones, but that are in the arteries and it shouldn’t be there. And it’s a marker for these buildups that we can easily detect and measure and through that, evaluate a patient's risk for heart disease.
Host: How does the calcium end up there when it’s not supposed to be there?
Dr. Taylor: The calcium comes because the arteries are becoming damaged from the buildups and as they heal, the body naturally lays down some calcium. So, it’s part of these plaques or buildups and it’s the one that we can detect with x-rays because x-rays detect bone, and this is basically bone in your arteries—little pieces of calcium. So, it’s easily detected with a simple scan, a CT scan, that we call a coronary calcium scan.
Host: Are there certain populations of patients who are at increased risk for high levels of coronary calcium?
Dr. Taylor: It’s interesting because simply by aging, that’s your major risk. Now, some people with high cholesterol or high blood pressure or diabetes or smokers - they may develop calcium in their heart arteries at a faster rate. But, just because you don’t have those things, doesn’t mean you’re not developing buildups; it doesn’t mean you don’t have coronary calcium. And the challenge is that by measuring those risk factors, we can detect somewhat of a patient’s risk for heart disease, but it’s only part of the story. And, the important thing about calcium scoring is that it tells us more of the story. It adds to what we already know about a patient and helps us to determine who really is at risk for heart disease.
Host: Is there anything that a patient has to do to prepare for this type of scoring test?
Dr. Taylor: The beautiful thing about this is it’s a very simple test. It’s done using a CAT scanner or CT scanner, but it uses very low doses of radiation. There’s no needle. There’s no medicines. All the patient does is lay down, get hooked up to a few electrocardiogram electrodes, and hold their breath for about 15 seconds. Within 5 minutes, they’re done, and the scan is complete.
Host: Now why does the patient have to hold their breath while they’re getting this test?
Dr. Taylor: The reason that you have to hold your breath is because if the heart is moving when you breathe, it’ll blur the images. So, it’s done during a breath hold. But, the breath hold is very short. The scans are very fast. And, virtually all patients can tolerate the scan. The scanners are very wide profile, there’s not a lot of claustrophobia or that feeling of being closed in by the scanner tube. And the radiation levels, which is previously or often a concern, are very, very low. They’re really like a couple of mammograms worth of radiation exposure. So, it’s a very simple test and actually they’re also very inexpensive. Most health systems will do these tests for under a hundred dollars, if insurance doesn’t cover it. And many insurance payers will actually cover the test.
Host: What happens next if a patient’s scan shows high levels of coronary calcium?
Dr. Taylor: Right. If you find calcium, what does it mean? It means you’re at increased risk for heart disease. By the converse, if you don’t find calcium, it means you’re at low risk for heart disease. So, it really puts a lot of clarity on who is and who’s not at risk. So, when you detect coronary calcium, there’s certain things you’re going to do. The most obvious things are live a better lifestyle since lifestyle changes are so important to heart disease risk. Eat a better diet, exercise more, get good rest, avoid stress, for example. And then, other health habits, like don’t smoke, make sure your cholesterol is well controlled, make sure your blood pressure is well controlled. Maybe you’ll need a cholesterol medicine to control your risk. Maybe you’ll need aspirin to control your risk. With this information, you can make the right lifestyle changes. And also make sure you’re on the right treatments to optimize reducing the risk for heart disease. Because, remember - heart disease is still the number one killer in this country.
Host: If those lifestyle changes don’t work, what treatment options are available to take care of that coronary calcium buildup?
Dr. Taylor: A common question we get is “Can you remove the calcium?” And, you can’t. But remember, if there’s calcium there, there’s plaque or other buildups. And it’s that other parts of the buildups we’re trying to treat by treating cholesterol, for example. Mostly we can show that we can stabilize the plaques, for instance, by lowering cholesterol a lot using very simple cholesterol medications that are very safe and very effective. But, some other choices might be there for patients, like do they or don’t they take an aspirin a day, for example, or what blood pressure targets should they be looking for? Or, maybe they’ve been avoiding diabetes treatments and they should get on treatments. Or, what types of diabetes treatments? So, with your doctor, there’s many healthcare choices that can be made to reduce the risk for heart disease. But, that’s the connection. You get the test, you clarify your risk, and then you treat the risk using those other interventions - lifestyle and then targeted treatments for certain heart risk factors.
Host: You’ve given us a lot of really good reasons to get this test and then to seek treatment after. But what if a patient doesn’t seek treatment? What are some of the risks to their health?
Dr. Taylor: Well, one thing we know is that many patients fear heart disease but may not have to fear it at all because, if you have no calcium in your arteries, the evidence shows the risk for heart disease over the next 10 years is extremely low, like .1 percent per year, one in a thousand. Very low. Now, if a patient does have coronary calcium and doesn’t seek treatment, that would not be the outcome we would want because anytime you do a test, you want to use that test to make better health choices. And, the evidence shows that, in fact, that is what happens. So, when people get this test, they’re more likely to get appropriate cholesterol medication, for example. They’re more likely to take appropriate measures, like taking aspirin. And, they’re also more likely to make other healthy lifestyle choices. So, I think the test has some great utility to help both patients and doctors more carefully identify risk and then respond in the right way. And, the evidence suggests that that’s actually what happens.
Host: Could you tell us about a patient who came in for a coronary calcium scoring test - maybe found that they had some calcium and made some changes to their life or were able to reduce their heart disease risk?
Dr. Taylor: Oh sure. I can tell you stories on both sides of the story. A friend of mine, he’s in is early 50s and has a family history of heart disease, has always worried that something inside of him is not...won’t be right, that genetics have led to him to have risk for heart disease. But he lives a healthy lifestyle, doesn’t have any risk factors. He got a scan - there was no calcium. So, he has been reassured that, in fact, whatever it was that led his loved one - it was one of his parents - to have heart disease, he, at least at this point in his life, doesn’t appear to have it. And it’s a pretty good time to screen, as people turn middle-aged, 50 to 60. That’s when heart disease risk really goes up and we can detect calcium, if it’s present, and how much. On the other side of the story, many, many successful stories that show how this test can be well utilized. For example, a woman who was also middle-aged, in her 50s, and she had been worried about her heart health and didn’t have a lot of risk factors. Not a smoker, good cholesterol. And, in fact, she has very high levels of coronary calcium. And, she’s way above average for age and that says that her risk is much higher than it should be. So, what did we do? Well, she’s now on a cholesterol medicine - her cholesterol wasn’t bad, now it’s perfect. And, not all healthy people should take aspirin, but her risk is high enough with this that we have, in fact, placed her on aspirin - carefully, because aspirin can cause bleeding, so you only want to use aspirin when patients have risk for heart disease. So, her treatments have been changed. Now, she’s still active and she’s still eating well. She was always doing those things. But now we’ve gone from the normal lifestyle changes to, in fact, a very proactive approach to reduce her risk and hopefully that risk is being optimized.
Host: What would you say to a patient who feels like maybe this isn’t for them or they don’t need this type of test?
Dr. Taylor: The interesting thing about calcium testing is that we can only predict, with heart risk factors, about a third, meaning a minority, of actually how much buildup is actually there. You only know by looking. You know, they’ve said ‘a picture says a thousand words?’ That’s the case with this. By doing this very simple test, you can get a complete view of heart risk within 5 minutes, and it’s something that no other test can provide.
Host: What makes the program here at MedStar Heart and Vascular Institute so unique for patients who have coronary artery calcium buildup?
Dr. Taylor: In the mid-Atlantic, MedStar Heart and Vascular Institute has been doing calcium scanning longer than anybody. And, many of our doctors, myself included, have conducted some of the seminal research, the important research, that’s shown the value of this test. And we provide this as a low-cost health service. So, even if patients’ insurance won’t provide it, we so strongly believe that this is the best test that a patient, age 50 and above, could take to really know their heart risk, that we provide this at very low cost. So, we believe in the test. We think it’s very important. And we provide that care so that no patient shouldn’t have the benefit of a coronary calcium scan.
Host: Thanks for joining us today, Dr. Taylor.
Dr. Taylor: Thank you so much.
Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting medstarwashington.org/podcast or subscribing in iTunes or iHeartRadio.