Coronary Artery Calcium Scan

Disease Management Above the Standard

Part 1: Earlier Plaque Detection

Click here for the 5-star Netflix documentary “The Widowmaker”.

These are three good reasons why you want to know if you have plaques and how much plaques you have in your coronary arteries.

1. Avoid sudden cardiac death due to plaque rupture that cause fatal arrythmia.

PM Urgency of Prevention - sudden death

2. Avoid heart attack, stroke, stent and heart bypass.

Save yourself, save  healthcare

3. Avoid contributing to the economic burden of cardiovascular disease estimated at $555 billion annually through lost productivity due to disability and premature death, more frequent hospitalizations and procedures, more out-of-pocket expenses from higher co-pays and premiums, etc.   

Million Heart Stats Dec 2015

The Million Hearts Initiative was the first attempt at the federal level to combat the cardiovascular disease (heart attack and stroke) nationally which is the number one public health problem that kills more Americans than the next 4 leading causes of death combined. It failed. We succeeded at a small scale - in my practice 10 years earlier and we can try to succeed at the community level five years from now.

The 15 second test

The first manifestations of heart disease is sudden death or acute heart attack in 62% of men and 42% of women. In addition to the human toll, there is a tremendous economic burden to America. Largely preventable cardiovascular disease supports and sustains a large cardiovascular healthcare industry. The best way to put a stop to the favored status quo is to identify those who are likely to have these events earlier and use proven medical therapy to stop disease progression. If you are male age 45 and older or female age 55 and older, with diabetes or other risk factors like high blood pressure, smoking, family history, high LDL cholesterol or low HDL cholesterol, consider getting your coronary calcium score.

Dual Approach

There is no single test that reliably predicts the risk for everyone. Framingham Risk Score is not based on the actual presence or absence of atherosclerosis. It is based on the presence of a limited combination of risk factors. The Framingham 10 Year Risk Score does not incorporate family history of premature CHD. A man and a woman with identical risk factors, a woman may have to wait 20 years later than a man before becoming eligible for aggressive preventive treatment. A nuclear stress test becomes positive only in the advanced stage when an artery is already severely obstructed. 

Detect Your Plaques Earlier and Live

Coronary calcium score test is based on the actual presence or absence of calcified plaques due to atherosclerosis, not risk factors. And if atherosclerosis is detected, it also estimates the amount of plaque burden. Some individuals with a Framingham Risk Score of less than 20% may actually be high risk. For this intermediate risk group, coronary calcium score is a good test option. In selected patients, 256 slice cardiac CT for coronary calcium score can be very helpful in directing therapy. The actual test only takes 30 seconds. There is no injection or special preparation needed.

Atherosclerosis is a progressive and diffuse disease. Early detection is important because medical treatment is highly effective. A nuclear stress test detects only severe plaques causing more than 60% to 70% obstruction - a late stage. The presence of calcium in the coronary arteries can be detected much earlier, many years or decades, before a nuclear stress test becomes positive. A nuclear stress test takes 4 hours to complete and costs over 20 to 50 times more.

The Results


The above is an example of a normal study - Zero Coronary Calcium Score. Patient is at low risk and statin treatment is usually not needed. Their survival rate is 99% in 10 years. Their need to utilize expensive cardiovascular healthcare resources is very low - a cost saving. 

Just the Tip of the Iceberg

Detecting the presence of calcified plaques in the coronary arteries is just discovering the tip of the iceberg. Only about 20% of the plaques are calcified initially. The presence of plaques in the heart also means plaques are present elsewhere - in the brain where they can cause stroke.

Extremely High CAC Score

A coronary calcium score of over 100 is associated with 10 times more cardiovascular events in the next 10 years compared to those with lower scores. It is similar for men and women, young and old, for whites, blacks, hispanics and asians (MESA Study). Compared to other risk prediction algorithms, coronary calcium score is the most robust. Patients who knew that they have high calcium score are seven times more likely to adhere to medical treatment.

Find out if your coronary calcium score is zero (very low risk) or over 400 (very high risk) or in-between. For less than $100, it removes guessing, over-treatment and under-treatment. 

This is precision medicine.

Redefining Heart Attack Risk

Traditionally, calculation based on age, sex, total cholesterol, HDL cholesterol, smoking and blood pressure determines the level of heart attack risk over the next ten years. The main limitation of the method is that it is not based on whether atherosclerosis is present or not. Using the approach, approximately 60% of adults worldwide are classified intermediate risk for a coronary event. Misclassification is very common. Many are in fact low risk and some are high or very high risk. There is cost to this misclassification - giving treatment to those at low risk who don’t need it while not providing optimal medical therapy to those at high and very high risk who need plaque stabilization-regression therapy.

The above slide represents 82,214 CACS cases in the International CACS Outcomes Registry. Data acquired from 33 medical facilities in 7 countries between 2012-2014. All patients were intermediate risk, asymptomatic, and without known CAD at time of the test.

Annual Increase in Coronary Calcium Score

N. J. Preventive Cardiology & Cholesterol Clinic, PC  © 2005     Eliminating most heart attacks and strokes in our community  is for the common good.     Disclaimer