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Because of family history my husband and I both had Coronary CT Calcium scans last month to get our Coronary Artery Calcium/CAC scores, the amount of calcified plaque in our arteries. This wasn't covered by insurance and cost us about $120. We have different doctors that recommended different additional tests. Neither of us had any other health issues or symptoms but we both have some calcified plaque, which is scary. But now we know. We've both been put on low dose statins which are supposed to stop/slow additional calcification.
We're both 65, active, healthy weight, don't eat junk, don't drink alcohol or smoke. We've had fit, healthy friends die recently. His score was over 400, mine over 200. His doctor sent him to a cardiologist who did several tests to make sure his heart function was good and said he's not worried. My doctor ordered the CT angiography which gave me a better CAC score, less than 200, but also pinpointed exactly where the calcification was.
So, do you know your score? What's your age? Were you put on meds or did you need a more extensive treatment? Now that we know, there will be no delay or questioning about whether to call 911 if we have any heart attack symptoms.
I participated in a study a couple years ago. my score was 0 which honestly surprised me given my age and somewhat elevated lab values for LDL and total cholesterol.
I don't know the details about this test but isn't there a soft/hard plaque issue that is very important but isn't part of the test results that people don't find out?
I don't know the details about this test but isn't there a soft/hard plaque issue that is very important but isn't part of the test results that people don't find out?
I'd like to know that too. I've tried to watch a lot of different doctors online. One said you usually don't have to worry about the calcified plaque, that the body has already healed that portion of the artery, it's the softer plaque that is still moving through your arteries that can cause issues.
I used to teach the students & residents not to order a test unless the results would influence your management plans.
There's two aspects to dealing with coronary arterial disease (CAD)-- preventive and remedy. We should all be doing the preventive thing-- regular exercise, sensible diet, no smoking, treat DM & HTN vigorously, treat hi chol when necessary....The other risk factor is strong family history of early (before age 60 or so) CAD-- choose your parents wisely.
We get suspicious that there's significant CAD present when a pt has two or more risk factors present. At that point, we want to do tests that may tell us the status of the coronaries--
A coronary calcium score is cheap and easy, but it has only about a 75% predictive value of who is due for a heart attack....It's best predictive use is when a score of "0" is obtained-- then the pt has a 98% chance of NOT having significant CAD...
OTOH, an exercise test/nuclear scan has both a sensitivity & specificity of 90%-- ie- a positive test tells us the pt probably does have enough CAD to warrant bypass or stenting, and a negative test tells us any blockage present (we all have at least a little) probably does not need a procedure yet....A positive test indicates that coronary angiography (the gold standard for finding CAD) needs to be done....
Calcium scores, OTOH don't give us a "red line value" above which we need angiography or below which we don't need it. It's best done in people with no positive risk factors as a "just in case" test when we don't suspect any problem-- but that has a very low yield, statistically speaking.
Conclusion- I don't think Calcium Coronary Scoring is quite ready for prime time.
Thanks for your post--very informative as the Calcium Coronary Scoring is what my doctor suggested. My mother died suddenly of a heart attack in the hospital. No history of heart problems although her father also died suddenly age 64 of heart attack. That's why I asked my doctor what tests I could take to flag any CAD in my own case.
Now I think I'll hold off on the Calcium Coronary test and revisit scheduling the exercise test. Nuclear scan has never been talked about so add that to discussion with doctor. I had a healthy friend (same age) die of a heart attack in her sleep last year. Her mother lived to 98 unlike mine who died at 76.
I balked at the exercise test because I knew a 40-something who had a fatal heart attack while taking the exercise test. Made me a little worried to do it. Her husband sued the hospital.
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I balked at the exercise test because I knew a 40-something who had a fatal heart attack while taking the exercise test. Made me a little worried to do it. Her husband sued the hospital.
Thanks for your post--very informative as the Calcium Coronary Scoring is what my doctor suggested. My mother died suddenly of a heart attack in the hospital. No history of heart problems although her father also died suddenly age 64 of heart attack. That's why I asked my doctor what tests I could take to flag any CAD in my own case.
Now I think I'll hold off on the Calcium Coronary test and revisit scheduling the exercise test. Nuclear scan has never been talked about so add that to discussion with doctor. I had a healthy friend (same age) die of a heart attack in her sleep last year. Her mother lived to 98 unlike mine who died at 76.
I balked at the exercise test because I knew a 40-something who had a fatal heart attack while taking the exercise test. Made me a little worried to do it. Her husband sued the hospital.
Clarification-- we usually do a treadmill exercise test immediately followed by a nuclear scan, not separate tests. The combination improves the sensitivity & specificity to over 90%.....If the pt has, say, orthopedic problems and can't use the treadmill, a "chemical test" can be done-- a cardiac stimulant is injected to speed up the HR and stress the heart.
Because significant CAD can cause PVCs, the stress of the test can bring them on and thus increase the risk of sudden death-- but that's awfully rare. For a pt with a lot of PVCs and we're sufficiently convinced he probably does have high grade CAD, just skip the stress test and go right for the angiography.
There's a difference between diagnostic testing (we think you probably do have the disease) vs tests for screening (we think you probably don't have the disease and we're just checking).
Thanks for your post--very informative as the Calcium Coronary Scoring is what my doctor suggested. My mother died suddenly of a heart attack in the hospital. No history of heart problems although her father also died suddenly age 64 of heart attack. That's why I asked my doctor what tests I could take to flag any CAD in my own case.
Now I think I'll hold off on the Calcium Coronary test and revisit scheduling the exercise test. Nuclear scan has never been talked about so add that to discussion with doctor. I had a healthy friend (same age) die of a heart attack in her sleep last year. Her mother lived to 98 unlike mine who died at 76.
I balked at the exercise test because I knew a 40-something who had a fatal heart attack while taking the exercise test. Made me a little worried to do it. Her husband sued the hospital.
I have a friend whose mother had a heart attack and when he went to the hospital and spoke with the Dr. he told the Dr that there wasn't heart disease in the family, he said the DR. just looked at him and said, "well, there is now".
So, I guess when your grandfather died of a heart attack, there is heart disease hence your mother now having it. If I understand this correctly. Both my father and brother died of sudden heart attacks, and I automatically assumed, I very well might develop it as well.
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