The coronary arteries are blood vessels that supply the heart muscle. To be able to function normally, heart muscle cells need a continuous supply of blood.
Most of the calcium within human body is found in bones and teeth. A small amount is dissolved in blood. As you age, some of this gets deposited in your blood vessels. Did you know that this calcium might be a clue to your heart health?
Cholesterol and calcium can build in the inner walls of these arteries over time and turn into plaque. That plaque can rupture and form blood clots leading to heart attacks or strokes.
Even though calcium deposition or calcification may be considered a normal process of aging, more recent evidence demonstrates that it is a more active process that involves active injury and inflammation. Your doctor can use what is called a coronary calcium score to determine the quantity of calcification in your coronary arteries and determine your risk of heart attack.
This heart scan uses a special type of X-ray called the CT scan. It takes pictures of your coronary arteries to check for your calcium. The presence and extent of coronary calcium are first and foremost markers of the extent of atherosclerosis within the coronary arteries. Nonetheless, it is important to understand that the coronary calcium score does not necessarily reflect the severity of narrowing (the degree of stenosis). Still, a patient with a high calcium score is more likely to have a significant narrowing of a coronary artery than a patient with a low calcium score. An individual without coronary artery calcification is very unlikely to have a severe narrowing of a coronary artery.
How to interpret the coronary calcium score?
The following definitions are used to relate the coronary artery calcium score to the extent of atherosclerotic coronary artery disease:
- Coronary calcium score 0: No identifiable plaque. Risk of coronary artery disease very low (<5%)
- Coronary calcium score 1-10: Mild identifiable plaque. Risk of coronary artery disease low (<10%)
- Coronary calcium score 11-100: Definite, at least mild atherosclerotic plaque. Mild or minimal coronary narrowings likely.
- Coronary calcium score 101-400: Definite, at least moderate atherosclerotic plaque. Mild coronary artery disease highly likely. Significant narrowings possible
- Coronary calcium score > 400: Extensive atherosclerotic plaque. High likelihood of at least one significant coronary narrowing.
Coronary calcium score may contribute to risk assessment in people at risk for future cardiovascular events. A score of zero is associated with very low risk. Limiting primary prevention with statin drugs to those with a score above zero could spare 1 in 4 elderly from taking life-long medication that will benefit only a few.
Who Should Get This Scan?
Like everything else in this world, this is not for everyone. First, you need to know your likelihood for getting heart disease. This can be based on several risk factors including your age, sex, smoking, cholesterol, blood pressure, diabetes, family history of heart disease, etc. Your doctor can tell you if your risk is low, moderate or high based on these risk factors. Getting a coronary calcium score makes most sense if you have moderate risk for heart disease based on these risk factors. Insurance does not cover the scan just yet – and it may cost you $100 to $300 out of pocket.
What Happens During the Scan?
You will probably be asked to not smoke or consume caffeine at least 4 hours prior to the test. When you are at the test center, you will change into a hospital gown, remove any jewelry or metallic wear and lie down on the CT scanner table on your back. During the test, the table will move slowly into a hollow tube that looks like a tunnel and takes pictures of your heart. The entire process takes only about 10 to 15 minutes, and then you can go about your day!
Treating not the average, but the individual patient – new lipid guidelines incorporating calcium score
Even the new lipid guidelines released by the American Heart Association in November, 2018 incorporate results from calcium scoring to assess need for prescription of cholesterol-lowering drugs called statins. For adults aged 40 to 75 years with LDL cholesterol 70 mg/dL or higher, without diabetes and with 10-year risk of at least 7.5%, a moderate-intensity statin regimen is recommended. If risk status is uncertain, coronary artery calcium scoring can be used to improve specificity.
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