CT scan can detect arterial calcium
By Tom Avril, The Philadelphia Inquirer | |
McClatchy-Tribune Information Services |
His maternal grandfather died of a heart attack at 55. His mother's brother made it to 57 before meeting the same fate. Several cousins on his mother's side also had heart disease -- including a second cousin who died at 40.
Yet Winans did not have especially high cholesterol levels, and at 38, the
Should he take statins as a precaution?
The answer, he hoped, lay in a big white doughnut at
Cardiologists caution that this scan is not for most people, only for those whose risk of heart disease is uncertain. The scan exposes the patient to a modest amount of radiation, which is better to avoid if there is no real benefit, and it costs from
But for someone who is not a clear-cut case, such as Winans, the calcium scan can be a useful tiebreaker in the decision of whether to take statins, said
Available for years, the scan is now getting renewed attention after it was cited in new guidelines for treating cholesterol, issued in November by the
Winans had an LDL ("bad") cholesterol reading of 138 -- not great, but common in people with a Western diet, and with his young age and otherwise good health, it was not enough to dictate a prescription for statins. The cholesterol-lowering drugs can cause muscle pain in some patients, so it would be better do without the pills if there was no need.
Yet there was the family history of heart disease. So cardiologist
"I just wanted to go in and be proactive," said Winans, a chef who teaches at the the
The scan itself took just a minute or so. If he had calcified, hardened plaque in his coronary arteries -- the vessels that supply oxygenated blood to the heart -- it would show up as bright white on the screen.
Software also would translate the amount and density of the whiteness into a calcium "score" -- a number that could range from zero to more than 400.
A week or two later, he got good news: a score of zero. No calcified plaque, so no statins for now.
Still, Winans takes pains to eat a balanced diet, and he runs and lifts weights. In two years, he will come back for another calcium scan.
The test is offered also at
She cautioned that the test does not measure soft plaque -- the fatty substance more likely to lead to a heart attack. It detects only the plaque that has hardened with calcium.
The rationale behind the scan is that if you have calcified plaque, then you are likely to have soft plaque that has yet to calcify, so statins or other treatments are a good idea.
But Duffy avoids using the scan in women under 40 and men under 35, as these people may have soft plaque that has not had time to harden.
"You could get a falsely reassuring zero score," Duffy said.
Soft plaque is a killer because it can rupture, leading to a clot that blocks blood flow to the heart, said cardiologist
Statins are useful both because they lower cholesterol and appear to stabilize soft plaque, she said.
So if there is a possible risk of heart disease, why not just err on the side of caution and prescribe statins, several of which are cheap generics?
Two reasons: In addition to the possible muscle pain, there also is some evidence linking statin use to memory loss.
Hence, the calcium scan.
In addition to using such scans on younger patients who might be candidates for statins, Temple's Edmundowicz also has used the test on older patients who already are taking statins but wish to stop because of the muscle pain.
Every so often, he gives them the all-clear: generally with women in their 80s who somehow have high total cholesterol levels, yet according to the test, have no coronary calcium.
The amount of radiation from a calcium scan varies depends on the type of machine.
Some older devices can expose the patient to up to five mammograms' worth of radiation. Temple is getting a new scanner this summer that will capture 256 "slices" of the heart with each snapshot, enabling a detailed image with less radiation than older machines -- about the same as a mammogram, Edmundowicz said.
Winans, for one, feels it is well worth it. He will be back to use it in two years.
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