First, some good news:
— Heart disease can often be prevented or controlled.
— Prevention includes lifestyle changes and, sometimes, medication.
— By doing just four things — eating right, being physically active, not smoking and maintaining a healthy weight — you can lower your risk of heart disease by 80 percent.
Now for the bad: Often referred to as hardening of the arteries, atherosclerosis occurs when cholesterol, fatty substances, calcium and a clotting protein called fibrin — collectively known as plaque — build up on the inner walls of arteries. The arteries can become inflamed, hardened and stiff. Plaque can break off and cause the formation of a blood clot inside the damaged vessel. Diseases fueled by this process, such as heart attacks and strokes, are the leading causes of illness and death for both men and women in the United States.
But because atherosclerosis is a slow process that occurs over decades, it can often be detected early, and preventive treatment can be initiated to ward off its most devastating consequences.
Are you at risk for atherosclerosis?
The first step in preventing and treating atherosclerosis is to determine if you are at risk.
While everyone should focus on making healthy lifestyle changes, those with elevated cardiovascular risk can benefit from preventive therapy with aspirin and cholesterol-lowering drugs called statins. Risk is determined by a combination of factors, including age, gender, blood pressure, cholesterol, diabetes and smoking. The latest risk score calculator estimates 10-year risk of heart attack and stroke among people ages 40 to 79 and can gauge the 30-year risk for those 20 to 59 years old.
In many cases, risk calculation is straightforward and treatment decisions are clear-cut, but for some patients with borderline risk scores, treatment choice can fall in a gray zone of uncertainty. Complicating matters further is that in certain groups of people, the risk score calculator can underestimate or overestimate risk. In cases of uncertainty, an additional test called a coronary artery calcium scan could provide much-needed clarity and move the needle in terms of treatment choice.
What is a coronary artery calcium score?
The test is based on CT scan images of the heart that visualize the presence and amount of calcium buildup inside the heart’s major blood vessels. Because it is dense like bone calcium, coronary calcium shows up on CT scans as bright white spots. Large calcium deposits signal hardening and narrowing of the arteries and portend elevated cardiovascular risk. In large studies, CAC scores have been shown to predict future risk of heart attacks better than age and other traditional risk factors such as cholesterol and blood pressure. The test is quick and painless, but there is a small amount of radiation exposure — about the same as a mammogram — and the test may occasionally pick up other incidental findings, such as nodules in the lung that require additional work-up.
Studies show that people with a CAC score of zero have a very low risk of heart attack over the next five to 10 years. These patients might not need any drug treatment now and can focus on maintaining a healthy lifestyle. But patients with scores greater than 100 may be at higher risk and may benefit from targeted prevention with medication.
Should I have a coronary artery calcium scan?
A coronary artery calcium scan isn’t for everyone, but among people with uncertain or borderline cardiac risk, the test can provide valuable information and guide treatment choice.
Patients at very low or very high risk for heart attack and stroke as determined by traditional risk calculation don’t need a CAC scan, as results are unlikely to change one’s recommended treatment plan.
The following groups of people might benefit from a CAC scan:
1. Patients with normal cholesterol but with elevated 10-year risk score of 5 percent or more due to other factors such as age, race or high blood pressure.
2. Patients who have a 10-year risk score of 15 percent or more and who normally would be treated with statins but who have serious side effects or are reluctant to take the medication; a CAC score may help guide the need for alternative cholesterol-lowering therapy.
3. Patients who are low risk as determined by the latest risk calculator but have other compelling factors to start treatment, such as:
— LDL, or bad cholesterol, of 160 milligrams per deciliter or higher or other evidence of genetic lipid disorders, and not already on statins.
— Those who have a family history of premature cardiovascular disease, defined as a first-degree relative with heart attack or stroke before age 65.
— Unique risk factors including rheumatologic or inflammatory chronic diseases.
— Patients with no known heart disease who are deemed to have low risk for heart disease but who have symptoms like chest pain that is not triggered by physical exertion
My CAC Score is elevated. Now what?
An elevated CAC score spells an increased risk for a heart attack and should lead to a conversation with your physician about treatment with aspirin or a statin. People who have high CAC scores but no symptoms require no further cardiac testing. Elevated CAC scores become more common as people age and not everyone with an elevated CAC score eventually gets a heart attack. Furthermore, getting a repeat CT scan to follow CAC scores is not recommended, as treatment lowers your risk for heart disease but does not make the calcium go away nor does it lower the score.
Concluding thoughts:
To prevent the onset and development of disease-fueling atherosclerosis, we recommend that patients eat less, eat smarter, move more daily and quit smoking. Patients should “know their numbers” for blood cholesterol, blood sugar and blood pressure and discuss their family history with their doctors. However, when risk remains uncertain, a CAC scan can be a reliable new tool to help define one’s risk. Using all the available data, patients and physicians can engage in risk discussion and, working together, choose the best course of action to prevent heart attacks and strokes.
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Assessing the Risk for Heart Attacks and Strokes: How a Coronary Artery Calcium Score May Help, and Who Needs the Test originally appeared on usnews.com
