Should You Get a Heart Scan? Simple Test Provides Important Health Information

Your cholesterol is elevated, and you’re worried about your heart health. Although your doctor advises against statins, suggesting that lifestyle changes can reduce your heart attack risk, your brother-in-law, who is a year younger than you and has similar cholesterol numbers, is on medication. What gives?

Advances in the field have made personalized cardiovascular care possible, say the experts at Baptist Health Heart & Vascular Care. And for many people, a simple, low-cost and pain-free diagnostic test ― a coronary artery calcium (CAC) scan ― can provide valuable information to better help determine risk and the best treatment for cardiovascular disease.

Why Get This Test?

Heart disease remains the number-one killer of both men and women in the U.S. today. With early detection crucial, the American Heart Association and other organizations endorsed coronary artery calcium scans in 2019 for particular patients ages 40 and up.

(Watch and hear from experts at Baptist Health Miami Cardiac & Vascular Institute about the coronary artery calcium (CAC) scan.) 

“The best way to determine someone’s true risk is using calcium scoring,” says Ricardo Cury, M.D., medical director of cardiac imaging at Baptist Health Miami Cardiac & Vascular Institute and Baptist Hospital. “It is a test that allows us to detect cardiovascular disease early and with precision.”

The scan looks for plaque buildup in the arteries that supply blood to the heart by creating pictures of the inside of the vessels with computed tomography (CT). As plaque calcifies, it can narrow the arteries and decrease blood flow or break off and lead to a blood clot. Either can cause a heart attack. The test is non-invasive, takes about 15 minutes and involves no anesthesia or down time.

Ricardo Cury, M.D., medical director of cardiac imaging at Baptist Health Miami Cardiac & Vascular Institute and Baptist Hospital.

 

What Do the Results Mean?

Test results, presented as a score, provide a more accurate picture of a patient’s risk. Generally, the higher the score, the greater the risk of a heart attack.

“Many people have been on statins for decades, because without additional information, we believed that was the best treatment,” says Adedapo Iluyomade, M.D., a preventive cardiologist at Miami Cardiac & Vascular Institute.

“But studies now show that with a CAC score of zero, a patient is at extremely low risk of a heart attack or other cardiovascular problem and can usually come off medication even if their cholesterol is elevated,” he added. “They usually express a sense of relief when they find out their risk is low. And the inverse is also true. We have patients who are treated with statins and get their cholesterol to normal levels and think they aren’t at risk, only to find out they have a high CAC score and need aggressive therapy.”

While the test isn’t new, what has been missing, the doctors say, is guidance on what to do with the results. To eliminate doubt, doctors at the Institute have developed succinct guidelines to help primary care and family medicine doctors, as well as cardiologists, decide what treatment is best based on how much calcified plaque is present in a patient’s heart arteries and the evaluation of other risk factors. Called pathways, these recommendations correlate to the patient’s CAC score, with higher scores requiring more-aggressive treatment.

Interpreting a Calcium Score

For example, a patient with a score of zero has no visible calcium in the heart, which suggests a very low chance of having a heart attack. Typically, these patients are placed on statins only if their LDL is above 190 and they are smokers or have major risk factors such as type 2 diabetes, a strong family history or two or more other risk enhancers, such as obesity, high blood pressure, chronic kidney disease, chronic inflammatory conditions including psoriasis, rheumatoid arthritis and lupus, or other health problems. LDL, or low-density lipoprotein, is often called “bad cholesterol” because in excess it leads to plaque buildup.

The doctors stress that everyone should lower their risk of cardiovascular disease by maintaining a healthy weight, exercising regularly, eating a heart-healthy diet and not smoking. But patients who have calcium deposits in their arteries may need much more. Recommendations are based on how much calcium is present and the severity of any other risk factors and include:

• Score of 1-99 – Target LDL is less than 100, and statins are considered if the patient has one or more other risk factors.
• Score of 100-399 – Target LDL is less than 70, and a moderate-intensity statin is recommended. Aspirin therapy may also be added.
• Score of 400-999 – Target LDL is less than 70, and a high-intensity statin plus aspirin therapy, along with non-statin medications, may be prescribed. Referral to a preventive cardiologist is recommended.
• Score of 1,000 or above – Target LDL is less than 55, and a high-intensity statin plus aspirin therapy, along with non-statin medications, may be prescribed. Referral to a preventive cardiologist is recommended.

Next Steps

Patients who are referred to a preventive cardiologist may be advised to undergo other diagnostic tests, which may include those that look for non-calcified deposits, known to be a precursor to the hardened calcium that can block vessels.

Another test frequently performed at Miami Cardiac & Vascular Institute is a high-sensitivity C-reactive protein (hs-CRP). “This is a test that is not normally done during an annual physical,” says Dr. Iluyomade. “It shows us how much inflammation is in the body.” The FDA recently approved the first medication to target inflammation to reduce cardiovascular events ― colchicine.

The Institute is involved in numerous clinical trials and research studies that range from the use of artificial intelligence to help physicians better quantify soft plaque in the arteries, which is difficult for the human eye to detect, to lowering CRP to reduce heart failure.

“We have moved beyond just having statins to offer our patients,” Dr. Cury says. “For patients at higher risk, we have medications that can slow down progression and even cause regression. And, with tests like the CAC scan, we can detect disease much earlier, when it is still minimal. Those are the patients we can really make an impact on.”

February is American Heart Month. Baptist Health has locations from Monroe County through Palm Beach County where you can undergo a CAC test. If you’d like to schedule an appointment, click here or call 833-596-2473. A prescription and an appointment are required.