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Written by: Dr. Steve Windley, MD
TEST TAKING Evaluating your risk for heart disease. Heart disease continues its reign as our nation’s number one killer, hurting quality of life and creating a huge financial burden. Like so many other chronic illnesses, prevention should always be the goal. The calcium heart score, or heart scan, is now being offered as an option to help assess a person’s risk. This test, a type of x-ray, may allow doctors and patients a noninvasive view of heart disease issues. Prevention should be a top priority in health care. Often, diagnosis and treatment of many diseases, including heart disease, comes after the illness is much more difficult to treat. Prevention of heart disease becomes even more of a priority since one of the most frequent symptoms of a heart attack is sudden death. Cholesterol treatment is now a prominent part of the heart disease treatment program, but it is certainly not the only part. There are people who suffer a heart attack with normal cholesterol levels. Many people are worried about talking to their doctor about their risk since this can lead to big tests like a stress test or a heart catheterization. There is a great need for a noninvasive assessment of heart disease risk. Many centers are using CT scans to compute a score for the amount of calcium measured in the arteries. This is commonly called a calcium heart score or heart scan. These tests are suggested to be a relatively simple way to obtain another heart disease risk factor to help outline how aggressive a treatment plan needs to be. At this point, several studies have been done to confirm that heart scans do provide useful information to the doctor and patient [1,2,3]. The heart score can be used as a helpful guide to help predict heart disease . The heart score is essentially a CT scan of the heart and its blood vessels. The calcium that has been deposited into the arteries is measured and a score is determined based on the amount of calcium present. Heart disease is the only known cause of calcium deposits in the arteries . A comparison percentile for males and females is made using age to help determine the risk of heart disease. A game plan for the heart can then be determined based on the score. Scores of zero are extremely low risk for heart disease. Scores of 10-100 and less than 75 percent for age are considered intermediate risk, meaning a 10-20 percent chance of heart disease is present per decade. Scores of 100 and greater than the 75 percentile for age show a high risk for heart disease over the next ten years. The heart score can then be added to other data to assess risk for each person. The heart score is one piece of data that should be part of a more complete plan. This plan should include labs like C-reactive protein , homocysteine , testosterone (for men), cholester ol , family history and diabetes risk. The plan should also target optimal nutrition to decrease inflammation and supplements to help maintain the health of the arteries.
Vitamin K , vitamin D and essential fatty acids are important for heart health. Vitamin K in particular is essential for helping the calcium go to the bones where it is needed and not the arteries where it is associated with heart disease. Patients with many risk factors, such as a high heart score and diabetes, should discuss with their health care team all the options available to help prevent further heart disease. The one drawback to CT heart scores is the radiation exposure. The test itself is fairly quick. Relative to other types of heart tests, this scan can be done for a very reasonable price. A simple chest x-ray is similar in radiation exposure to smoking one cigarette. A CT scan will have noticeably more radiation . There may soon be other types of heart tests like heart rate variability, which can gauge stress on the heart noninvasively without radiation. Currently, there is no readily available or commonly used diagnostic test beyond the heart scan. The heart score offers an option for those wishing to better understand their risks for heart disease. A doctor cannot assess your risk through just a stethoscope or even an EKG. To truly know if you are at a high risk for heart disease there has to be some kind of in-depth study. The heart score does have the risk of radiation from the CT, but it is otherwise noninvasive and much cheaper than many standard medical tests. It can help provide more constructive guidance for the patient and physician by knowing how aggressive the heart disease prevention program should be. References: 1. Rumberger, JA. (2009). Practical tips and tricks in cardiovascular computed tomography: non-contrast “heartscans” – beyond the calcium heart score. J Cardiovasc Comput Tomogr, 3(1):52-6. 2. Hopkins, PN. (2006). Association of coronary artery calcified plaque with clinical coronary heart disease in the National Heart, Lung, and Blood Institute's Family Heart Study. Am J Cardiol, 97(11):1564-9. 3. Shaw, LJ. (2003). Cost effectiveness of screening for cardiovascular disease with measures of coronary calcium. Prog Cardiovasc Dis, 46(2):171-84. 4. Rumberger, JA. (2003). Clinical use of coronary calcium scanning with computed tomography. Cardiol Clin, 21(4):535-47. 5. Jerijan, K., Brant-Zawadzki, MN. (2001). Radiation dose in coronary calcium: comparison of multi-slice and electron beam CT scanners. Radiology, 221:365. Other Trusted Source: Mayo Clinic
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