The pandemic is fading and it’s now time to take charge of our health again.
The number of deaths from heart disease, caused by traditional risk factors, far exceeds the cardiac deaths caused by Covid-19. Heart disease caused by blockage in the coronary arteries still remains the leading cause of death in this country.
The coronary arteries supply the heart muscle itself. They are subjected to inflammation throughout our lives that eventually leads to plaque formation in the lining of the arteries. This is called atherosclerosis or “hardening of the arteries”.
Gradual buildup of plaque leads to a restriction of blood flow that can starve the heart muscle for blood, leading to symptoms of shortness of breath or chest discomfort. We call these symptoms “angina”.
Sudden closure of the artery leads to total shut off of blood to a segment of the heart. This leads to damage of the heart muscle which we call a heart attack.
Most heart attacks are caused by plaque rupture, similar to a pimple bursting in the coronary artery channel. Often there are no prior symptoms since the artery channel is wide open until plaque ruptures. Almost half of all heart attacks lead to sudden death.
Imagine if we had an easy method to detect who has hardening of the coronary arteries!
Most of us believe that early detection of cancers save lives. We believe in mammograms to detect early breast cancer, colonoscopy to screen for colon cancer, and PSA for prostate cancer screening. We do have a method for early detection of coronary heart disease—think of it as “the mammogram for the heart”—that can save lives and is inexpensive, yet it is still not fully understood or prescribed by many physicians. It is called coronary calcium screening.
The method uses high-speed, low radiation CT scans such as Electron Beam CT scans. EBCT heart scans are the gold standard, but other CT scans are also beneficial to detect calcium in the coronary arteries.
Coronary calcium is the same as plaque or atherosclerosis. The more coronary calcium, the more likely a heart attack will occur unless there is an intervention with cholesterol-lowering meds (usually statins) and/or lifestyle changes.
The cholesterol meds stabilize the plaque, reducing the chance of plaque rupture and a subsequent heart attack, even before the cholesterol is reduced, by reducing inflammation in the lining of the coronary arteries. The scan takes five minutes, no special preparation is needed.
The scanner software will add up all the bits of calcium in the coronaries and give a coronary calcium score (CACS). Know your score! The lower the score, the better.
The benefits of coronary calcium screening are profound because it changes what might otherwise be done. For instance, half of all heart attacks occur in persons with normal cholesterol! If you can identify these patients by finding a large amount of coronary calcium, starting a cholesterol medication in this situation can significantly reduce the risk of a heart attack.
At the other end of the spectrum, if you have high cholesterol levels, you may avoid being on cholesterol medication if you get a coronary calcium scan and have zero or very little calcium. Again, it changes what might traditionally be done: give cholesterol meds to someone with normal cholesterol and lots of coronary calcium; avoid giving meds to those with high cholesterol who do not need it.
Who should get the scan?
- Men > 35 years old or women > 40 years old
- At least one traditional risk factor: family history of heart disease, high blood pressure, diabetes, obesity, smoking history, high cholesterol or low HDL (HDL is the good, protective cholesterol), sedentary lifestyle.
- If you had a prior heart attack, a coronary stent or prior coronary bypass surgery, this is not the test for you because we know you have hardening of the coronary arteries.
- No symptoms: if you have chest pain or shortness of breath, you need a stress test.
The test cost: $150 -$200, not covered by most insurance companies.
The two centers with some of the longest experience:
- The Dick Butkus Center for Cardiovascular Wellness at Saint Joseph Hospital in Orange, California, 714-744-8849; this is an EBCT scanner
- UCLA: 310-825-2631
Larry Santora, MD, FACC
Interventional and Preventive Cardiology
Medical Director of Orange County Heart Institute
Orange, CA
Medical Director of The Dick Butkus Center for Cardiovascular Wellness
Saint Joseph Hospital
Orange, CA
