Coronary Calcium Scoring

Facts about heart disease: (Source: American Heart Association)

• 58 million Americans have one or more forms of cardiovascular disease.
• Coronary heart disease is the number one killer of men and women in the United States.
• More Americans die of heart disease, than all types of cancer combined.
• At least 250,000 people a year die of a heart attack within one hour of the onset of symptoms and before they reach a hospital.
• 12 million people alive today have a history of heart attack, chest pain or both.

What are the risk factors for heart disease?

The risk factors for heart disease include the following:
• Age (men 45 or older, women 55 or older)
• Family history of heart disease
• High cholesterol
• History of smoking
• High blood pressure
• High stress levels,
• Sedentary lifestyle
• Diabetes

What causes heart disease?

The primary cause of heart disease is the build-up of plaque (atherosclerosis) in the arteries of the heart. This build-up can cause the arteries to narrow. Plaque can also break away from the artery walls and cause a blockage. In both instances the heart muscle does not receive enough blood flow and oxygen-thus a heart attack can occur.s

What is cardiac scoring?

Cardiac scoring is a revolutionary, pain-free, non-invasive and inexpensive procedure requiring less than 10 minutes. Using CT imaging with sub-second scanning capability, the equipment takes 70-90 images of your coronary arteries without any injections, needles or removal of your clothing. The amount of calcium or plaque detected in your coronary arteries is used to establish your cardiac score.

CT scan reveals moderate calcification (plaque build-up) in the left coronary artery.

What does the procedure involve?

First, you complete a brief risk factor questionnaire. Next, you lie down on the imaging table while a CT technologist places a few EKG leads on you. You are then asked to hold your breath while the images are taken. That's it. You can return to your regular routine.

A board certified radiologist, using high tech software, calculates your cardiac score based on the images taken.

Reconstructed 3-dimensional image of the heart obtained from CT scanning

Is cardiac scoring safe?

The radiation exposure during cardiac scoring is very minimal (comparable to the radiation received during a chest x-ray). No intravenous injections or needles are required.

Not only is it safe, but it is also simple. In most cases (unless there are certain types of buttons or bra metal involved), patients may keep their shirt or blouse on during the procedure.

What can my cardiac score tell me and my doctor?

Subtle early warning signs of heart disease can be detected. Cardiac scoring is the latest diagnostic tool to detect plaque in the coronary arteries. With this information, your doctor can recommend the appropriate treatment, including diet and lifestyle changes, medication and/or further testing.

Is coronary artery disease treatable?

Yes, the plaque build-up process can be slowed, stabilized and reversed, in some cases, through aggressive lifestyle modification and/or through medication therapies under the guidance of your physician.

What are the general recommendations for interpretation of calcium scores?

0	No identifiable atherosclerotic plaque. Very low cardiovascular disease (CVD) risk	Healthy Diet (low in saturated fat and cholesterol) Stop Smoking Maintain Recommended Weight
1-10	Minimal plaque burden Low CVD risk	All recommendations above PLUS Tight control of Diabetes and Hypertension Consider use of Statins in cases of High Cholesterol
11-100	Mild plaque burden Moderate CVD risk	All recommendations above PLUS Estrogen for Post-Menopausal Women Aspirin Use Use of Statins in cases of High Cholesterol
101-400	Moderate plaque burden High CVD risk	All recommendations above PLUS Exercise program Use of Statins in cases of high and borderline cholesterol levels Consider use of Folic Acid, Vitam E, Fish Oils
> 400	Extensive plaque burden Very high CVD risk	All recommendations above PLUS Exercise Test to rule out obstructive disease Consider angiogram for symptomatic patients or those in high risk occupations

Learn more about National Cholesterol Education Program (NCEP)

How does my score compare with others in my age group?

Coronary Artery Calcium Scores
(percentile rankings in over 19,000 patients)

%	AGE
	40-45	46-50	51-55	56-60	61-65	66-70	70+
MEN
10%	0	0	0	1	1	3	3
25%	0.5	1	2	5	12	30	65
50%	2	3	15	54	117	166	350
75%	11	36	110	229	386	538	844
90%	69	151	346	588	933	1151	1650
WOMEN
10%	0	0	0	0	0	0	0
25%	0.1	0.1	0.1	0.2	0.5	1	4
50%	0.1	0.1	1	1	3	25	51
75%	1	2	6	22	68	148	231
90%	3	21	61	127	208	327	698

Conventional Methods for Detecting Coronary Artery Disease

Test	Advantages	Disadvantages
Stress Test	Ideal for patients who are symptomatic Used to determine extent of ishemia	Does not produce an image of coronary arteries Significant blockage must be present to detect ischemia (i.e. does not detect preclinical disease)
Angiography	"Gold standard" Shows narrowing of lumen Shows number of diseased vessels	Generally used only with demonstrable ischemia Invasive Expensive No information regarding type of plaque (soft or hard)
Intravascular Ultrasound	Direct visualization of vessel wall and lumen size; useful for angioplasty and stent placement Can detect calcification	Generally used only with demonstrable ischemia Invasive Expensive
Helical/EBCT Cardiac Score	Noninvasive Detects and quantifies coronary calcification May be used in asymptomatic patients May be used to estimate total atherosclerotic plaque burden and risk of future events	Does not identify stenotic lesions Conflicting evidence regarding correlation of CAC score to risk of events No universally defined treatment plans for those with positive test results