If you’re on the fence about whether to take a statin, this test might make sense.
Cardiologists constantly seek better ways to predict who will have a heart attack. Among the many potentially helpful options is a coronary artery calcium scan. This test uses a special x-ray machine called a computed tomography (CT) scanner that takes multiple pictures of the heart in thin sections. Combined, the scans produce a view that can reveal specks of calcium in the walls of the heart’s arteries. These specks, called calcifications, are an early sign of cardiovascular disease.
But this test doesn’t make sense for everyone. A person who is under age 40 or has a very low risk of heart disease shouldn’t have one; nor should a person who already has heart disease. In both of those cases, the test results are unlikely to change their treatment. “But for a person without heart disease whose risk falls somewhere in the middle and who is trying to decide whether to take a statin, the results from a coronary artery calcium scan can be helpful,” says Dr. Ron Blankstein, a cardiovascular imaging specialist and preventive cardiologist at Harvard-affiliated Brigham and Women’s Hospital.
The middle ground
In 2013, an expert panel recommended statins for people who have cardiovascular disease are ages 40 to 75 and have diabetes have an LDL cholesterol level of 190 mg/dL or higher have at least a 7.5% estimated risk of heart attack or stroke within the next decade (a figure your health care provider can calculate and discuss with you).
In all cases, providers should discuss the pros and cons of statin therapy and consider the patient’s preferences, says Dr. Ron Blankstein. For those people who don’t fall into the above groups, a coronary artery calcium scan could offer helpful information.
Help with the statin decision
Consider a 58-year-old man whose 10-year risk of heart attack is around 7% and who is on the fence about whether to take a statin. If his calcium score is greater than zero, and especially if it is greater than 100, treatment with a statin (and often aspirin) would likely be important, says Dr. Blankstein. And some research suggests that receiving a high score helps motivate people to work harder on their heart disease prevention efforts, like adopting healthy eating and exercise habits.
On the flip side, the absence of coronary calcifications (a calcium score of zero) suggests a very low risk of heart attack. In that case, a statin is less likely to offer significant benefit. Focusing on lifestyle changes and controlling high blood pressure or other risk factors might be enough.
Costs and risks
Insurance coverage for coronary artery calcium scans varies widely, but the out-of-pocket cost typically ranges between $100 and $200. The scan itself takes less than 10 seconds and doesn’t require an intravenous injection. It does involve a small amount of radiation exposure, similar to the amount from a mammogram or the amount of background radiation a person normally receives from the environment over four months. But unlike a mammogram, which is often done on a yearly basis, a coronary artery calcium scan should be done no more than once every 10 years, says Dr. Blankstein.
Still, some cardiologists are less enthusiastic about the usefulness of the test. One reason is that there’s never been a major study comparing the outcomes of people who were or were not screened with coronary artery calcium scans and then treated accordingly. However, that’s also true for the new statin guidelines, which have never been shown in a randomized trial to improve heart health or survival, says Dr. Blankstein. Medicine always entails some level of uncertainty, he notes. If you’re in a mid-range risk group, a conversation with a trusted physician can help you decide if this scan could help clarify some of the uncertainty about your own heart disease risk.
(Harvard Health Publications)