Computed tomography (CT) coronary artery calcium (CAC) scoring has been around for about 30 years, and was added as a recommendation to the 2018 American Heart Association (AHA) guidelines for cholesterol. Some hospitals are offering CAC scans at a very low cost for cardiovascular screening. But the real value of CAC scans for patients is that cardiologists are increasingly using them to determine if they need to take aspirin with statins, or even take stains at all if they have side effects.
Health Imaging spoke with cardiac imaging expert Renee Bullock-Palmer, MD, FSCCT, director, Women’s Heart Center, and director, non-invasive cardiac imaging, at the Deborah Heart and Lung Center in Browns Mills, New Jersey. She presented on several clinical trials that support the use cardiac CT and CAC at the 2023 Society of Cardiovascular Computed Tomography (SCCT) meeting.
"With calcium scoring to more precisely identify the patient who is at risk and customize the treatment plan, and I have used calcium scoring for quite a long time in my practice and I use it in two ways. One for patients who might be reluctant to be on medications who are at risk. When they do the calcium score and they do have calcium, you can then tell them 'you really need to take stains because you have heart disease,'" Bullock-Palmer explained. "So I think the trials give us more evidence in terms of being able to customize the treatment plan for your patient.
She added that, while there are a plethora of scoring systems out there, many of them are flawed, either overestimating or underestimating the risk to these patients. Many patients are being placed on the medication, sometimes inappropriately, when their calcium score is zero. She said patients experience side effects as a result, and ask if they really need to keep taking them. Bullock-Palmer said the answer can be found in the CAC score. If a patient has a score off zero, it means they are at very low 10-year risk of coronary disease or a heart attack.
"I've had patients who are on these medications for years have a multitude of side effects and they just either refuse to take the medications or are not taking it consistently. I do the calcium score, it's zero, or I said, okay, well we can take you off the medication. But one of the main things I always emphasize with the patients is that this doesn't mean that you're going to go and get your next hamburger, but you really want to stick to a very healthy lifestyle to prevent the development of calcification," Bullock-Palmer explained.
Calcium forms in arteries as part of the disease process of atherosclerosis. It is caused by the healing process in vessels damaged by the plaques and inflammation. These rock-like deposits are clearly visible on low-does CT scans of the heart. The calcium can be analyzed manually by looking at each coronary artery and tallying the amount of the mineral present. But, in most cases the CAC score analysis is all automated by artificial intelligence algorithms.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com