In the battle against atherosclerosis, the stakes remain high. Scientists
have made exciting medical advances, but the disease persists as a leading
cause of illness and death in the United States. This year alone,
atherosclerosis will contribute to about 1.2 million heart attacks among
“While we have very good therapies and tests to identify the disease and
predict the risk, none of them is perfect,” says Stephen Nicholls, MBBS
(bachelor of medicine/surgery), PhD, clinical director...
"Why are cholesterol, smoking, family history so lousy? Because they're
just risk factors," says Naghavi, chairman of the Society for Heart Attack
Prevention and Eradication (SHAPE) and director of American Heart Technologies
"They don't speak to whether the arteries are diseased. So we need to
directly visualize the artery. Is there plaque and is the artery dilating
properly? You can have a diseased artery regardless of how may risk factors you
That disconnect has led more doctors to recommend that patients undergo
high-tech heart tests that offer detailed images of the blood vessels as a
means of lowering heart disease risks. The three tests -- calcium coronary
scores, carotid artery ultrasound, and CT heart scans (CT angiography) --
"are all good at determining early atherosclerosis, or hardening of the
arteries," says American Heart Association (AHA) past president Robert
Bonow, MD, head of cardiology at Northwestern University's Feinberg School of
Medicine in Chicago. "They can help to identify people early on that need
aggressive risk factor modification."
But as with anything, these tests have their merits and drawbacks. So how
can you tell if these tests are for you? To find out, WebMD spoke with three
leading heart health experts: Naghavi, Bonow, and Todd C. Villines, MD,
co-director of cardiac CT at Walter Reed Army Medical Center in Washington,
1. Coronary Calcium Scores
What Are Coronary Calcium Scores?
Calcium is one component of plaque that can build up inside the coronary
arteries that supply oxygen-rich blood to heart muscle. Measuring it can help
determine the level of plaque buildup that leads to narrowing of the heart
arteries, the hallmark of coronary artery disease.
During the test, you lie in a hollow CT scanner. X-ray beams create multiple
images of the heart; a computer measures the amount and density of calcium
deposits in the artery walls and provides a calcium score. The score can range
from 0 to more than 400, and any score over 100 is associated with an increased
risk of heart disease.
"Studies have consistently shown that the higher your calcium score, the
higher your risk of heart attack or other coronary artery disease event,"
Villines says. One of the most recent studies, published last year in the
New England Journal of Medicine, showed that the coronary calcium score
predicted heart events -- heart attack, death from coronary heart disease, or
chest pain (angina) -- among men and women of all races. In that study, people
with a coronary calcium score of 101-300 were more than seven times as likely
to experience a heart event than someone with no evidence of coronary calcium;
people with higher scores were at even greater risk.