The New Heart Tests: Which Ones Should You Have?
Experts explain the pros and cons of coronary calcium scores, carotid artery ultrasound, and CT heart scans.
1. Coronary Calcium Scores continued...
Who Should Get Coronary Calcium Scores?
People at intermediate risk of heart disease based on traditional risk
factors. This includes men over 50 with at least one added risk factor and
women over 60 with at least two added risk factors, such as high blood pressure
or high cholesterol, according to Villines. In these individuals, the need to
commence medications to control these risk factors may not be clear.
For people at intermediate risk, a high calcium score would likely lead to
more aggressive lifestyle changes, such as aspirin therapy, and even high-dose
statin drugs to control cholesterol, Bonow says.
On the other hand, if you're at high risk to begin with (because you have
diabetes or because you have heart or vascular disease), you should already be
on aggressive therapy, so measuring the calcium score wouldn't change anything,
Bonow explains. And people at low risk are unlikely to have calcium buildup;
even if they do, their overall risk of a cardiac event is usually still low, he
One exception may be low-risk women, Villines says. "Data from the
Multi-Ethnic Study of Atherosclerosis trial showed that women at low risk and a
high calcium score faced the same risk of heart attack or dying of heart
disease as people at high risk. So even though it's not integrated into the
guidelines, I would consider this test in women aged 45 to 65 with at least one
risk factor -- or even with no risk factors when there is a strong family
history. It might change management."
Naghavi believes that all men ages 45 to 75 and women ages 55 to 75 should
undergo screening with either the coronary calcium scan or carotid artery
ultrasound -- regardless of whether they have other risk factors. People may
have low cholesterol levels or other low risk factors and still have heart
problems, he says. "We need to go beyond traditional risk factors."
Bonow, Villines, and many other doctors disagree, saying that further study
is needed to show that widespread screening will truly help. "Testing
everyone would lead to a lot of costs and detection of minor abnormalities that
mean nothing but can cause needless anxiety and further testing," Bonow
Advantages of Coronary Calcium Scores
Villines notes that the only study directly comparing coronary calcium
scores to carotid artery ultrasound showed that calcium scores are better at
predicting risk of future heart problems. Adds Bonow, "Of the two tests,
coronary calcium is probably the better studied. Calcium in the blood vessels
is clearly a marker of atherosclerosis, and it can be quantified."
"The test is painless and quick," he adds.
Disadvantages of Coronary Calcium Scores
Because calcium deposition is not the first thing that happens during plaque
buildup, "a negative test doesn't mean you don't have [any]
atherosclerosis," so a low or absent calcium score may make you feel safe
even if you're at risk, Bonow says.