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Calcium in Heart Scan Predicts Disease

EBT Scan Most Useful in People at Intermediate Risk of Heart Attack
By
WebMD Health News

May 12, 2003 -- Roughly half of all heart attacks and other coronary deaths occur in people without symptoms of heart disease. A new and somewhat controversial screening method that measures calcium deposits in the walls of the arteries that cover the heart offers the promise of predicting these events in this group of hard-to-identify patients.

In the largest study ever published assessing electron beam coronary artery calcium scanning as a screening tool for heart disease, researchers concluded that the diagnostic method was remarkably useful for identifying future trouble in people at moderate risk. Compared with men with the lowest levels of the calcium deposits in the coronary arteries, men with the highest levels of calcium scores were twice as likely to have heart attacks and 10 times as likely to need bypass surgery or angioplasty.

"Electron beam tomography (EBT) provided incremental information above the traditional risk factor assessment for this intermediate risk group," lead researcher George T. Kondos, MD, tells WebMD. "This appears to be much better than the traditional treadmill test for identifying people with asymptomatic disease."

In this study, Kondos and colleagues at the University of Illinois College of Medicine used EBT to evaluate the risk for coronary events among 5,635 men and women with no symptoms of heart disease. Participants were asked to hold their breath on two occasions for 30 seconds to one minute while lying on a special couch that slid into a hollow computed tomography (CT) scanner. During this time, electron beams create multiple images of the heart, and a computer measures the density of calcium deposits in the artery walls.

Within three-and-a-half years of having the test, 224 of the volunteers developed evidence of heart disease. They either required bypass surgery or angioplasty to open clogged arteries, had heart attacks, or died of coronary-related causes. EBT scanning detected high amounts of calcium deposits in 95% of these participants, but low amounts of calcium were detected in 67% of the participants who did not experience coronary events.

Compared with people with the lowest calcium levels, women with the highest levels were almost four times as likely to need heart bypass surgery or angioplasty during the follow-up, and men were 10 times as likely to require the procedures.

Kondos tells WebMD that EBT probably has little value in predicting future heart disease in people at very low or high risk for heart disease. Those at intermediate risk -- including men over 45 and women over 50 with at least one added risk factor, such as diabetes, high blood pressure, high cholesterol, family history, or vascular disease -- would benefit from this screening.

"This study reinforces (the idea) that the test is best reserved for individuals at intermediate risk in the population," American Heart Disease President Robert Bonow, MD, says in a news release.

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