Coronary calcium scoring: Personalized preventive care for those most at
risk

Date:
July 6, 2020
Source:
University of Miami Miller School of Medicine
Summary:
An imaging test called coronary calcium scoring can help
doctors to make the right recommendation about the use of statin
therapy. The test is a 10-minute CT (computed tomography) scan
looking for calcium deposits in the arteries supplying blood to the
heart. Calcium deposits indicate the presence of coronary plaque,
also known as atherosclerosis.



FULL STORY ==========================================================================
Your doctor tells you that you need a statin to lower your cholesterol
and reduce your heart attack risk. You don't like taking medicine and your friend tells you that he had achy muscles after he started a statin. You
wonder if you should listen to your doctor or go without the medicine. An article just published in Mayo Clinic Proceedings by Dr. Carl E Orringer
of the University of Miami Miller School of Medicine and Dr. Kevin C Maki
of Indiana University's School of Public Health may help your doctor to
make the right decision.


==========================================================================
The American Heart Association, American College of Cardiology and
10 other medical organizations published a Guideline in late 2018 to
help doctors determine which patients are most likely to benefit from cholesterol-lowering drug treatment. Statins, the most widely prescribed cholesterol-lowering medicines, have well-established benefits for
lowering heart attack and stroke risk.

For those who don't have a previous history of cardiovascular disease
or other high-risk conditions, the Guideline recommends that doctors
use a risk calculator to help to decide which patients have high enough cardiovascular risk to benefit from a statin. A statin is recommended for
those at high risk, and not recommended for those at low risk. However,
most have risk somewhere in between, where the decision about the need
for statin treatment is uncertain.

An imaging test called coronary calcium scoring can help doctors to make
the right recommendation about the use of statin therapy. The test is
a 10-minute CT (computed tomography) scan looking for calcium deposits
in the arteries supplying blood to the heart. Calcium deposits indicate
the presence of coronary plaque, also known as atherosclerosis.

The test requires no injections, produces less radiation exposure than
a routine mammogram, and is widely available, usually costing $99 or
less. This test has been available for about 20 years, but its use to
guide treatment decisions for heart attack and stroke prevention has only recently been supported by enough evidence to recommend widespread use.

Up to half (generally 40-50%) of people with a calculated heart attack
and stroke risk in the middle group between the low and high categories
have a calcium score of zero. These people have such low heart attack and stroke risk over the next 10 years that taking a statin provides, at most, minimal protection. On the other hand, those with evidence of significant calcium build-up are very likely to benefit from taking a statin.

Taking a statin is not a small decision, since doing so means that buying
the medicine, taking it daily, and undergoing follow-up blood tests
and medical appointments to be sure that the treatment is working. In
addition, a small percentage of patients have side effects that may
require additional testing and medical appointments. That is why
Drs. Orringer and Maki make the point in this article that coronary
calcium scoring in this "middle risk" group is so important. They
recommend that patients in this group get the test, whenever possible,
so that therapy can be more effectively targeted to those most likely
to benefit.

Cardiovascular diseases such as heart attack and stroke are the
leading causes of death for both men and women in the United States. An important point made in the article is that coronary calcium scoring
may be particularly useful in women 50 years of age and older. There
is more than a 50% chance that a woman in her 50s will eventually
develop cardiovascular disease. The risk of developing breast cancer
over a lifetime (about 12-13%) is much lower than for cardiovascular
disease. Women who are 55 years of age or older and at average breast
cancer risk are advised to have a screening mammogram annually, or every
other year.

For those with calculated cardiovascular risk in the middle range (not
high or low), it is reasonable to substitute a single coronary calcium
test for one annual mammogram. Women with a coronary calcium score of
zero will gain peace of mind about their heart attack and stroke risk,
while those with significant coronary calcium can take a statin to lower
their cardiovascular risk.


========================================================================== Story Source: Materials provided by University_of_Miami_Miller_School_of_Medicine. Note: Content may be
edited for style and length.


========================================================================== Journal Reference:
1. Carl E. Orringer, Kevin C. Maki. HOPE for Rational Statin
Allocation for
Primary Prevention: A Coronary Artery Calcium Picture
Is Worth 1000 Words. Mayo Clinic Proceedings, 2020; DOI:
10.1016/j.mayocp.2020.01.016 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/07/200706100816.htm

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