Coronary Calcium Score Test for Heart Risk

Podcast Transcript

Announcer:
Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic, and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Milind Desai, MD, MBA:
Hello everybody, and thank you for joining. My name is Dr. Milind Desai, and I'm a cardiologist at the Cleveland Clinic in Cleveland, Ohio. I'm also the Director of Clinical Operations for the department. Today, I am excited to announce that we have launched a very important initiative throughout our various sites in Northeast Ohio, where we are offering coronary artery calcium scans. As all of you know, coronary disease is the leading cause of death and morbidity amongst our population, due to a combination of factors that include aging, the increasing risk factors like diabetes, hypertension, hypercholesterolemia, family history, stress, obesity, et cetera.

Milind Desai, MD, MBA:
Despite our significant improvements, technological, and improvements in drug therapies, coronary artery disease still occurs at a very high rate. And so the buzz is clearly towards primary prevention, to be proactive rather than reactive. As many of us have come to recognize, coronary artery calcium scoring is a very powerful tool that is used to help for the risk stratification in a primary prevention setting.

Milind Desai, MD, MBA:
Again, this involves a non-contrast very low radiation CT scan of the chest and the heart, and it measures the buildup of coronary artery calcification. This basically is very accurate way of identifying plaque burden. Of course, there will be a small proportion of patients who only have noncalcified plaque, where there is no presence of calcification. But studies have shown that detection of calcific plaque in a primary prevention setting is very useful and helps with excellent risk stratification.

Milind Desai, MD, MBA:
So, which patients should undergo coronary artery calcium scanning? This is typically reserved for asymptomatic individuals without prior documented coronary artery disease, typically falling in the age range of 40 to 70 years of age. In certain scenarios, in especially patients with malignant familial hypercholesterolemia, one could consider doing calcium scoring less than 40 years of age.

Milind Desai, MD, MBA:
Where do we not want patients to have this is essentially a younger patients that are symptomatic. Symptomatic patients should get evaluated for their cardiovascular symptoms appropriately and do other testing. Calcium scoring is typically not recommended in that population. The other scenario is if you have documented coronary artery disease or you had prior coronary artery revascularization, it is not a good idea to send your patient for coronary artery calcium scoring.

Milind Desai, MD, MBA:
Now, as many of us are aware, once we obtain the calcium score, it can range from anywhere from zero to more than 400. And it could be in the thousands, depending upon the given patient and his or her set of risk factors. Subsequently, once we obtain the scan, what we end up doing is putting in a formula that has been published by the MESA study, multi-ethnic study of subclinical atherosclerosis.

Milind Desai, MD, MBA:
Basically it takes into account your age, your gender, and your ethnicity to give out a, not only an absolute score, not only a score based on different coronary artery distributions, but a percentile score based on age, gender, and ethnicity. And this helps optimize risk stratification in a primary prevention population. So obviously, if your score is more than 75th percentile, your long-term risk is much higher than somebody who has no coronary artery calcification.

Milind Desai, MD, MBA:
That brings me to a very important point: the power of zero calcium score. So studies have shown that unlike other markers like CRP or family history or flow mediated brachial artery dilation, et cetera, coronary artery calcification tends to be a very powerful risk stratifier. And if your calcium score is zero, it downgrades your risk of a future heart attack or cardiac event significantly more than any other technique that we use today.

Milind Desai, MD, MBA:
In fact, in a Cleveland Clinic study of almost 2000 patients, we have shown that addition of calcium scoring in a primary prevention setting reclassified risks either above or below in almost 40% of cases. Think about that. 40% of cases. So, how do you put this into the full context? If you do a calcium score, and your patient's score is zero, then you can repeat the calcium scoring in about five years or so. If the score is less than 25th percentile, then the patient clearly needs risk factor modification and primary prevention strategy may need to see a cardiologist. Certainly anything worse than that, they should do all the things plus consider seeing a cardiologist for appropriate subsequent testing.

Milind Desai, MD, MBA:
Now, there's always a law of unintended consequences. If you do a CT scan, you may stumble across other pathology like lung nodules, lung cancers, other mediastinal pathology. We have also seen that in about eight to 10% of our calcium scoring population, they have a dilated aorta or in some cases, patients have had frank aortic aneurysms that they did not know about. So, bottom line is you will get information. There's also potential for getting additional information.

Milind Desai, MD, MBA:
Now, how is this going to work from a logistics perspective? So this test is going to be offered not only at the main campus, but at the regional satellite hospitals, as well as the regional medical centers. You can get the information on our calcium scoring website. That will be available on the Cleveland Clinic website. This test is not covered by most insurances. And so, Cleveland Clinic, in taking into account our patients and the power of primary prevention, we have decided to offer this to not only Cleveland Clinic patient, but anybody who is willing to come for a scan to get this scan for $95.

Milind Desai, MD, MBA:
What you get in return would be within one business day, a Cleveland Clinic expert in cardiovascular radiology will review the scans, will generate a report, and it will be available through the electronic record or your referring doctor will get the report. And then the patients can discuss this with the referring provider to institute further management plans. So, we are very excited that this is coming. This will be available in a broad sense throughout the Northeast Ohio Cleveland Clinic facilities, and it will be at a very affordable rate. Thank you so much.

Announcer:
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