Published On: Tue, Nov 13th, 2018

Doctors Urge Use Of Coronary Calcium Tests To Predict Heart Attack Risk

Last year, President Donald Trump’s doctors screened him for heart disease using a test unfamiliar to many Americans.Now, research shows that that test, either alone or combined with other evaluation methods, is better at predicting whether a symptomatic patient required heart surgery than the standard evaluation.

Heart Attack Risk

“If you’re concerned about your risk of heart disease, then you should ask your doctor about the coronary artery calcium score,” said Dr. Jeffrey Anderson, lead author of the new study, presented Monday at the American Heart Association Scientific Session conference. He is also a clinical and research physician and past director of cardiovascular research at Intermountain Medical Center Heart Institute in Salt Lake City, Utah.

A measure of actual plaque

Last year, White House physician Dr. Ronny Jackson revealed that as part of his physical exam, Trump had undergone a coronary calcium CT scan, a test that has been around since at least 1990. The president’s score was 133, which indicates that some plaque is present and would place him in the middle-risk category as defined by the new study. The lowest-risk category includes patients with scores of zero, and the highest-risk category includes patients with scores of 1,000 or higher.

Anderson said the study questioned which of three types of evaluations is the best predictor of either a major coronary event, including heart attack, or the need for surgery to place a stent or perform a bypass.

The first evaluation is the current standard used by doctors. The second includes all the same factors as the standard evaluation method, along with a patient’s CAC score. The third evaluation was a CAC score alone.

The CAC score gives actual “anatomic information,” he said. “You’re actually seeing plaque — not all the plaque, not the soft plaque, but advanced plaque where calcium is present.”

None of the three evaluation methods did a good job of predicting heart attack risk, the study found.

Heart association urges use

Dr. Mary Norine Walsh, medical director of the heart failure and cardiac transplantation program at St. Vincent hospital in Indianapolis, said the new study — along with a recommendation to use CAC scoring in new cholesterol guidelines from the American Heart Association — show that “CAC scoring has really come into its own now.”

Generally, people who have risk factors such as “abnormal cholesterol levels, diabetes, family history of heart disease, hypertension, smoking — all those traditional risk factors — those people have a higher chance of having an abnormal CAC score,” Walsh said.

The new study, combined with the new recommendation to use the test in asymptomatic patients in the middle-risk category, when “put together, show us that this is going to be a test we’re going to use more in the future,” Walsh said.