Calculating cardiac calcium scores

Coronary artery disease test could benefit thousands

June 19, 2008|By Frank D. Roylance | Frank D. Roylance,Sun reporter

On the X-ray image they printed out for me, trouble is a pink triangular speck, labeled LAD.

The pink spot represents a calcium buildup - hardened plaque. And the LAD tag means the plaque lies in my "left anterior descending" coronary artery - the one cardiologists call "the widow maker."

A blockage in the LAD tends to kill you.

No one has said definitively that's what killed NBC newsman Tim Russert last week at the age of 58. But it wouldn't be a bad bet.

Russert died after a heart attack in his Washington office. Three attempts to shock his heart back to life failed.

For those of us in his age group, Russert's death came as a vivid reminder of our own mortality. Dr. Stephen Pollock is 58 and chief of cardiology at St. Joseph Medical Center in Towson.

"His death upsets me," Pollock said.

"My father died at 58 of a heart attack," he added. "I've been scared of this forever."

But more importantly, Pollock believes thousands of lives could be saved every year if everyone 40 and older would get a quick and simple test called a calcium score and, if needed, seek treatment.

American Heart Association guidelines say calcium scores aren't needed for people in low-risk categories or for those whose history and behavior indicate they're at high risk.

But "for the people who have one or two risk factors, who are asymptomatic or having chest discomfort, coronary calcium scoring can be beneficial," said Dr. Shannon J. Winakur, a cardiologist with Midatlantic Cardiovascular Associates and an AHA spokeswoman.

Risk factors include hypertension, diabetes, high cholesterol, a smoking habit, family history of heart disease and advancing age.

"Calcium scoring is helpful to see if somebody has coronary disease," she said. "It's not as helpful to determine ... where critical blockages are or which plaque is going to cause a problem. It's a good screening test. We go from there to try to reduce the risk of having a heart attack."

It would not have helped Russert, according to his doctors. He already knew he had coronary artery disease. He was taking medicine for it, exercising and watching what he ate.

But "that's not the point," Pollock said. Early diagnoses with calcium scoring could help thousands.

Pollock had the test five years ago. It changed everything for him.

With his poor family history, he was already on alert for signs of heart disease. "I took a stress test every year, and every year it was normal," he said. He reckoned he was doing fine and saw no need to push his cholesterol levels down with drugs that can have significant side effects.

But when the calcium test became available, he took it. His score was "really high," he said. A subsequent nuclear stress test revealed two blocked coronary arteries. Two stents opened those arteries, and he started taking aspirin and cholesterol-lowering drugs. "So far, so good," he said.

Russert, too, had passed a stress test not long before he died. That's not uncommon. "Normal" results don't mean you don't have coronary artery disease, Pollock said. "It just means it's not critical."

You could still have a 50 percent blockage. And if a piece of that plaque breaks off and plugs up a coronary artery, heart muscle dies.

"This happens 850 times a day in this country - cardiac death - frequently with people who had no warning. They didn't know they had coronary artery disease, which is eminently treatable if you get on cardiac drugs," Pollock said.

He finds it exasperating that more people don't get that diagnosis earlier. "Everyone in this country knows if you're over 50 you should get a colonoscopy," he said. Women know they need regular mammograms, and men routinely get PSA tests, as part of their regular checkups, to catch the early signs of prostate cancer.

"But nobody gets a test for the No.1 [killer] disease in this country," he said. Worse, insurance companies that pay for colonoscopies, mammograms and PSA tests won't cover calcium scoring.

Pollock felt so passionate about the topic that 18 months ago, he and St. Joseph established the Heart Aware program, offering calcium score tests to men ages 45 to 75 and women 55 to 75. At $90, the price of the test does not cover the hospital's cost to administer the test, said cardiology services manager Jean Seiler. Almost 1,000 people have had the test.

Heart Aware patients can calculate their own risk factors online at stjosephheartaware.com, get tested and receive counseling afterward from a nurse. Seiler said 42 percent of test-takers have scored high enough to warrant a follow-up with a physician.

Other area hospitals also offer the test at fees ranging from $75 to $250. Among them are Anne Arundel Medical Center, Greater Baltimore Medical Center, Johns Hopkins Hospital and University of Maryland Medical Center .

I have no family history of coronary artery disease, and my cholesterol numbers aren't too bad. I passed a nuclear stress test a few years back. My cardiologist told me I had the heart of a 35-year-old. At least that's how I remember it.

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