As we enter the new year, we find medicine evolving and gradually shifting its focus to the principles that Integrative Medicine has taught us for years.
Forward thinking doctors are increasingly focusing on prevention of disease rather than just reactive treatment of disease. They realize that once damage has occurred in an organ, it is very hard to change the tissues back to healthy tissues.
Since heart attack and stroke are some of the most common causes of death in our country, we should pay special attention to measures that can prevent these diseases.
Of course, diet and lifestyle are two of the most important predictors for the development of both heart attacks and strokes.
Now a new study shows that the Coronary Artery Calcium screening test can play a very prominent role in helping determine an individual’s risk for heart attack. Coronary Artery Calcium (CAC) screening is a tool that gives us a direct measure of calcium deposits (hard plaque) in the heart arteries which can subsequently lead to blockage of the arteries.
This is a noninvasive test that uses a CT scanner to take a picture of the heart. Calcium can be seen in the heart arteries and this can be quantitated. The more calcium in the arteries, the more likely for that person to have a heart attack.
In this new study, one of lead authors, Michael Silverman M.D. who is a fellow at the Brigham and Women’s Hospital in Boston, stated “We showed that by using only the traditional risk factors, we miss a significant percentage of individuals at high risk. We also may be over treating a large number of people who can safely avoid lifelong treatment.”
In the study, which was just published, the researchers looked at two different approaches to assessing an individual’s risk for heart attack. The first approach looked only at traditional risk factors, including cholesterol, blood pressure,current smoking and diabetes. The other group used the direct measurement of atherosclerosis(hardening of the arteries) as shown by the CAC score.
What the researchers found was that “15% of people believed to be at very low risk actually had high coronary artery calcium scores above 100 and were at relatively high risk of a cardiac event over the next seven years” according to Roger Blumenthal M.D. who is a co-author of the study.
Most importantly, he went on to say “On the other hand, 35% of study participants thought to be at very high risk of needing aggressive therapy with aspirin and statin medication actually had no coronary artery calcium and extremely low event rate over the next seven years. For them, we can emphasize lifestyle modifications.”
What this is saying is that significant numbers of people are given medication for the rest of their life including statin drugs when they really have no need for it whatsoever. To me it is very exciting that this study has been published and cardiologists will be reading it.
Furthermore, Khurram Nais M.D., one the senior authors of the study is quoted as saying “Our study shows that coronary artery calcium testing holds promise as a front-line assessment for people before they develop heart disease symptoms. In the meantime, we believe that doctors should consider offering a coronary artery calcium scan to their patients to markedly improve risk prediction if they are unsure whether they should be on lifelong statin and aspirin therapy.”
As a preventive medicine and lifestyle oriented physician, I am delighted to see this article and the comments made by the researchers themselves.
I truly hope that this will have an effect on physicians all over the country in not only finding heart disease in apparently low-risk individuals, but also in avoiding giving pharmaceutical drugs to patients, for the rest of their life, who do not need them.
At the present time, in Los Angeles, insurance will not cover a Coronary Artery Calcium scan, in most instances. In that case the patient must pay for the scan themselves, and that is a drawback for doing the test.
Hopefully, with the publication of this article and subsequent articles, insurance companies will find it is much cheaper to do this preventive scan, rather than to treat someone for a heart attack. When that occurs, they will start covering this test as a screening test, much as they do for a cholesterol blood test now.
As an after note, I want to remind my patients and my readers, that we now have an even better test than the Coronary Artery Calcium Scan. It is called the CT Angiogram.
This test is similar to the CAC, except that iodine is injected in the vein of the patient while they are in the scanner. The iodine then allows us to see what is going on inside the arteries as well is on the wall of the arteries, where the calcium forms. Inside the arteries, there can be soft plaque which is missed by simply doing the CAC. Soft plaque can be particularly dangerous because it can break off, causing a clot in the artery which then leads to a heart attack.
In my own practice of medicine, for patients who can afford the difference in price between the CAC and the CT Angiogram, I always recommend the CT Angiogram. It gives much more information. It is theoretically possible that someone will have no calcium in the artery wall, but they can still have soft plaque inside the artery, and that is why I prefer the more advanced test.
If you are my patient, please feel free to talk to me about these new technology tests.
For all my readers, please talk to your physicians about this new information and ask them if the Coronary Artery Calcium scan is appropriate for you in evaluating your risk for heart attack. It could save your life. Or it could take you off a drug you do not need!