Coronary Calcium Analysis: A Heart Test That May Help Guide Treatment

In an editorial on “The potential and pitfalls of scoring calcium in coronary arteries”, published in JAMA Cardiology in October, Dr Kha...


In an editorial on “The potential and pitfalls of scoring calcium in coronary arteries”, published in JAMA Cardiology in October, Dr Khan and his co-author Dr Ann Marie Navar, cardiologist at the Southwestern Medical School at the University of Texas, concluded that for middle-aged and older adults like my Friend, the calcium test is one of the best and safest ways to identify the presence of otherwise hidden atherosclerosis.

The results of a calcium test can also be important to young men and women – and sometimes their doctors, who may not take risk factors in young patients as seriously as they should.

“Given the strong association between coronary artery calcium and cardiovascular disease,” Drs. Khan and Navar wrote: “The presence of calcium in the coronary arteries in young adults should be a wake-up call for a high-risk patient. As Dr. Khan explained in an interview, “The presence of all calcium in the coronary arteries is a sign of heart disease.

When atherosclerosis begins to develop, arterial damage, called plaques, is not calcified, explained Dr Philip Greenland, also a preventive cardiologist at Northwestern. Instead, the lesions acquire the bone deposits over time which gradually increase as the plaque ruptures and is repaired. The healing process causes calcification, he said.

Dr Greenland cautioned that patients and doctors should never assume that a calcium score of zero means there is nothing to worry about. He said that in men under 40 and women under 50, “you cannot rely solely on the calcium from the coronary arteries because the level is usually zero, even with atherosclerosis.”

On the contrary, he and Dr Kahn said that in young adults, follow-up testing and medical advice should be based on the extent of patients’ cardiovascular risk, including whether they have symptoms of heart disease, such as shortness of breath when climbing stairs or chest pain during exertion.

Dr Greenland said people with “a low risk factor profile and a zero calcium score have some sort of guarantee that they won’t have a heart attack within 10 years.”

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