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PRO / CON

Using CT scans to see plaque in coronary arteries

The test, called, coronary artery calcium scoring, is meant to reveal patients at risk for heart attack but may prompt some to get unnecessary surgery.

December 28, 2009|By Brendan Borrell

"Numerous studies show that coronary calciumpredicts death and heart attack in men and women of many ethnicities. The St. Francis heart study shows that if you put patients with high calcium scores on a statin, you get a 43% reduction in heart attack and death. The JUPITER and St. Francis studies were almost identical, except the JUPITER study was larger (17,802 patients versus 4,900 patients) and sponsored by a pharmaceutical company rather than a group of doctors. In five head-to-head studies, calcium scoring outperforms CRP.

"Calcium scoring requires a low radiation dose that is equivalent to a mammogram. I'm advocating one calcium score once every five years for people in the intermediate risk group: men over 45 and women after menopause with one other risk factor. For comparison, women are getting a mammogram every other year.

"There's also an additional benefit to calcium scoring, which is that it has been shown to alter patient behavior. I've published data that patients are seven times more likely to stay on medication after seeing their calcium score elevated. CRP blood tests have never been shown to improve a patient's behavior.

"I agree with Dr. Nissen that doctors can always do the wrong follow-up and people who are asymptomatic for heart disease should not be getting a cardiac stent. If you have clogged arteries, you should be taking aspirin, a statin and altering your lifestyle. The calcium score phenomenon is not unique -- it's a problem of the appropriate use of all medical tests. I also don't think patients should be screened using CT angiography, but I dispute Nissen's contention that it's being widely done.

"Finally, there are no billboards. I drive a lot in Los Angeles, and I have never seen a billboard. There used to be some radio ads five or 10 years ago. Calcium scoring is a low-radiation test that, used properly, will do a lot more good than potential harm. That's why Medicare has decided to pay for it in a majority of states."

health@latimes.com

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