Cardiologists are fans of calcium testing, because they regularly encounter patients reluctant to take statins.
A long list of Lynda Hollander’s paternal relatives had heart disease, and several had undergone major surgeries. So when she hit her mid-50s and saw her cholesterol levels creeping up after menopause, she said, “I didn’t want to take a chance.”
A cardiologist told Hollander that based on factors like age, sex, cholesterol, and blood pressure, she faced a moderate risk of a major cardiac event, like a heart attack, within the next 10 years.
Doctors typically counsel such patients about the importance of diet and exercise, but Hollander, now 64, a social worker in West Orange, New Jersey, didn’t have much room for improvement. She was already a serious runner, and although “I fall off the wagon once in a while,” her diet was basically healthy. Attempts to lose weight didn’t lower her cholesterol.
Her doctor explained that a coronary artery calcium test, something Hollander had never heard of, could provide a more precise estimate of her risk of atherosclerotic heart disease. Her doctor explained that a coronary artery calcium test, something Ms. Hollander had never heard of, could provide a more precise estimate of her risk of atherosclerotic heart disease. A brief and painless CT scan, it would indicate whether the fatty deposits called plaque were developing in the arteries leading to her heart.
When plaque ruptures, it can cause clots that block blood flow and trigger heart attacks. The scan would help determine whether Hollander would benefit from taking a statin, which could reduce plaque and prevent more from forming.
“The test is used by more people every year,” said Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled from 2006 to 2017, his research team reported, and Google searches for related terms have risen even more sharply.
Yet “it’s still being underused compared to its value,” he said.
One reason is that although the test is comparatively inexpensive — sometimes up to $300, but often $100 or less — patients usually must pay for it out-of-pocket. Medicare rarely covers it, though some doctors argue that it should.
Patients with a CAC score of zero — no calcification — have lower risk than their initial assessments indicate and aren’t candidates for cholesterol-lowering drugs. But Hollander’s score was in the 50s — not high but not negligible.
“It was the first indication of what was going on inside my arteries,” she said.
Though guidelines vary, cardiologists generally offer statins to patients with calcium scores over zero, and suggest higher intensity statins when scores exceed 100. At over 300, patients’ risks approach those of people who’ve already had heart attacks; they may need still more aggressive treatment.
Hollander has taken a low dose of rosuvastatin (brand name: Crestor) ever since, supplemented by a non-statin drug, a shot called evolocumab (Repatha).
