Peripheral Arterial Disease (PAD) Expert Forum
Coronary Artery Calcium Score: Accuracy? Implications?
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Questions in the Peripheral Arterial Disease forum are answered by Dr. Lee Kirksey, associate professor at The University of Pennsylvania School of Medicine. Topics covered include abdominal aortic aneurysm , amputation, arteriovenous fistula, atherectomy, carotid artery surgery , cholesterol , claudication, deep vein thrombosis (DVT) , endovascular aortic stent graft (EVAR), stent placement , stroke prevention, varicose veins , and venous insufficiency .

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Coronary Artery Calcium Score: Accuracy? Implications?

Someone close to me:  Male 45 had a coronary artery scan.  He exercises everyday, is in great shape, and is not overweight, etc.  Normal Cholesteral levels.  No symptoms.  Niether parents have had heart disease, nor grandparents.  But all have had TIA's or strokes.  

His calcium score result was a 109 with an 87% percentile.

After doing some reading, it seems that this is a very high percentile rank and means his risk for future heart attack is very high..... like 30% in the next 10 years.   Is that true?  I'm very concerned.

What is the significance of the this test result and its associated risk profile.  It seems quite concerning....  (He will ultimately see an cardiologist, but please give me some perspective on this.)   I have not seen any information to the contrary on the risk associated with this percentile rank, so it seem credible that he is at high risk.  Also, does it matter which arteries etc...

Thank you in advance!  Any advice or input is appreciated.
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Coronary calcium scans, also known as heart scans or CT angiography provide pictures of the coronary blood vessel (blood supply to the heart). They provide information regarding the presence of calcium in these arteries and in some cases, the degree of blockage within the vessel

Doctors and researchers dispute whether the coronary calcium score is actually useful.
Proponents of the test suggest that doctors can interpret the test to create a score that reflects a persons risk for a future cardiac event. Some research suggests that the more calcium one has, the greater the risk for some future cardiac event. It is important to note that calcium in and of itself, does not necessarily cause a heart attack. Heart attacks are usually caused by plaques, made of cholesterol and scar, that rupture and cause narrowing of the artery which impairs blood supply to the heart muscle. Calcium is associated with the development of plaques but not all of the time and the correlation is unclear currently.

The American Heart Association and American College of Cardiology's official stance since 2000 is that the routine use of heart scans in individuals who lack any symptoms such as chest pain, shortness of breath etc is not indicated. The concern is that the test is not predictive enough and a false positive will lead to more costly and possible dangerous sequence of tests which are not indicated

Having said that, I think an indisputable benefit of these types of tests is that they create some degree of anxiety that may motivate one to change to healthy lifestyle behaviors (diet, exercise, smoking cessation, stress management) or to recommit if those behaviors have waned

In any case, I would recommend that the heart scan be interpreted in the context of all risk factors (family history, smoking, cholesterol, hypertension, diet, weight etc) and that the appropriate risk factor modification and treatment be instituted. That is to say, that it really does not change how the physician and patient should work in a collaborative fashion to optimize the patient's health.
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