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Dear Dr. Roach: I'm 67 and in decent shape. I run 3-4 miles three times a week and lift weights three days a week. I take 20 mg of rosuvastatin daily. My LDL cholestrol is 85 mg/dL, and my HDL is over 80 mg/dL. I have controlled blood pressure at 125-130/80 mmHg with an angiotensin II receptor blocker (ARB).
Seven years ago, my provider asked me to do a coronary artery calcium (CAC) scan because it could be performed at no cost to me. I did, and my score was 530. The recommendations were to get on a statin, which I was already on (rosuvastatin), as well as low-dose aspirin.
Recently, a new primary care physician asked me to repeat the test, and my score was 1,200. The higher progressive score alarmed me as the report said that my chances of a cardiac event were extremely high over the next few years. My physician then referred me to a cardiologist.
The cardiologist eased my concerns somewhat, as he said that although this is a high score, it doesn't mean anything other than lots of calcium in my artery plaque. He did schedule me for a stress test. Can you please provide your take on the interpretation of my calcium score and the potential benefit in getting the test? -- R.S.
Answer: A CAC scan is an easy way to get additional information about a person's risk of having a heart attack. I don't recommend these scans for my low-risk patients, nor do I recommend them for my patients who are already on treatment.
I find them most useful in people where it's not clear whether they should be on treatment such as a statin (like the rosuvastatin you are on). Sometimes I have a patient who is equivocal about being on a statin (which I understand), and sometimes I'd like to get more information before giving a recommendation to a patient.
The ideal CAC score is zero. However, a high CAC score doesn't guarantee a heart attack. I use the MESA score (tinyurl.com/MESARisk) in combination with your clinical factors, and the tool estimates your risk of having a cardiac event (heart attack, cardiac arrest, death due to a heart attack or stroke, or confirmed blockages that lead to surgery or a stent placement) at 14.8% in the next 10 years. If you had a calcium score of zero, your risk would only be 2.3%, so the CAC really did make a significant difference in understanding your risk.
In my opinion, a stress test is a reasonable suggestion.