Coronary calcium scans: Heart scans mired in controversy

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Coronary calcium scans: Heart scans mired in controversy

Coronary calcium scans: Find out the pros and cons and who should get them.

Heart attacks often come with no warning. But an imaging technology called coronary calcium scan uses computerized tomography (CT) to scan the heart in just minutes and may provide some advance notice of problems.

Coronary calcium scans, also known as heart scans or CT angiography, provide pictures of the coronary arteries so your doctor can identify the presence of calcium in the arteries and look for blockages. The result of this test is often called a coronary calcium score.

Heart scans and coronary calcium scoring may indicate if you're at higher risk of a heart attack or other problems well before you have any outward symptoms of disease.

Coronary calcium scans aren't for everyone, though. While some medical facilities advertise directly to consumers, urging them to stop by for a quick check, the widespread use of coronary calcium scans remains controversial. Doctors and researchers dispute who can actually benefit from heart scans and whether a coronary calcium score is useful.

Find out more about this type of heart scan so that you can decide if getting one is really worth your while.

Walk-in centers target the worried well seeking reassurance

Certain medical facilities and walk-in centers urge consumers to drop in for a quick heart scan. Advertisements and brochures often target the worried well — people who worry that they might have a particular disease even if they seem healthy and have no known risk factors. Facilities that promote coronary calcium scans for the general public don't require a referral from a doctor. You can walk in off the street and get the scan. However, you may pay out of pocket for these scans as insurance coverage varies.

The pluses: Early detection and an action plan

Proponents of heart scans suggest that the scans can serve as a wake-up call that will inspire you to change your lifestyle. When anti-smoking ads don't work, a peek at the plaques inside your arteries could be compelling enough to get you to adopt healthier habits — and prevent you from developing heart disease.

If you do opt for a heart scan, this is best done through your primary care provider and in conjunction with an assessment of your risk factors, such as your cholesterol level. If you opt for a walk-in scan, be sure to take a copy of the results to your own doctor for follow-up. He or she can advise you on what sort of treatment, if any, is necessary, and how to modify your risk factors to prevent heart disease.

The drawbacks: Heart scans don't always fulfill their promises

They sound good, but how useful are heart scans? Some doctors don't think coronary calcium scans should be used to screen the general public for heart disease.

Routine use of heart scans on people who lack any symptoms of heart disease is not recommended by the American Heart Association or the American College of Cardiology, a position that has remained unchanged since 2000.

The scientific evidence is somewhat conflicting. Critics of heart scans say the technology isn't yet refined enough to accurately predict who will have a heart attack.

Occasionally, the mere presence of coronary calcification, for instance, may not necessarily indicate that you have heart disease at all. Such deposits can be false-positives — erroneous indications that you might have heart disease. That means you could be subject to unnecessary, anxiety-inducing diagnostic tests that require invasive procedures, such as cardiac catheterization or angioplasty.

Don't get a heart scan under these circumstances

Experts agree that you shouldn't get a heart scan if:

  • You've had a heart attack
  • You've undergone coronary bypass surgery
  • You've had angioplasty with or without stent placement
  • You're at high risk of heart disease

In these cases, you should already be under a doctor's care for treatment of existing heart disease or aggressive prevention strategies. A heart scan is meant as a screening tool for someone who may be at risk of heart disease — not someone who already has heart disease or is known to be at high risk.

Also, because of the radiation exposure, don't get a heart scan if you're pregnant.

Don't forget traditional risk factors

Heart scan technology continues to improve, and scientists are learning more about the role of calcium in heart disease. In the meantime, don't overlook the traditional risk factors that can increase your chance of developing heart disease, such as smoking and high cholesterol levels. And remember that if you do have a heart scan, it's useful only if you actually follow up with your doctor and make lifestyle changes that can prevent worsening heart disease.

Last Updated: 11/10/2006
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