Cardiologists are coming to recognize calcium-score screening as a useful method in predicting coronary disease, with low risk and reasonable cost to the patient.
“Data has come out in some of the recent literature that has indicated growing support for doing calcium-score screening,” said John McBrayer, MD of the Heart South Cardiovascular Group office in Alabaster.
Heart South offers the procedure, which is not currently reimbursed by insurance, for $99, a cost that is comparable to the expense of testing lipid levels.
“The analogy I use is that it’s kind of akin to doing vaccinations for prevention and breast mammograms,” McBrayer said. “It’s good preventive medicine. It has as much, if not more, correlation with coronary disease and predictability than some of the other common indicators, such as lipids, age, and gender, in predicting coronary disease.
“There are a lot of other screening things that are available right now — C-reactive protein, HDL and subparticles of different cholesterol — and all of that is important,” he said. “But I think the correlation with the actual incidence of disease is much greater with calcium scores. That’s been proven in the literature, so it’s time that we start thinking about doing calcium scores routinely in those people that are interested in screening for coronary disease.”
According to McBrayer, patients with a family history of heart disease, but without a known coronary disorder, often do not want to take lipid-lowering medications because of the expense and side effects. However, if the patient was screened and showed a high calcium score, the physician could recommend aggressive statin drugs in an effort to prevent coronary disease. On the other hand, if the patient showed a low calcium score, the physician could recommend diet, prevention, and routine follow-up of his lipid levels, instead.
Calcium-score screening, which is done with a 64 slice CT machine, “is a capability we didn’t have in the Birmingham community, widespread, for so long,” McBrayer said. “They had that original EBCT machine at HealthSouth, and now we have the 64-slice machine in several places,” including the Heart South office in Alabaster.
“We were sort of ahead of the curve” at Heart South, McBrayer said. “It’s been good for us in that we were able to get a lot of experience. We’ve done about 2,800 angiographic studies on the 64-slice machine, where you can actually put dye in the arteries and CT the heart or CT the peripheral vascular system: carotid arteries, renal arteries, iliacs and runoff into the legs.”
Heart South uses the 64-slice CT mostly for angiography, he said, explaining that the practice is not doing a lot of calcium scores at this time, partially because the physicians simply may not be accustomed to using this information and partially because the public is still not fully aware of it.
“Most of the time when I talk to somebody about it, they give me a blank look,” McBrayer said. “I really think it’s a useful tool that I would like to be more public, where people have the perception that it is useful information.”
However, McBrayer cautions against overtesting.
“It’s something you always have to be careful of in medicine. You don’t want to overutilize our resources, order too many tests and order things that aren’t helpful,” he said. “You don’t want the patients to have a perception that you are pushing a test on them that they don’t need or a test that is dangerous to them or anything like that. That’s just the environment we work in, the day and age.”
With the calcium-score procedure, which uses a small amount of radiation, “there’s practically no risk,” he said.
February 2008
