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Do you really need cholesterol-lowering medication?

A new use of an old test may help you decide if you really need cholesterol-lowering medication.  If you are one of the 45 million Americans whose cholesterol levels make them potential candidates for statin therapy (medications like Crestor and Lipitor) – but you don't have heart disease -- there may be other options.

A new study looking at calcium scoring CT scans concluded that this special kind of X-ray can reclassify half of these 45 million people as being so low risk that they can avoid potentially unnecessary treatment with statins.

Calcium can build up in the arteries that deliver blood to the heart, creating blockages that can raise the risk of a heart attack.  Cholesterol lowering medications can lower this risk.   But, the authors of this new study conclude, if you have a zero score on this special CT scan,  your risk of a heart attack is so low that you might not need medication.  Further, a zero score means that it is unlikely that a cardiac event such as a heart attack will occur for as long as ten years.  The scan involves minimal radiation exposure as it is basically just a snapshot of the coronary artery, does not involve any dye or intravenous lines and takes about 15 minutes.

Calcium scoring CT scans have been around for years, and are readily available.  Yet, many people have never heard of the test.  It is not covered by most insurance companies, and doctors have been reluctant to suggest it as its role has been unclear.

This new information suggests that the scan may actually save insurance companies a lot of money by limiting overtreatment with statins. But this about more than cost savings.

Taking statins to prevent heart disease can be associated with side effects such as muscle aches.  Almost half of patients prescribed a statin will stop them within a year or two, often not telling their doctor.

Who is a candidate for a calcium scoring CT scan?

  1. People with borderline cholesterol values, who have been told they need statins, but have never had a heart attack, stent or bypass.

  2. People with a strong family history of coronary disease who want to predict their own risk

  3. Statin-users who want to know if they really need to continue the medication.

Who would not benefit from the scan?

  1. Someone who has had a heart attack, stent, or bypass surgery. We already know that people with coronary artery disease are helped by statins.

  2. People with an LDL (bad) cholesterol over 190 mg/dl, and those with diabetes. We already know their risk is high and statins can help; the test won't provide new information.

If your calcium CT score is above zero, then a stress test may be recommended. A recent study suggests the knowledge patients get from such testing can encourage lifestyle change, and even make patients more willing to use preventive medications such as statins.

Calcium build-up in coronary arteries is not related to your dietary calcium intake.  Do not stop your calcium intake because you have calcium detected on this scan.

Unlike most medical services, this is even a test that has come down in price. It used to cost over $350. Today at Temple University Hospital, for instance, it's $105.

Perhaps these new insights into the value of these CT scans for certain patients could even help convince insurance companies to begin to cover the cost of calcium scoring.

Paying more attention to lifestyle, diet and stress is good medicine for everyone. Some will also need a pill, but talk to your doctor about this test if you think you may be a candidate.

Dr. David Becker is a board certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. and has been in practice for 25 years. In 1993, after extensive research, Dr. Becker launched Healthy Change of Heart™, an innovative 10-week program designed to reverse heart disease and improve quality of life through diet, exercise, and stress management. Since then, thousands of patients have participated in the program, achieving significant results in improving cardiac wellness.

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