David Becker is a board-certified cardiologist with Chestnut Hill Temple Cardiology.
He wrote this for the "Check Up" blog,
A new use of an old test may help you decide whether 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 special kind of X-ray can reclassify half of these 45 million people as being so low risk 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 reduce that 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 you might not need medication. Further, a zero score means a cardiac event such as a heart attack would be unlikely for up to 10 years from the time of the test. 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 them. They are not covered by most insurance companies, and doctors have been reluctant to suggest them, as their role has been unclear.
This new information suggests the scans may actually save insurance companies a lot of money by limiting over-treatment with statins. But this is about more than cost saving.
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 doctors.
Who is a candidate for a calcium-scoring CT scan?
People with borderline cholesterol values who have been told they need statins, but who have never had a heart attack, stent, or bypass.
People with a strong family history of coronary disease who want to predict their own risk.
Statin users who want to know whether they really need to continue the medication.
Who would not benefit from the scan?
Someone who has had a heart attack, stent, or bypass surgery. We already know that people with coronary artery disease are helped by statins.
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, a stress test may be recommended. A recent study suggests the knowledge patients get from such testing can encourage lifestyle changes, and even make patients more willing to use preventive medications such as statins.
Calcium build-up in coronary arteries is not related to dietary calcium intake. Do not stop your calcium intake because you have calcium detected on this scan.
Unlike most medical services, this is a test that has even come down in price. It used to cost more than $350. Today at Temple University Hospital, for instance, it's $105.
Perhaps these new insights into the value of these CT scans could even help persuade insurance companies to begin to cover the cost of calcium scoring.