The coronary calcium score is probably the biggest bang for your buck when it comes to preventative testing for coronary artery heart disease.
What is not to love about the coronary calcium score (CAC)? It can be performed quickly and without any IV contrast dye.
Why do I love the coronary calcium score (CAC)?
It's non-invasive and does not require IV contrast (injection)
It delivers a low-dose radiation, not high
It's low cost
It's available at most hospitals
It is excellent for detecting coronary artery disease (CAD)
It is helpful for someone who is asymptomatic (does not have angina)
If your score is zero, you can feel better about your LDL cholesterol level
The result is good for 5 years
Having a low score can reduce the potential for coronary catheterization
What is a CAC looking for?
The CAC measures the amount of calcium deposits in the coronary artery walls. High levels of calcium deposits correlate with coronary artery disease. The test is limited in that it cannot assess fatty plaques. Fatty plaque deposits in the coronary arteries are the highest risk for myocardial infarction (heart attack), which occurs when fatty plaques rupture and occlude the blood vessels. Calcified plaques do not rupture but can decrease the diameter of blood vessels, resulting in limited blood flow to the heart muscle.
We're having a CAC done; the ultimate goal is to have a score of zero. The higher the number, the more calcification in the blood vessel walls. As the number increases, this is further correlated with people of the same age.
My LDL cholesterol is "high," and I don't want to take a statin or change my diet.
Although risk calculators are helpful, the CAC adds more information when it comes to assessing if an LDL cholesterol level is problematic. I especially love this test because it helps my patient and me decide how to treat cholesterol numbers when no known heart disease exists. I have seen patients with very high LDL cholesterol have a CAC of zero, which is ideal. On the flip side, I've seen patients with low LDL cholesterol who exercise a lot and have no symptoms or other cardiac risk factors have an elevated coronary calcium score.
Even without any cardiac risk factors (smoker, overweight, family history of heart disease, sedentary lifestyle, insulin resistance, abnormal lipid profile), my patients have access to this test and are not "punished" for being healthy.
Insurance generally never covers this test...and this is good.
Many years ago, when I was starting my Internal Medicine practice up north and the CCTA was becoming readily available, hospitals were lobbying to have the test covered by Medicare, Medicaid, and other insurance companies as a preventative screening test. Because the test is a CT scan, I expected that it would be valued at $800-$1,000 by insurers and providers. We all got lucky when the payors refused to cover this test. This resulted in the CCTA being available to all of us for $100-$200 almost everywhere in the country. The one caveat is that to get the test, you must have a "physician order" to schedule the test. Because the CAC score is direct to the consumer, a person with no cardiac risk factors can get this test.
Although a CCTA is generally not a covered service when done for preventative reasons, it may be covered when ordered for pre-existing cardiac conditions or after cardiac surgery.
Above the image on the left, the green arrow points to calcification. The middle blue arrow points to calcification. Right is the same image at the top with a high CAC of 1,200 and significantly visible calcifications.
Is there a minimum age for getting a CAC?
Currently, it is recommended that this test not be done on people under the age of 40. However, this may be changing as, in recent years, in the urgent care/ER setting, the age for having a strong index of suspicion for heart disease has been lowered to 35 years. It can be argued that if a person has a very strong family history of early heart disease or sudden cardiac death, this test could be done at a much younger age.
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