Note:
Since the last update four years ago, not much has changed in terms of Calcium Scoring Tests. A few comments, and updates on three of the anecdotes from 2010.
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Since the last update four years ago, not much has changed in terms of Calcium Scoring Tests. A few comments, and updates on three of the anecdotes from 2010.
The cost of Calcium Scoring Tests has decreased
substantially. In many areas, they are
only about $100.
The literature continues to advance to show the
utility of Calcium Scoring Tests.
However, most physicians continue not to put much
stock in the usefulness of Calcium Scoring Tests. The general attitude is, “Statistically
speaking, they don’t add much to the predictions from conventional risk factor
calculations, so why bother?” The
answer, of course, is that individuals aren’t statistics. If a supposedly low-risk individual has a
very high Calcium Score, more evaluation and potential treatment is indicated - and lives might have been saved as a result (see Anecdote 7 below and the earlier posts about newsman Tim Russert). On the other hand, if a medium-risk
individual has a low Calcium Score, the cost and possible side effects of drugs
(e.g., statins) might be avoided.
Along those line, guidelines have recently been
promulgated which, if followed, would mean that essentially all men age 64 or
older, and all women age 71 or older, would be put on statins, even with
optimum cholesterol, blood pressure, etc., because they would have a calculated
10-year heart attack/stroke risk of 7.5% or higher. Here are links to the recommendations and the
risk calculator:
Plug in an age (e.g., 64 for men) and optimum values
for the other parameters, and you’ll see the age at which statins are
recommended for everybody above that age by the medical establishment.
The side effects of statins are becoming increasingly
well known, even if they are ignored by the medical establishment. A snarky comment would be that perhaps the
people promulgating the guidelines have been on statins for so long that the
documented effects of statins on cognition have become apparent.
Updates on the anecdotes from November 2, 2010 (I’ll
repeat the original anecdotes after the updates so you don’t have to scroll
down):
CACS = Coronary Artery Calcium Score
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Anecdote 4 Update
Jane’s first Calcium Scoring Test was in 2007, with a
score CACS = 11.
She had another test in 2013, with a score CACS = 38
This increase (a factor of 3.45 in 6 years)
corresponds to the CACS increasing about 23% per year (1.236 = 3.46).
Original Anecdote 4.
A 64-year-old woman ("Jane") was newly
diagnosed with Type 1 diabetes. [Note: it is extremely rare for someone this
old to develop Type 1 diabetes - Type 1 diabetes is generally called
"juvenile-onset diabetes" for a good reason. However, antibody tests
confirmed the Type 1 diagnosis.] Jane's physicians immediately said that her
diabetes was a risk factor equivalent to having already had a heart attack.
[Note: this is medical dogma, but really isn't true for a newly-diagnosed
diabetic; the damage from diabetes builds up over a relatively long time.]
Jane's physicians said she needed to take statins.
Jane could not tolerate statins: muscle weakness and pain, bleeding around
insulin injection sites, and erratic blood sugars. Jane had a calcium scoring
test, and the result was CACS=11. Jane's physicians decided to have her take a
Cardiolite test as well, and no problems were found. Jane currently does not
take statins. [Note: Jane is well aware that a low CACS does not guarantee she
will never have a heart condition, but a low CACS does mean that she can
consider the risks versus benefits of statin therapy in low-risk patients. The
long-term risks of statins are a subject for another day.]
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Anecdote 5 Update
Bill’s first Calcium Scoring Test was in 2007, with a
score CACS = 25.
He had another test in 2013, with a score CACS = 62.
This increase (a factor of 2.48) corresponds to the
CACS increasing about 16% per year (1.166=2.44).
Original Anecdote 5.
A 64-year-old man ("Bill") with no symptoms,
normal blood pressure, and no significant risk factors had his CACS measured,
and the result was CACS=25. This is the sort of "worried well" case
for which the usefulness of the CACS can be questioned. On the other hand, the
only downsides to the test were its cost of $200 and - possibly - a 0.01% risk
of cancer as a result of the radiation from the test (one chance in 10,000 as a
result of the test compared with the population risk of 1 chance in 5).
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Anecdote 7 Update
Unfortunately and sadly, John died from a sudden
massive heart attack in 2014. John was a
good guy and a good friend. I ended the
earlier anecdote with, “We hope the cardiologist is right [not to do more
testing].” He wasn’t.
I haven’t approached the family about the details of
John’s autopsy; they may not know the details.
Whether more detailed testing would have resulted in, say, a stent for
John is unknowable. And whether a stent
would have been life-saving is also unknowable; much remains to be learned
about the details of how and why heart attacks occur. What is knowable is that
more could have been and should have been done.
Original Anecdote 7.
A 64-year-old man ("John") whose father had
a non-fatal heart attack when the father was in his mid 50s. John's brother had
a mild heart attack when the brother was 59. John is a former smoker, but for
the last 30 years has been very physically active (running, golf, etc.). John
has previously been treated for irregular heartbeat (I don't know the details).
John had his CACS measured, with the result CACS=500. John's cardiologist has
not ordered additional testing, but has prescribed statins. Whether the
cardiologist is correct, or if more extensive testing should be done (e.g.,
Cardiolite) remains to be seen. We hope the cardiologist is right.
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