Cardiovascular Disease — 5

In much more common use is a calcium score, as obtained from a CT scan. This test assesses buildup of calcium in the coronary arteries, which may or may not relate to the accumulation of atherosclerotic plaque inside the arteries. It’s therefore an indirect test that is heavily marketed, such as a gift for Valentine’s Day, and overused by doctors for people with no risk factors. Many patients that have been referred to me have a score above one hundred and are panicked that they are at risk from a fatal heart attack. While there is some correlation between the score, which is indexed to age, and risk of a heart attack, it applies only for scores well above three hundred. Surprisingly, I have seen a substantial number of patients with a score of zero or extremely low who have had repeat testing every year or two, which is completely unnecessary. These tests are usually not covered by insurance and typically cost $150 but can range up to $400. Nearly forty years after the calcium score tests were introduced, there are finally randomized trials underway to determine whether the results have a meaningful impact on patient outcomes. CT heart scans with contrast dye to delineate the arteries may turn out to have a role for detecting inflammation in heart arteries, which we’ll get to shortly.