Coronary artery calcium score. Best universal predictor of heart disease? 9

Coronary artery calcium can be determined by a fast, low radiation exposure CT scan that takes 16 seconds. Presence of calcium in coronary artery can be a universal predictor of heart disease and heart attack risks. Leading cardiologist explains. Coronary artery calcification and cardiovascular risks. Dr. Anton Titov, MD. You did a clinical trial about the impact of coronary calcium on heart attack risks. You investigated heart disease risks in the setting of hypertension. Dr. Anton Titov, MD. Could you discuss the impact of coronary calcifications on heart disease risks? Dr. Ehud Grossman, MD. We have been doing the clinical trials on coronary calcifications for 10-15 years. Patients in the world accepted our results. But our results didn’t come into the treatment guidelines. The recent heart treatment guidelines of the American Heart Association for the first time mentioned coronary calcium score. It is a very good criterion to decide whether to treat patients with statins or not. The main finding that we saw is this. Dr. Ehud Grossman, MD. You can see with a very fast heart CT scan that takes 16 seconds. It is a relatively low X-ray exposure. You can discover if the patient has coronary calcification. Dr. Anton Titov, MD. Is there is a calcium in the coronary artery? If the patient has coronary calcium, then he has atherosclerosis. So this is already heart disease. We found that we could compare the long-term results, patients with and without coronary calcium had different risks of heart attack. Dr. Ehud Grossman, MD. We could see that those without calcium have very very few cardiovascular events. Those patients with coronary calcium have higher risk with heart attacks. By “long-term” results I mean not 5 years, but 12 – 15 years of follow-up. It is true even for patients with diabetes. When they don’t have coronary calcification, their prognosis is very good regarding heart disease. We believe that the coronary calcium is a summarized index of atherosclerosis. Because today you measure the cholesterol, you measure the glucose, you measure the blood pressure. Dr. Anton Titov, MD. You try to say, what is heart disease risk of the patient? I can give you one risk index. If he has coronary calcium, he is high-risk patient. If he doesn’t have calcium, he is a low-risk patient for heart disease and stroke. We did repeated coronary CT scans in several hundred patients. We saw that after three years those who didn’t have coronary calcium in the first time, they didn’t have calcium in coronary arteries in the second time. Because if you don’t have atherosclerosis when you are 55, you will not have coronary atherosclerosis when you’re 60 or 65. This means that if you are protected from coronary artery disease, you continue to be protected from heart disease. Dr. Ehud Grossman, MD. So that probably implies a very strong genetic factor in atherosclerosis? It’s a genetic factor. But it also gives you a picture. What is the myocardial infarction risk of the patient? Sometimes he is already atherosclerotic. If he has coronary calcium, then you know that you have to be very aggressive to lower the blood pressure. You must lower the cholesterol. You may start aspirin because this is a high-risk patient for heart disease. On the other hand, someone may look like a high-risk patient for heart disease. But that patient doesn’t have coronary artery calcifications. Then he is in good shape. Dr. Anton Titov, MD. This is very interesting. Because someone  may have a CT angiogram of coronary arteries done. That person may have increased, relative for age, calcium in the coronary arteries. But he has no atherosclerotic plaques. Dr. Anton Titov, MD. That nevertheless places that person at risk for coronary heart disease? Dr. Ehud Grossman, MD. Definitely! But you don’t have to do coronary artery catheterization. It is a very fast CT scan, it takes several seconds. You can tell exactly how much calcium is in coronary arteries. You can give a number [calcium index score] and then you can say what is the heart disease risk for this patient.