February is National Heart Month. While cancer is the leading cause of death in people less than 85 years old, heart disease is the leading cause of death overall. Different ailments can affect the heart but the most common is coronary artery disease (CAD). CAD is attributable to build up of plaque in the wall of the blood vessels that supply blood to the heart muscle. A sudden blockage of a coronary artery causes a heart attack or otherwise known as a myocardial infarction.
Sometimes the first sign of coronary disease is a heart attack. In order to try to prevent that from happening, healthcare providers and patients try to identify risk factors and modify those factors to reduce risk. The No. 1 risk factor is smoking followed by high blood pressure, diabetes and high cholesterol. Much of preventive healthcare is focused on controlling these factors. Other factors that can increase risk are inactivity, diet, obesity, and family history.
Lately you may have heard about screening tests being offered and promoted to try to detect coronary disease. One of the most actively promoted is coronary artery calcium scoring done by a CT scan of the heart. The scan measures the calcium in the coronary arteries and tabulates it to calculate a score. This test does not require a doctor’s order and is generally paid for by the patient.
By definition, a screening test is done on people who have no symptoms. The goal is to identify a problem that was not previously known. In order to be effective though, the results would lead to interventions that would benefit the person being screened.
Unlike screenings for certain cancers, the data on the benefits of screening tests for coronary artery disease are not conclusive. There is debate and controversy about calcium scoring of the coronary arteries. The test is felt to be fairly accurate in predicting low risk if the score is low. However, if the score is moderately elevated or high, it shows there is some hardening of the artery but it does not tell the level of blockage nor does it consistently predict who will have a heart attack.
The American College of Cardiology and the American Heart Association have recommended coronary artery calcium scoring may be of benefit in selected asymptomatic patients. The patients who may benefit are those with an intermediate risk based on calculations related to age, cholesterol results and blood pressure. The coronary calcium score in those patients may prompt more aggressive treatment of risk factors. It is recommended that low-risk and high-risk patients not be screened because the benefit has not been demonstrated. Generally, it would be wise to have the coronary risk calculated by your provider and then discuss whether the coronary calcium scoring would be of benefit.
Another possible screening test for CAD is stress testing. Routine cardiac stress testing of asymptomatic patients also is controversial because of lack of data that shows benefit. But, patients who have symptoms of chest pain should be evaluated and may benefit from further testing like stress tests.
The risk of a coronary artery blockage cannot be completely eliminated but the best known ways to reduce risk is to avoid smoking, control blood pressure, screen for and control diabetes, screen for and control cholesterol, eat a healthy diet, and be active. Stay healthy my friends.
By: P. Michael Shattuck, M.D. – Community Health Network Family Physician