Tag Archives: heart disease

Scan for heart-disease risk before symptoms

The coronary calcium scan is a screening test to evaluate risk for future coronary events. It uses a state-of-the-art computerized tomography (CT) scan to detect calcium deposits found in atherosclerotic plaques in the coronary arteries. It is a sensitive way to detect atherosclerosis before symptoms develop.

Main risk factors for coronary artery disease are:

  • Personal/family history of coronary artery disease
  • Males over the age of 45, females over 55
  • History of smoking (past or present)
  • Overweight
  • High cholesterol
  • Diabetes
  • High blood pressure
  • Inactive lifestyle

Your doctor can use the results of the scan to help make treatment decisions on how to lower your risk for heart disease. This test is most helpful for patients who do not have known heart disease but are at medium risk for disease after evaluating the main risk factors listed above.

Some studies have shown that a cardiac calcium scan might be a motivational factor for people at moderate risk to follow treatment plans and to make lifestyle changes.

The screening test is NOT for you, if

  • you don’t have any risk factors for heart disease
  • you are at high risk for heart disease
  • you have already been diagnosed with heart disease – since the information obtained from the scan will not impact your recommended treatment.

The result of the test is a number called the cardiac calcium score, or Agatston score.

The score is calculated from the total area of calcium deposits and the density of the calcium.

  • A score of zero means no calcium is present in the coronary arteries, which suggests a low likelihood of having a heart attack in the future.
  • A score of 100-300 is indicative of moderate plaque deposition in the arteries and is associated with a relatively higher risk of heart attack or heart disease over the next three to five years.
  • A score greater than 300, is considered very severe with high risk of heart attack or heart disease.

What are the concerns of getting a scan?

  • You are exposed to a low dose of radiation.
  • False positives are possible leading to further testing or treatment that you don’t need.
  • Not all arteries with heart disease have calcium “soft plaque atherosclerosis,” so it is possible to get a low score and still be at risk.
  • The scan is not covered under most insurance plans and Medicare, so the cost is out-of-pocket.

Many people do not know that they have heart disease until they have a heart attack. A coronary calcium scan is one way to find out if you have early heart disease, but other risk factors must be evaluated along with the score to give you a truer assessment of your cardiac risk. Your doctor can use your score to help you make lifestyle changes and/or to decide to treat high cholesterol or high blood pressure with medication.

SUSAN LOCKE is Healthnetwork Foundation’s medical director

Reduce your risk of coronary vascular disease

Dr. Susan Locke shows how to become heart-healthy with these few simple steps . . .

Coronary vascular disease (CVD) includes coronary heart disease, stroke and peripheral vascular disease. It’s the leading cause of death in the U.S., killing more than 900,000 annually. Mortality rates have decreased by about 25% over the last 30 years due to improved medical therapies and risk factor reduction.

You can’t change your genes, but you can change modifiable risk factors such as smoking, hypertension, diet, dyslipidemia, physical inactivity, obesity and diabetes. Here are our top tips:

Quit smoking. One year after quitting, the risk of a myocardial infarction (MI) and death from coronary heart disease is reduced by half. After several years, the risk for both MI and stroke approaches that of nonsmokers. In terms of your heart, it’s never too late to quit.

Treat high blood pressure. Hypertension is defined by a systolic (top number) pressure >140 and diastolic (bottom number) pressure >90. What’s important to know is that even small decreases in blood pressure can reduce CVD. Therefore, there is benefit to treating even mild hypertension. Prehypertension is defined as a BP of 120-139/80-89. Therapeutic lifestyle changes can cause a significant reduction in the hypertension development rate.

Modify your diet. Of the possible changes, limiting how much saturated and trans fats you eat is the most important step you can take to reduce your blood cholesterol and lower your risk of CVD. Polyunsaturated and monounsaturated fats decrease the risk of CHD. So reading food labels is important. Commit to a diet rich in whole grains, fruits, vegetables, fiber and omega-3 fatty acids (found in fish or fish-oil supplements), which can help reduce your risk of CVD. Small to moderate amounts of alcohol (defined as one drink/day for women and two drinks/day for men) may lower the risk for CVD. However, the beneficial effects must be weighed against the possible increased risk of other diseases including several types of cancer.

Treat abnormal lipids or fats in your blood (dyslipidemia). Lowering cholesterol and triglycerides reduces the risk of CVD. The ideal levels depend upon what other risk factors you have. The more of these risk factors you have, the lower cholesterol levels you should have. A reasonable goal for LDL (bad) cholesterol is <130 if you have  one risk factor and an LDL <100 if you have two or more risk factors. Treatment should start with lifestyle modifications of diet and exercise as well as medication if CVD is already present or if there are multiple risk factors.

Exercise. Thirty minutes of moderate intensity exercise on five or more days a week yields a 50% reduction in mortality for CHD.

Effects of obesity and diabetes. Obesity can cause increased blood pressure, insulin resistance and glucose intolerance (diabetic precursors), elevated LDL and triglycerides, and lowered HDL cholesterol, therefore increasing your risk for CVD. If you are diabetic, tight control of blood sugar and reduction of other risk factors is necessary to reduce mortality.

So get heart healthy! Stop smoking, exercise, drink in moderation, maintain a normal weight, change your diet, and control your blood pressure. You won’t regret it!

Susan Locke, MD, is Healthnetwork Foundation’s medical director.

Healthnetwork is a Legatus membership benefit, a health care “concierge service” that provides members and their families access to some of the most respected hospitals in the world. One Call Starts It All: (866) 968-2467 or (440) 893-0830. Email: help@healthnetworkfoundation.org

Testing for heart disease

Dr. Susan Locke discusses the pros and cons of some new tests for heart disease . . . . . .

Suan Locke, MD

Suan Locke, MD

Cardiovascular disease accounts for one in three deaths of American adults, according to the American Heart Association. Healthnetwork Foundation receives frequent requests for referrals to heart centers for diagnosis, treatment and second opinions.

One of the newer diagnostic tools for cardiovascular disease is cardiac calcium scoring, which is used to diagnose coronary artery disease, one of the most common forms of heart disease.

Cardiac calcium scoring (CCS), also known as coronary artery calcium scoring, is a new non-invasive test to detect and quantify calcium deposits in the coronary arteries.

The coronary arteries supply blood to the heart and normally don’t contain calcium. Calcium in the arteries is a sign of coronary heart disease.

The test is done by a special type of CT scan — electron beam computed tomography (EBCT) — which allows for more rapid scanning than traditional CT scans and allows for measurement of coronary calcium density and area. A cardiac calcium “score” is generated from the measurements.

heartappleA high calcium score suggests the presence of coronary heart disease. However, it is important to note that soft plaque cannot be found by CCS. Soft plaque is the earliest form of damage to coronary arteries. So if you have soft plaque, you may get a false-negative result. Test results may also be affected by a rapid heart rate, smoking and caffeine use.

The American Heart Association doesn’t recommend EBCT for general screening for heart disease. Richard Lang, MD, of the Cleveland Clinic Wellness Center says he doesn’t use CCS as a routine screening test during an executive physical. It may be a helpful tool when a patient has other cardiac risk factors like high LDL cholesterol, hypertension, diabetes, obesity, smoking history and strong family history of cardiovascular disease.

Richard Lang, MD

Richard Lang, MD

Lang also says CCS can be helpful in making decisions about how aggressively to approach risk factor management. Lang emphasizes that CCS is best used in conjunction with a “functional” study of the heart.

A stress echocardiogram or a myocardial perfusion imaging study is an example of functional studies that can provide your physician with valuable information about your heart. In the future, serial cardiac calcium scoring may become a tool for monitoring coronary artery lesions after lifestyle modifications or pharmacologic interventions.

An open dialogue with your personal physician is the best way to decide what testing is appropriate for you. Contact Healthnetwork for an appointment with a heart specialist or to schedule an executive health exam at one of our medical centers of excellence.

Susan Locke, MD, is Healthnetwork’s medical director.

Healthnetwork is a Legatus membership benefit, a healthcare “concierge service” that provides members and their families access to some of the most respected hospitals in the world. To learn how this can work for you, call (866) 968-2467 or (440) 893-0830. E-mail: help@healthnetworkfoundation.org