Know Your Heart Attack Risk: Get a Coronary Artery Calcium Scan

There’s a quick, pain-free and relatively inexpensive test that can help predict the chance of a heart attack or stroke and guide treatment to prevent a catastrophic event. Yet cardiovascular disease remains the number one cause of death in the U.S. To experts at Baptist Health Miami Cardiac & Vascular Institute, it’s a worrisome predicament.

Ricardo Cury, M.D., medical director of cardiac imaging at Baptist Health Miami Cardiac & Vascular Institute and Baptist Hospital.

 

“We have the ability to detect cardiovascular disease early and with precision with a coronary artery calcium (CAC) scan,” says Ricardo Cury, M.D., medical director of cardiac imaging at the Institute and Baptist Hospital. “But the simple fact is that not enough people are having the test.”

A CAC scan uses computed tomography (CT) to look for plaque buildup in the arteries that supply blood to the heart. Plaque can be made up of calcium, cholesterol, fat and other substances. As it calcifies it can narrow the arteries and decrease blood flow or break off and lead to a blood clot. Either could cause a heart attack.

The test provides results as a calcium score. In general, and depending on the patient’s age, the higher the score, the greater the risk of a heart attack. A score of Zero puts you at very low risk, a score under 100 puts you at low risk, 100-399 is considered moderate risk and a score greater than 400 is considered high risk. Depending upon your score, age and other risk factors, cardiologists may recommend lifestyle modifications, medications or a combination of strategies to combat disease and future problems.

Previously, physicians primarily used risk assessment tools to determine the likelihood of a cardiovascular event. You may be at greater risk if you:

• Smoke
• Have a family history of heart disease
• Are overweight
• Have high cholesterol, high blood pressure or diabetes
• Lead an inactive lifestyle

Risk factors are still a very important element of a cardiologist’s assessment. But, as Dr. Cury explains, the evidence gathered in a CAC scan is particularly valuable.

“We have the ability to save lives when coronary artery disease is detected early,” Dr. Cury says. “And part of the strength of a coronary artery calcium scan is that plaque buildup can be detected in patients who are asymptomatic.”

While some people with cardiovascular disease experience symptoms such as shortness of breath, chest pain, fatigue or other problems, others have no symptoms at all.

Miami Cardiac & Vascular Institute is leading the way in the prevention and detection of heart disease, helping to develop artificial intelligence (AI) models to increase the ability to find plaque, participating in clinical trials and designing large-population cardiovascular studies. One of those, the Miami Heart Study (MiHeart), was launched in 2015. A diverse group of more than 2500 initial volunteers, ages 40-65, took part. The first report from the study, issued in 2022, showed that 49 percent of participants had plaque in their coronary arteries. They were previously undiagnosed.

“One in two participants had silent coronary atherosclerosis,” Dr. Cury says. But even those who have a zero-calcium score aren’t necessarily in the clear. “Of those patients who scored a zero, 16 percent were found to have non-calcified plaque through additional testing ― coronary computed tomography angiography (CCTA). This was plaque that hadn’t calcified yet and so wasn’t visible on the CAC scan.”

A CAC score, however, is the best starting point, he believes. And in 2019, the American Heart Association, along with other organizations such as the American College of Cardiology, endorsed the test for particular patients age 40 and up to guide prevention therapies, particularly for asymptomatic intermediate risk patients, and to help with decision aid in the need for statin therapy.

Dr. Cury encourages everyone to speak to their doctors about the simple test. “You are only able to know your specific risk if you know your score,” he says. “It’s what allows us to tailor therapy to the individual.”

Primary care and family physicians can order a CAC for patients and manage most who have low to moderate risk, starting patients on statins and blood pressure medications and recommending lifestyle changes. Patients at higher risk are often referred to a cardiologist for additional studies or more aggressive treatment.

“We even have medications now that both reduce plaque that is already there and prevent new formation,” Cury says. “We are seeing a shift in the cardiology field, transitioning from risk assessment in broad populations to early detection of disease on an individual basis and precision medicine with tailored therapies to patients at increased risk. And that is what will continue to improve patient outcomes.”

February is American Heart Month. Baptist Health has locations from Monroe County through Palm Beach County where you can undergo a CAC test. If you’d like to schedule an appointment, click here or call 833-596-2473. A prescription and an appointment are required.