If you had a crystal ball that could predict the future of your heart health, would you use it?
While it’s not a crystal ball, there is a next best thing – an imaging diagnostic tool called calcium scoring that assesses an individual’s risk of developing heart disease by measuring the presence and quantity of calcium deposits in the coronary arteries. These deposits serve as a marker for plaque buildup, a primary contributor to heart disease.
“Looking at calcium in the heart is something I have a lot of experience with and I’ve read close to 40,000 of them over the years,” said Dr. Mary (Leslie) Oberst, a cardiologist with Cleveland Clinic Indian River Hospital who is trained in cardiac CT and advanced imaging, and has been doing calcium scoring since 2002. “I’ve seen first-hand how it helps people.
One of the key strengths is [the test’s] ability to identify patients who might be at risk for heart disease, even before any noticeable symptoms emerge.”
A calcium score test is quick and noninvasive. There is no contrast and no IV. The patient stays fully clothed and simply lays down on a bench that goes into the scanner, which scans your heart. The scan takes only about a minute and the software scores the calcium level which can range from zero to more than 1,000.
Your calcium score tells how much calcium is in your arteries, thereby giving doctors a jump on formulating preventative strategies. This preventative approach allows for early interventions, such as lifestyle modifications or medication, which can significantly reduce the likelihood of future cardiovascular events.
“You can’t always tell if someone is sick by looking at them,” Dr. Oberst explained. “The calcium score is done with a non-contact CT scan that scans through the chest and over the heart. The scan can pick up calcium deposits in the heart readily and accurately. The software is able to circle the calcium it sees in the coronary arteries and score based on its density. The higher the score, the more likely you’ll get heart disease. It’s very predictable.”
A normal calcium test score is zero. Any score above zero means that there’s some evidence of coronary artery disease and higher scores indicate that you could be at risk for a heart attack. According to Cleveland Clinic, scores of 100 or less are mild proof of coronary artery disease, up to 400 is moderate proof you have CAD, and above 400 is strong proof you have CAD.
“Some people are feeling great and out there playing golf,” Dr. Oberst explained. “They don’t think they have anything to worry about yet hidden in the background they have some atherosclerosis and they aren’t being treated because they don’t know it’s there.”
Dr. Oberst advises men over the age of 40 and women over the age of 55 to get a calcium scoring test whether they are experiencing any symptoms of heart failure or not.
“Everyone can benefit from knowing their calcium score,” Dr. Oberst said. “It’s especially helpful for anyone with a family history of heart disease. Smokers, overweight patients, those with low HDL cholesterol and diabetics are also at a higher risk for heart disease. The calcium score shows coronary disease in people who had no idea they had it. This scan helps determine if you need to take a statin drug – if it shows any calcium all you should take a statin. If the calcium score is zero then there is nothing to worry about.
“I had one patient who was a triathlete and the picture of perfect health, and he had a score of over 800,” Dr. Oberst continued. “I thought this score was high so we did a stress test.
He didn’t pass the stress test and ultimately needed a stint in the main artery. If not for the calcium score test, he probably would have died while out jogging one day. Another gentleman had fatigue symptoms but no chest pain or shortness of breath. His calcium score came back at almost 5000 and he ended up with triple bypass surgery.”
Nuclear stress tests, exercise stress tests on a treadmill and cardiac CT are advanced screening techniques reserved for patients who have symptoms.
An exercise stress test uses an EKG to monitor your heart while you’re resting and then while exercising, while a nuclear stress test includes images of your heart. A tracer is injected into your veins and a special camera takes pictures of your heart before and after exercise. The problem is that the nuclear test will only pick up blockage over 70 percent. A preventative calcium score test will pick up a smaller percentage.
“Fifty percent of all heart attacks and strokes occur from plaque rupturing, meaning the artery is not 70 percent blocked,” Dr. Oberst said. “Even with only a 40 percent blockage, plaque can rupture and form blood clots that travel to another part of the body. If a clot blocks a blood vessel that feeds the heart, it causes a heart attack. If it blocks a blood vessel that feeds the brain, it causes a stroke.”
Dr. Oberst utilizes calcium scoring as a preventative tool in the broader context of cardiovascular risk assessment using other diagnostic tests and risk assessment tools, such as lipid profiles and stress tests. This allows for a more accurate and comprehensive understanding of the patient’s health.
“Calcium scoring identifies heart disease earlier than other diagnostic testing and has a higher predictive value,” Dr. Oberst concluded. “If we catch it earlier in life, we can treat it more aggressively and hopefully prevent life threatening coronary events in the future.”
After earning her medical degree at the University of Louisville School of Medicine in Kentucky, Dr. Oberst completed the Internal Medicine Residency at Rush University Medical Center in Chicago. She went on to complete the Cardiology Fellowship Program at Baylor College of Medicine in Houston, and an additional year of training in cardiovascular MRI at Texas Heart in Houston. Her office is in Cleveland Clinic Indian River Hospital’s Health and Wellness Center at 3450 11th Court in Vero Beach. Call 772-778-8687 for an appointment.