The calcium score or calcium screening heart scan has been available for over two decades.  Surprisingly, very few patients have had this most important cardiac test.  The calcium score is an essential part of the evaluation for heart disease and plays a central role in preventive cardiology.  Equally suprising is that it is not covered by insurance.

• Researchers have once again have demonstrated a benefit of a calcium screening heart scan over traditional risk factor assessment. 
• 5,878 asymptomatic patients without known coronary artery (heart) disease were screened with a CT scan known as a calcium score, to determine if a calcium screening heart scan helped their physicians identify them as high risk or low risk future heart attack or stroke. 
• Patients were categorized into high, medium and low risk subsets using the traditional Framingham Risk Score.  A calcium screening heart scan was then performed.  

Result:  the use of a calcium screening heart scan allowed patients to be recategorized more accurately into high and low risk subgroups.  In other words, a calcium screening heart scan added tremendous value in predicting the aggressiveness of care required.

Comment: 

We agree with these findings. 

A calcium score is the MOST SENSITIVE method of detecting coronary artery disease. 

Who should have a calcium score? 

1.  Asymptomatic patients.  If you have chest pain or shortness of breath or any symptoms, a calcium score is NOT appropriate. 

2.  Patients with ‘intermediate’ risk factors for developing heart disease:  hypertension, hypercholesterolemia, diabetes, family history of heart disease or stroke, smoking. 

3.  Is this covered by my insurance plan?  No.  Unfortunately, our private insurers and Medicare do not allow the routine use of calcium scoring in the manner described in this article. 

4.  How much does a Calcium Score Cost? Approximately $400 dollars + tax. 

Patients of our practice will receive a 40% discount on this study. 

Each of us must decide, based upon the risks and benefits, our perception of value in Preventative Medicine.

Polonsky TS et al. Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA 2010 Apr 28; 303:1610.

Author:  Gregg M. Yamada, MD FACC