Patients of our practice will receive a 40% discount on this price, $250 + tax. 

• Persons interested may contact our office at 347-8019 or by email at contact@pacificcardiologyhawaii.com.
• We will arrange for your Calcium Score to be performed at Queens/Accuimaging Pearlridge.

Queens Imaging Pearlridge

• A follow up preventative consultation will be arranged (covered by your insurance).

COMMENT: 

• We are pleased to do our part to make prevention of heart disease, more affordable to our patients, their family and their friends. 

Author:  Gregg M. Yamada, MD FACC

• 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

Comment:

We agree with the findings of this study.

It is well known that the traditional risk factor assessments that physician use to predict heart attack risk underestimate a persons true risk. 

Calcium scoring is a useful tool in selective patients that increases your physician’s ability to predict if you are an increased risk for heart attack/cardiac death.

We have used calcium scoring in our practice since 1996.  Unfortunately, this test is NOT COVERED by medical insurance.  Private insurance and Medicare DO NOT COVER preventative testing. 

Author:  Gregg M. Yamada, MD FACC

Author Dr. PK Shah (Cedars Sinai) notes: “The SHAPE (Screening for Heart Attack Prevention and Education) Task Force screening guidelines recommend noninvasive atherosclerosis imaging of all asymptomatic men (ages 45-75 years) and women (ages 55-75 years), except those at very low risk, to augment conventional cardiovascular risk assessment algorithms. Using SHAPE guidelines, between 35-48% of persons are placed in a higher risk stratum, making them eligible for lipid-lowering therapy, and the number needed to reclassify one individual as newly eligible (or no longer eligible) for lipid-lowering therapy ranged from 4.1 to 7.8, depending on the CCS threshold used.”

 Comment:

We agree with these findings. 

Approximately 85% of patients who suffer a heart attack had no warning symptoms.  Patients with diabetes and women are especially at risk for silent heart disease.

Unfortunately, our local insurance carriers do not reimburse calcium screening heart scans.   

Author: Gregg M. Yamada, MD FACC

Comment:  Although this study and others do demonstrate a potential benefit of serial calcium scores, our practice does not recommend this. 

If a calcium score is low or zero and risk factor reduction is undertaken, then repeating a calcium score may not be necessary. 

We feel that benefit of the calcium score is in helping stratify patients who are in intermediate risk categories (10 year event risk) into either high or low categories, where treatments differ.

Unfortunately, the calcium screening heart scan is not allowed by private insurance or Medicare.

Author:  Gregg M. Yamada, MD FACC

These investigators combined the results (meta analysis) of 13 studies to evaluate a patients prognosis if 0 coronary calcium was detected by a calcium screening heart scan.  Out of 65,000 asymptomatic patients 26000 had 0 coronary calcium.  Only 146 (0.6%) had a cardiac event over the next 51 months

Comment: We agree with these findings.

These findings are not surprising.

Calcium scores is best used in persons who are at risk for heart disease, but who have no symptoms.  

It is not appropriate for patients with chest pain, those at low risk for heart disease, younger individuals who may not have yet developed coronary artery calcification.

Additionally, it is important to utilize this technology appropriately. In patients who are under the age of 45 (men) or 50 (women), calcium heart scans are not recommended by Pacific Cardiology.

Despite it’s demonstrated importance, calcium scoring is not covered by private insurance and Medicare.

Author:  Gregg M. Yamada, MD FACC

Investigators “compared CCTA with stress testing through exercise ECG or nuclear stress testing in 517 patients who had been referred by their treating physician for evaluation of possible coronary disease symptoms.”  Researchers found:  “The clinical utility of CCTA was superior to that of stress testing in patients with an intermediate pretest probability.”  In addition, “in patients with an intermediate (20–80%) pre-test likelihood for having CAD, a positive CCTA result suggested a need to proceed with invasive catheterization.  A negative result suggested no need for further testing (post-test probability, 1%).” In addition, ”in patients with a high (>80%) pre-test probability, physicians could proceed directly with ICA in patients, and the researchers comment that ‘neither stress testing nor CCTA offers much additional diagnostic value.’”  (reprinted from CV News Digest)

Comment:  We agree with these findings. 

However, our local insurers, hospitals and medicare do not agree with the role of cardiac CT.  Some of our local insurers to not reimburse for this procedure in Hawaii despite it being proven superior in accuracy to all forms of stress testing. 

We suggest patients consider a calcium screening heart scan prior to considering a coronary CT angiogram. 

Author: Gregg M. Yamada, MD FACC

Comment: We recommend that persons who have intermediate risk for developing heart disease, have a calcium score performed. If any calcium is present, then LDL should be under 70 mg/dl. A negative stress test does not exclude the presence of CAD.

Author:  Gregg M. Yamada, MD FACC

Every 34 seconds, someone will suffer a heart attack in the U.S. 

Every 60 seconds, someone will die from a heart attack.

1.4 million Americans suffer a heart attack each year.

• 785,000 heart attacks are first heart attacks.
• 470,000 heart attacks are recurrent.
• 195,000 heart attacks are ‘silent’-discovered incidentally.

Symptoms:  Only 18% of heart attacks are preceded by chest pain. 

• 82%-85% of heart attacks occur in patients who never had any complains.

Consequences:  If you have a heart attack, the chances of dying within ONE YEAR:

• Age 40-49: 18% of men will die within one year of suffering a heart attack.  23% of women will die.
• Age 50-69: 14% of men will die within one year of suffering a heart attack.  12% of women will die.
• Age  70 and older:  27% of men will die within one year of suffering a heart attack.  28% of women will die.

If you suffer  a heart attack, the chances of dying within 5 YEARS:

• Age 40-49: 33% of men will die within 5 years of suffering a heart attack.  43% of women will die
• Age 50-69: 27% of men will die within 5 years of suffering a heart attack.  32% of women will die
• Age  70 and older:  56% of men will die within 5 years of suffering a heart attack.  62% of women will die

Treatment: 1.3 million angioplasties and 448,000 bypass surgeries are performed each year. 

Cost:  2009: $165.4 billion dollars

Comment: I continue this particular post because it best characterizes my philosophy as a cardiologist and as a physician:  Prevention.

Unfortunately, simple lifestyle changes which are the basis of preventive cardiology are often neglected for that very reason–they are viewed as too simplistic. 

For example, if your treadmill is negative and you have no symptoms but do have risk factors for heart disease (high blood pressure, high cholesterol, diabetes, obesity, sedentary lifestyle, etc.) a simple 30 minute walk, 5 days per week, may be more effective at reducing the risk of a heart attack than is a coronary artery stent. 

Clearly, what makes the most sense is to lose weight gradually, exercise regularly, and eat sensibly.  If you have high blood pressure, diabetes or elevated cholesterol–have these intensively monitored and treated.   

Do your very best to take the appropriate, simple measures to avoid having the need to see a cardiologist in the future. 

You may wish to watch a CNN special report entitled, ‘The Last Heart Attack’. 

Author:  Gregg M. Yamada, MD FACC

The study revealed that:

• more than 30% of patients who underwent elective coronary angiograms did not have coronary artery disease
• over 60% did not have significant blockages. 

The study concluded, “Better strategies for risk stratification are needed to inform decisions and to increase the diagnostic yield of cardiac catheterization in routine clinical practice.”

Comment:

• These findings are not surprising. 
• Well over 1.8 million invasive angiograms are performed each year.  Unfortunately, many are unnecessary.
• 60% of patients undergoing invasive catheterizations should not have had the procedure performed.
• More concerning is that many angioplasties/coronary artery stents are placed unnecessarily. 

Author:  Gregg M. Yamada, MD FACC