heart screening test

[Johnmos]

correction
Hi
I am a male 40 years old, 6'0 275lbs being treated for high blood pressure and cholesterol. I do not smoke and I exercise moderately 4 times a week. Besides the exercise, I have a desk job 5 days a week getting little other exercise. Someone suggested that I consider  inner imaging screening (EBT Hart scan). I am on Benicar and Vytorin, I was taken off of Lipitor two months ago because of the back pain and an elevated CPK 200's.  Recent blood test revealed my cholesterol at 118 but my CPK at 205 and still experiencing lower back back pain. My blood pressure is 110/70 to 120/80. No prior hart problems.
Do you think I should consider this image screening?

[Lee Kirksey, MD]

Great question,
I have posted a recent ny times article. Also view my blog on heart scan aka fast ct. The bottom line is that the presence of calcium ( which is what the heart scan evaluates) does not necessarily correlate with blockages which cause heart attacks. Furthermore, just because you have a blockage doensnt mean that you will have a heart attack. Some blockages referred to as unstable plaque, have a greater predilection to rupture and go on to cause complete obstruction of the blood vessel and result in a heart attack. Heart scan can not identify this unstable plaque, in fact no current test can accurately and reliably do so.

The heart scan exposes you to high doses of radiation equivalent to many chest x rays ( over 1000) and this radiation dosage is cumulative. so it is not without potential harm.

I think the heart scan serves a purpose in people who need tangible evidence to get off of their butt and change there lifestyles because they see blockages. For people already optimizing their life, it is unneccesary and potentially dangerous.

It there was some undetected heart problem in you, a stress test should identify a large percentage of these and a cardiac cath the rest. Good luck

http://www.nytimes.com/2008/06/29/business/29scan.html?ex=1372564800&en=79317c0449f0817c&ei=5124&partner=permalink&exprod=permalink

[A_Kap]

I'm no doctor, but I would definitely recommend getting a screening. You may have some hidden problem that is not directly visible.

Also, just some future suggestions... I noticed you said that you are 6'0'' and 275lbs... You should definitely work on lowering your weight. High cholesterol and blood pressure are contributed mainly by the buildup of fat.

[vctr]

You should first understand the difference between a Heart Scan (Calcium Score) and a CT angiogram the first being very low radiation and thus quite suitable for screening where coletsoral screening fails to identify 50 % of heart attack victims. Calcium scoring is difinitve and quantitcative. CT angiogram is a high radiation dose and not suitable for screening. An example of colesterol failure is mine total 180 and a very high( ninety percentile) for my age calcium burden per scan. and my wife total Col 275, and zero plaque per calcium score. The point is do i have a heart problem or not. No way od knowing without scan . for more info go to www.trackyourplaque.com

[Lee Kirksey, MD]

We agree that a heart scan is different than a CT angio. We also agree that a CT angiogram exposes the patient to more radiation than a heart scan. However the radiation dosage of a heart scan is not zero and the dose with each test is quite dependent on body habitus.

With regards to your comment that coletsoral (I think that you meant cholesterol) screening fails to identify 50% of heart attack victims. There is no medical evidence that demonstrates a statistically significant ability to predict heart attack based on quantitative calcium analysis. If you know of that information, please produce that body of evidence and I will be enlightened.

As I said in my comment, science has not provided us with a tool which allows us to assess the stability of a plaque. The stability of a plaque is what makes some plaques (composed of cholesterol/lipid and fibrous material) more prone to rupture. There is no medical evidence that a high quantity of calcium is related to rupture predilection. In fact, if we extrapolate from the other area of the body where plaques rupture, which is the carotid blood vessel, a greater quantity of calcium is less prone to rupture. Bottom line: the implications of the presence of calcium is unclear and if we look at most people over the age of 60, they will have calcium.

So what will your doctor do with your calcium score results. Will he stop treating your wife for high cholesterol because her calcium score is low: absolutely not. Will he start treating you with very high doses of cholesterol lowering agent, potentially increasing your risk of liver failure, for an unclear ultimate benefit,

If you would like to have everyone in the US undergo very expensive government reimbursed screening test so that they can then be put on very expensive government reimbursed lifetime medications (to the benefit of the pharmaceutical industry) before we have any proven benefit that the screening test is effective in decreasing death by heart attack, I firmly disagree with your thinking.

In fact, Ill go as far to say that in a country where 70% of people are overweight and 30% are obese and suffer from diabetes, a person should have to demonstrate that they have altered there lifestyle behaviors with smoking cessation, weight reduction, dietary manipulation and an active exercise program before I want my tax money spent to support screening and treatment of their problem that results from their self destructive lifestyle patterns.

And lastly, I don't need to go to an industry supported website to promote generating income from the manufacturers, sellers and distributors (hospitals and doctors) of technology to determine my position on the topic. You should go read the medical literature, not a promotional website.