Volume 3, Issue 46
December 2, 2010
Should you know your
Wouldn’t it be great if you could predict with almost complete certainty if you were going to have a heart attack or not? Well, a recent article in the Journal of the American Medical Association says you might be able to. But is it really worth it?
The article says that your coronary artery calcification score can predict whether you will develop a “cardiovascular event” or not. That means either angina (heart pains) or an outright heart attack. The conclusion that many might arrive at when looking at the results of this study is that measuring your calcium score is a good thing to do. In fact, your doctor may give you the idea that it will somehow alert you if you have an increased risk.
But before you rush out and ask your doctor to measure your calcium score, let’s look at the actual numbers. I think you’ll see why I don’t recommend this test.
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Your doctor determines your calcium score by taking an X-ray of your heart using a CT scanner. This involves more than just a trivial amount of radiation.
The scanner measures the amount of calcium that you have in your coronary arteries. These are the arteries that often get clogged up and can lead to heart disease. The overall amount of calcium that you have in your arteries is used to compute your calcium score. The higher your calcium score, the more likely you are to develop coronary artery disease at a later date. There is no debate about this.
The problem is that a different study, this one published a couple of years before the first, made an important discovery. It found that the actual number of people for whom this test would be valuable is extremely low. So low, in my opinion, that it’s not worth doing.
This study appeared in the New England Journal of Medicine. In this study, researchers measured the calcium scores of 6,722 healthy men and women. Then they followed the participants for an average of 3.8 years.
According to the results of the study, in those people with a calcium score of zero, only 1 in 400 will go on to develop a cardiovascular event. In those with a calcium score between 0-100, about 6 people in 400 will have one. In those with a score between 100-300 only 12 in 400 people will have one. And in those with a very high calcium score — greater than 300 — only 15 out of 400 will have a cardiovascular event. I maintain that this is not very helpful information. Just look at the people with the very high calcium scores greater than 300.
Out of 400 people who have a calcium score over 300, the overwhelming majority of them, 385 to be specific, never had one single problem. This means that 96% of everyone with a very high calcium score will worry needlessly, and will not be alerted to anything that actually happened. In the group between 100-300, still considered an elevated score, 388 never had a problem. In this group, 97% will worry for no reason at all. And, of course, the value of the score becomes even more useless the lower the numbers go.
I’m sure that I can come up with a better guessing rate than that simply by watching a patient walk across the room! You probably can too.
So forget having your calcium score measured. Save your money, and save yourself from extra radiation. Radiation from CT scans increases your risk of cancer. Yes, it’s a small increase in risk. So if you really need one, go ahead and get it. But who needs the extra risk, small or not, from a test that gives no helpful information better than 95% of the time? And who needs the false worry?
Here's a better idea. Instead of getting your calcium score, get your fitness score. Develop a regular routine that you stick to that will put you in good cardiovascular condition. This is your best guarantee against heart disease, and just about every other disease out there.
Finding your Real Cures,
Frank Shallenberger, MD
REF: Polonsky TS, McClelland RL, Jorgensen NW, Coronary artery calcium score and risk classification for coronary heart disease prediction. JAMA. 2010 Apr 28;303(16):1610-6.
Detrano R, Guerci A, Carr J, et al. Coronary Calcium as a Predictor of Coronary Events in Four Racial or Ethnic Groups N Engl J Med 2008; 358:1336-1345, March 27, 2008.
Copyright 2010 Soundview Publishing, LLC
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