Treatment guide: heart scans for heart disease

This is the first of a series of paid-for reports explaining the five basic pillars of good health. For more information and to read previous columns of this type, visit our Science Commission on Health

Most patients undergoing coronary calcium scans would see this test as the last resort because the results are usually not conclusive. It tells you how much calcium has accumulated within the walls of your coronary arteries.

Most people need only a simple blood test to detect calcium in their blood vessels. “Early detection is the number one benefit of coronary calcium scanning,” says Dr Ed Zullo, a London-based consultant cardiologist. “Of the 1,300 patients I see each year, around 70% respond positively to this test.”

The heart imaging technique is currently only available through a few specialist hospitals in the UK. For a scan to be processed, either by a European Heart Diagnostic Imaging (EHDI) equipment, or a US firm, for which the technology is licensed, a patient must have a T-scan awn fit on an artery, or need this for emergency treatment (if an artery bursts, for example). The table above illustrates the consultation process, and costs from £300.

The screen is performed in two separate stages: the image scan is taken using a swab and then advanced x-ray images are assembled. Patient results are stored in a database and re-viewed by a cardiologist who then provides treatment recommendations.

“There’s some debate as to the health implications of this scan for people who don’t need to be scanned,” says Dr Stuart Walsh, the author of the book University of Science Report on Health. “People who have had heart attacks may need this scan, but there may be warnings for non-invasive tests as well.”

The risk of heart disease is mainly increased by the fact that people who smoke, have diabetes, high blood pressure or get enough physical activity are much more likely to suffer the disease. It is then exacerbated by family history and a sedentary lifestyle, both of which are bad for the heart.

However, most people in the UK are not at risk of heart disease. However, many are obese, unhealthy and are sedentary, which all increases the chance of early heart attack. By accumulating passive coronary calcium, the human heart can begin to seek out and store damaged vessels. When this happens in men, as in boys, this can cause aortic stenosis, a narrowing in the aorta – the body’s largest artery.

By age 40, someone with atherosclerosis can expect to have a seven-fold increase in the likelihood of an early heart attack, and by age 70, the increase can be 50-fold. “This is very striking and scary to people,” says Zullo. “I’ve seen patients come in at such a young age and have very late diagnoses because of the test.”

More than half of the people who develop coronary calcium in the heart also have an established history of coronary artery disease. This means that 50% of people who have a heart attack and coronary calcium are also at increased risk of that heart attack occurring again, so screening may be expensive and unnecessary.

There is also some debate as to whether the scan itself is useful for providing a simple blood test for calcium levels, although both scans and blood tests are not suitable for routine use.

But, says Walsh, “the ability to detect this type of information – calcium or otherwise – is so important.”

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