Coronary Artery Calcium Score
 

It is becoming more common to see the recommendation that if you are worried about cholesterol numbers, have a CT Coronary Artery Calcium Score done. The history of the resistance to its use was part of the movie 'The Widowmaker.' Dr. William Davis has used it for years, now it is accepted by the NIH and AHA as a useful test.

Dr. Jeffrey Gerber had his done, here is his review of the procedure. http://denversdietdoctor.com/lchf-1...ium-score-zero/

The question of cost was started on another thread.
My previous posts were:

Here's what my Radiologist's office has to say about coverage...likely to vary by state. In Texas it is mandatory thanks to one legislator who pushed for it.

http://www.wakerad.com/procedures/a...alcium-scoring/

Once you find out how it works in your state, call around to various radiology labs to find the cheapest. Our state and BC have a big push to shop price...they are putting common procedures on a website. Get out of high cost areas and go to the rad lab of a small town hospital and maybe cut the price dramatically. Or not. Duke! had the cheapest hospital colonoscopy in the Triangle, way cheaper than the private gastro I used ten years ago.

At one local hospital, a CAC is $225, you do need a doctor's order to have one, and BC/BS does not cover it because they still consider it an "investigational service or procedure". The privately owned Radiology practice I use charges $350 (umm...need to check my Mammo prices ) Now to check a few other hospitals as it is not on that BC price checker, since it is not a covered service.
But possible checking other CT heart procedures will direct me to other cost effective solutions.
. [Edit, this didn't work well, price for stents and the heart procedures on the price checker are all over the place, and not related to the Radiologist's prices]

Haven’t done a thing since those original posts, until now. (DH has doctor appointment tomorrow). Found a community health service down on the coast that charges $125 and $149 at a radiologist in Charlotte. Helpful info about the test at http://www.charlotteradiology.com/p...s.cfm?proc_id=7

Now to find a place without the road trip, but I have a base line price....

Edit a few minutes later. $150 right in our town. :thup: A private imaging service I have not heard of before, But googled Radiology near Raleigh to find it.

2/10th of a mile and $200 separate the two private radiology practices in town. :)

I'm thinking of having one done in February (heart month). My doctor wrote me up a prescription for a local lab that she says typically has a special during heart month. I haven't started shopping price on it, but I will be soon. I'll post what I find.

:thup: Oh, what a good idea. Will call back that bright receptionist (who knew the price off the top of her head...try getting any price info out of any hospital!) and ask if there might be a special next month. Definitely need a doctor's order in this state. Thanks Ken, knowing what the going price is around the country will be helpful. So many CT scanners now, the price has supposedly dropped, along with the dose of X-ray needed.

I had a CT scan done over 5 years ago, maybe closer to 10 now. At the time it was $250, none of it covered by insurance. I bet the price has dropped dramatically by now, will also be curious what it runs.

My doctor urged me to get it because 1) they had a new machine and they were recommending everyone get it (at least she was upfront, they needed to pay for the machine) and 2) because it would give me a more accurate view if I should be worried about blocked arteries (both parents died of heart disease). I already had lowish cholesterol (thanks to LC) but my zero score gave me real peace of mind that there was not something serious lurking.

Ken you seem like the perfect candidate since you've been a bit concerned about your cholesterol since eating LC.

:thup: :thup: Great Tip, Ken

$99 for :rheart: :rheart: month.

Saved $250 over my usual radiologist.
Doctor will fax order to this Diagnostic Imaging service, they will call us to make a Feb appointment.

Excellent interview with Dr. Malhotra on the "Fat Summit" on cholesterol, heart disease, statins, etc. He mentioned this alternate Risk Calculator (from UK in cm and kilos).

http://qrisk.org

It's Treatment threshold is 20% Not the 10% in US that triggered my DH's doctors advice based only on his age and a slightly high LDL. His fantastic Trig/HDL ratio is ignored. This UK and the US calculator both use HDL and total, but not Trigs.

http://qrisk.org/BMJ-QRISK2.pdf

Dr. Bernstein on the CAC and statin side effects: https://www.youtube.com/watch?v=6lr...L4BPhvMo0Ck_lcY

In May 15, he said the radiation was not insignificant...need to look into this more.

Also Direct Labs February specials are all Heart related...including the Cardio IQ , another version of a lipid panel that gives particle numbers and extra info.

"Description of Cardio IQ:

This panel directly measures your standard lipid panel in addition to your lipoprotein subfractions. LDL exists as small, dense molecules and large, buoyant ones and evidence suggests that more small particles greatly increase the risk of heart disease. This test also measures your Apolipoprotein B and Lipoprotein(a).

This is a good test for people who are already on cholesterol lowering medications."

http://education.questdiagnostics.com/faq/FAQ134

http://education.questdiagnostics.c...entation_id=332



EDIT: Here is the average Radiation dose...not bad, but as Dr Bernstein said...once every ten years would OK.
http://www.radiologyinfo.org/en/info.cfm?pg=safety-xray

Article on the CAC today on MedPage:

The final conclusion... :thup: :thup: :thup:

This test was a snap, not even ten minutes, clothed except for top shirt, and results were back a few days later. Only a score of 1 for a 67 yo man who had a high stress job many years and has followed LCHF for past five years!

(Almost) unbelievable, the doctor's note suggested that this test shows little calcified plaque, but not newer plaque in process (what test shows a problem before it happens? :lol: maybe your cholesterol will go up in the future?) and with the new AHA risk assessment cholesterol lowering medication may be considered. Even the doctor couldn't bring himself to say he would prescribe statins at this point, but he CYA'd his chart.

I of course cornered the poor technician for a discussion on radiation dose. The test results include dose now, and she gave it to me after the scan. CT's are measured in DLP and CTDI, and that can be converted to Milliseverts.
http://www.xrayrisk.com/index.php
The newest CT machines use a much lower dose than previously (and thanks to some lobbying, a state law requires imaging centers to use the lower dose machines by x date) and armed with the actual dose, and nifty conversion tables, this proved out. Where the estimate for a CAC was 3 in the above link, my DH's exposure (it will vary by person) was a little less than half that. So that's about three times a mammogram now, which is still exceedingly low. The tech also explained that the CAC exposure is focused only on a small rectangle over the left chest (my concern is right chest). So although she may have been doing a sales job for their $99 special, I was assured enough to go ahead myself.
Read up on this test, watch the WidowMaker, and consider it if a doctor starts using that S Word. Very reassuring.

Janet, this is fascinating. Thanks for posting it! I was thinking of waiting until 65 for one, but maybe I should get one now (57).

Well worth getting the test. It found my heart disease.

Must save this thread :thup:

Glad this thread popped up again, a reminder to get a doctor's order for this. The $99 special is for both heart month and next (Feb and March at our imaging center) so it had dropped down my to-do list.
Indylm, sure the CAC alerted your doctors to much more than just the cholesterol levels. Better to develop a targeted treatment plan for you and your FH.

Absolutely Janet!!

Dr Kendrick' VERY long series on Heart Disease discusses calcification today. http://drmalcolmkendrick.org/2016/0...disease-part-x/
Confident my DH won't die of heart disease now. I see my GP tomorrow and will get an order for CAC before month end.

My GP was happy to order to CAC (and impressed by the $99 price, so much less than Duke...like this should be a surprise to her :lol: ) The good news is that the score was low enough after plugging score/age adjusted and other coronary markers into all the Risk Evaluations she did not recommend statins or any medical interventions. Just improve lifestyle. My understanding is that once calcium is in the arteries it doesn't reverse...you just do not want to see progression. My score was 14 (Low end of Mild evidence of CAD) for plaque in one artery, so now I can worry why, what in my past formed it? Years of overweight, not enough exercise, too much calcium?....whatever, it is truly low on the scale, but I'm miffed at the all the 0s and 1s other LCers have ;) The test is super simple, hold your breath a few times, the scan is "open" so no loud noise or enclosed feeling. But as my GP said, you also have to be prepared that the test will show something and then she would advise statins. We know that wouldn't end well. :)

Score levels and further info: http://www.radiologyinfo.org/en/inf...g=ct_calscoring

http://www.mayoclinic.org/tests-pro...on/prc-20015000

Yes, and isn't this true of all medical testing?? I've got some tests lined up, but I'm not so sure I want to know.

Glad you feel reassured about your arteries now, in spite of the What did I do? questions about your past.

Thanks for the report, Janet. Nice to see a play-by-pay for your experience with the test. Congratulations on getting an acceptable score. At least now you have a baseline to measure against on future tests.

I planned on having one done by now. I lost the prescription that my doctor wrote me for it 6 months ago and I forgot to ask for another one at my checkup last week. I have a smelly colon test that I'm doing now and I will be returning it to the doctor's office in a few weeks. I'll call ahead and get another prescription. I would like to have a baseline, too. I'm aware of the possibility that I may not like what I see. But it does not do any good to bury your head in the sand. I am cautiously optimistic, though - after the last cholesterol labs I just had. :thup:

Being competitive, I am just miffed that DH (skinny all his life) got a 1 :lol:
Not sure where I read this, but a CAC, if you don't have flagrant evidence of disease, is a one-time thing. A high score (in the hundreds or over 400) may indicate that more invasive tests be done? If it is low at age 65, you're good. We all calcify as we age everywhere around the body (isn't that reassuring!) so over 75 this test is less telling.
http://www.docsopinion.com/2014/08/...-calcium-score/

Dr. Jeffrey Gerber's poster presentation at AHS16 on Challenging Cardiovascular Risk Assessment . http://denversdietdoctor.com/challe...isk-assessment/
Then download a high-Res .pdf which includes the CAC scoring.
http://denversdietdoctor.com/wp-con...mmins_Final.pdf

Here is a new study using the CAC score to analyze what Calcium supplements can do to our arteries. This study may be the explanation why my DH's score was 1 and I had a 14.
I stopped taking extra Calcium a few years ago, but now Searching for a multi without any.

https://www.peoplespharmacy.com/201...heart-arteries/

Hmmmph. Time to ditch the calcium sups, which I have taken conscientiously for many years. Funny how we just keep doing stuff our doctors recommended.

I like that this study included the fact that FOOD provides all the good calcium our bodies need.

I'm happy that I followed my doc's advice to get a calcium heart scan. My calcium number is Zero. But since heart disease is a consequence of many factors, I mostly just feel lucky.

I found a multi at Costco without calcium that looks good...but since when did so many Adult Vitamins come as Gummi Candy!? Another trend I missed until today :lol:

Yeah. That gummi candy thing was always suspect for kids. Now--so-called adults need sugar to make the medicine go down? Hey--there should be a song about that! :lol: Perhaps a couple of generations brainwashed by Julie Andrews??

I remember Dr. Davis talking about calcium supplements ending up in our arteries years ago. I'm happy now I've never taken them for long. I do eat a lot of veggies with calcium, no dairy though, and sardines.

I stopped taking calcium supplements after watching this lecture https://www.youtube.com/#/watch?v=jqMSi3qQBRY by Dr Fung

I've been taking them religiously, ever since I got a DX of osteoporosis from a bone scan. The next one, three years later, had improved to osteopenia, so I thought I was doing the right thing.

I'll cut back. Not quite ready to quit, but I lower by a factor of three.

And, when I have a physical next month, will ask to have a CAC ordered.

Shop around for that CAC. Local hospital had a Heart Special. Fifty bucks. This may be one diagnostic procedure where you can actually exercise consumer choice.

Usual story - my wife and I had our physicals and the blood work showed that we had high LDL and total cholesterol, but with good HDL and triglycerides. (We are both 66.) Our doctor says we should both take statins. And we both said no - not with more evidence like a CAC score or better blood tests like NMR.

A nurse called back to us to say that we could get a CAC from the hospital associated with the doctor's office for $450!! Each!

We found another option in a nearby town (Lincoln, NE) that only costs $119 each. Since Medicare won't pay for it, this is a much better choice.

So...in just a few hours we will have the test done. I will post the results when we get them.