Coronary artery calcium testing can reveal plaque in arteries, but is underused

Summary

A long list of Lynda Hollander’s paternal relatives had heart disease, and several had undergone major surgeries. So when she hit her mid-50s and saw her cholesterol levels creeping up after menopause, she said, “I didn’t want to take a chance.”A cardiologist told Ms. Hollander that based on factors like age, sex, cholesterol and blood pressure, she faced a moderate risk of a major cardiac event, like a heart attack, within the next 10 years.Doctors typically counsel such patients about the importance of diet and exercise, but Ms. Hollander, now 64, a social worker in West Orange, N.J., didn’t have much room for improvement. She was already a serious runner, and although “I fall off the wagon once in a while,” her diet was basically healthy. Attempts to lose weight didn’t lower her cholesterol.Her doctor explained that a coronary artery calcium test, something Ms. Hollander had never heard of, could provide a more precise estimate of her risk of atherosclerotic heart disease. A brief and painless CT scan, it would show whether the fatty deposits called plaque were developing in the arteries leading to her heart.When plaque ruptures, it can cause clots that block blood flow and trigger heart attacks. The scan would help determine whether Ms. Hollander would benefit from taking a statin, which could reduce plaque and prevent more from forming.“The test is used by more people every year,” said Dr. Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled between 2006 and 2017, his research team reported, and Google searches for related terms have risen even more sharply.Yet “it’s still being underused compared to its value,” he said.One reason is that although the test is comparatively inexpensive — sometimes up to $300, but often $100 or less — patients must pay for it out of pocket. Medicare rarely covers it, though some doctors argue that it should.Patients with a C.A.C. score of zero — no plaque — have low...