Multi-slice computed tomography
Heart disease is the No. 1 killer of Americans, claiming some 800,000 lives in 2017 and accounting for one out of every three deaths. More than 90 million Americans are living with the disease today. Lifestyle changes are slowly making a dent in those grim statistics, but we’ve got a long way to go. That’s why testing is so important for people who are at higher risk.
Dr. Bijoy Khandheria, a cardiologist at Aurora St. Luke’s in Milwaukee and the former chair of the Mayo Clinic’s Division of Cardiovascular Diseases, says those risk factors include obesity, a family history of heart disease, high blood pressure (hypertension), diabetes, smoking, a sedentary lifestyle and an abnormal cholesterol profile, meaning “bad” (LDL) cholesterol of 130 or higher and “good” (HDL) cholesterol of 39 or lower. Notably, one’s risk profile increases with age; simply being a male over 50 is considered a risk factor.
“Beyond the stress test, EKG and echocardiogram, the best predictor of disease of the blood vessels is the cardiac, or multi-slice computed tomography (CT) scan, also called a noninvasive angiogram,” Khandheria says. This 3-D computerized image measures the amount of calcified plaque in the blood and is extremely accurate in predicting blockages in blood vessels. Calcified plaque is a key warning sign of coronary artery disease since it shows up long before a heart attack strikes. The goal is to catch the problem early and begin treating it in hopes of preventing a heart attack or stroke.
The test involves spending 15 to 30 minutes in a scanner, depending on the age and speed of the machine. Newer models, such as the one at St. Luke’s, are faster and expose the patient to far less radiation.
Most at-risk people are good candidates for this procedure, with the notable exception of those with advanced chronic kidney disease (CKD). Because a dye is inserted into the bloodstream, patients with CKD may not be able to excrete the dye, which carries a low but real potential of toxicity. Also, hypertensive and diabetic patients need to be carefully evaluated by their cardiologist to asses them for risk of toxicity. The scan may or may not be covered by insurance, and it may or require pre-authorization or a preliminary stress test.