The Coronary Artery Calcium Scan (CAC): How to actually know if you’re in danger
Sadly, despite the advances in modern healthcare such as drugs, angiograms and stents, heart disease is still the number one killer in Australia, UK and the United States. Yet we know that the majority of the heart disease is probably preventable by avoiding metabolic syndrome and its complications of high blood pressure, diabetes and poor lipid markers. Unfortunately many people only realise they have heart disease once they’ve developed chest pain in the form of a heart attack or angina or worse they die of a sudden cardiac event. By the time you're having a heart attack, severe damage is being done to your heart that often can’t be reversed especially if you’re hours or days away from a major hospital . This leads to heart failure which impairs your ability to walk and exercise and when severe enough, it impairs your ability to perform daily functions leading to a lifetime reliance of increasing doses of medications to keep the heart functioning and to a reduced quality of life.
It makes no sense to me that we screen everyone over the age of 50 for things like colon cancer, we screen men with a blood test for prostate cancer and we screen women for breast cancer with a mammogram, a type of X-ray, that actually looks to see if they have any changes in their breast tissue that might be cancer. Why don’t we then screen our heart with a type of X-ray? Instead the traditional approach is to rely on a set of risk factors and if you have enough of them then you’ll be treated for your high blood pressure, your “high cholesterol” and your diabetes with a number of medications in the hope that you don’t develop heart disease. And then one day when you’re walking up the stairs you’ll develop some chest pain and shortness of breath which you may or may not ignore initially.
If you decide to ignore it, the pains will come back next time you take the stairs and this is because the blocked arteries of the heart can’t supply enough blood and oxygen to the heart muscle itself and it starts to cry out for help. If you continue to ignore the pain or shortness of breath the blockage may one day completely stop the blood flow and you’ll develop severe chest pain. You'll either die before getting to a hospital from an abnormal heart rhythm or get to a hospital in time for the cardiologists to poke needles into your groin or wrist and feed wires into your arteries that lead back to the heart and try to unblock the clots that are starving your heart muscle of vital oxygen. If you’re lucky they’ll be successful, if not, well…. that’s no good. All in all its quite an unpleasant experience and is completely avoidable.
To me this whole set of circumstances is backward. Why wait till we get symptoms to start investigating whether we have heart disease… It just makes no sense. Wouldn’t you rather want know if you have an issue before you either drop dead, have a heart attack or develop life long heart failure? This is especially relevant if you are heading to remote locations as the life saving options will not be available in time.
The answer to this question lies in a simple radiological test called a Coronary Artery Calcium Scan or CAC scan. Much like a mammogram of the breast showing a likely cancer, a CAC scan actually shows if you have heart disease or not. It really does take the guess work out the equation. No more wondering if the high blood pressure you’ve had and the “high cholesterol” you’ve been treated for has actually caused any damage or whether you’re next in line for a heart attack because your parents and brother had heart disease.
The CAC scan can be ordered by any GP or a specialist. The procedure is very simple. You arrive at the imaging centre, get changed into one of their unflattering gowns and lie down on the CT table. You are then connected up to the CT machine via 3 sticky dots which measures your heart rate. The CT table, with you on it then slides in and out of the machine. The whole procedure takes about 5 minutes. The images are interpreted by a radiologist and you have your answer.
A zero score means that you have no calcium in your coronary arteries and it's very unlikely that you have any significant heart disease. In fact, a zero score means that the chances of having a heart attack in the next 10 years is about 0.4%, which is very, very low. You should be hoping for a zero score. A zero calcium score is also associated with a decreased chance of developing cancer and dementia as both of these are also related to metabolic syndrome. So a zero CAC score is great news all round. It can cost up to a couple of hundred dollars, depending on where you go and it involves as much radiation as a couple of mammograms (which is minimal) but it's a great investment in your future. You should have it done the closer you are to age 50, especially if you have some metabolic syndrome features and possibly earlier if you have a strong family history of heart disease. (1)
Any calcium deposits in your arteries means that you have some plaque present and that plaque has been around long enough to be become calcified or hardened. The calcification of the plaque is the body's way of stabilising the weakened area of the blood vessel to prevent it from rupturing and causing a heart attack. So if you have a positive calcium score you have some damage. The higher the score the more the damage. Calcium scores can be in the thousands.
Unfortunately, I had a positive calcium score. I’d exercised all my life, watched what I’d eaten or so I thought, never been terribly overweight but still ended up with a positive result. I was only 46 at the time. To say that I was shocked, annoyed, disappointed and angry is an understatement.
However, I am so grateful that I became aware of this test, a test I had no idea existed despite being an emergency physician. Once I’d had it done I no longer had to wonder what was going on inside there. I now had the information to drive me to improve my health and keep me living longer. .
Now here’s the thing, you should only get this test done if you are prepared to do something about the result. If your score comes back at zero, that is fantastic. That means that you have gotten away with things so far. But it is not a guarantee. If you don’t monitor your metabolic health, continue eating and drinking the wrong things your score may start to rise and now you have a problem.
If your score is positive like mine was then you need to evaluate everything you’ve done in your life that led to that score. You should see a cardiologist and probably have some further tests. You should reverse any elements of metabolic syndrome that you can and you may even need to take some medications and supplements depending on the severity of your disease. But the important thing is that you’ve found the problem before it has harmed you. I’m sure no one wants the surprise heart attack especially in the middle of the Canning Stock Route.
So why don’t these tests get done more often and for more people? Well that’s an interesting question probably best answered by watching the following video https://www.youtube.com/watch?v=NSPcuGjstN4 that was put together by the Irish Heart Disease Awareness group. Funded by an Irish businessman who was a marathon runner and thought to be in excellent health by all standard medical tests. He was found to have a very high score with diffuse disease in all his coronary arteries. He went on to form this charity to create awareness and spread the word about the CAC score. His spokesperson, Ivor Cummins, a systems engineer with a biochemical background, has done extensive research into the root cause of heart disease and how the CAC scan can be of benefit.
It’s thanks to Ivor that I know my score!
You should know yours too.
(1)The Cardiac Society of Australia and New Zealand
Coronary Artery Calcium Scoring – Position Statement