Should I have a coronary calcium scan to check for heart disease?

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's advice.

Key points in making your decision

This information is only for people who are curious about their risk for heart disease but who don't have any symptoms such as chest pain. If you have symptoms, or if you have already been diagnosed with heart disease, this Decision Point is not for you. If you'd like to learn more about other tests for heart disease, see the Exams and Tests section of the topic Coronary Artery Disease.

Consider the following when making your decision:

• Coronary calcium scanning checks for calcium buildup in the coronary arteries. Calcium in these arteries is an early sign of heart disease. A high score on a calcium scan can mean that you have a higher chance of having a heart attack than someone with a low score.
• The results of a coronary calcium scan may prompt you to make some lifestyle changes, such as exercising, eating better, and quitting smoking. But if you're worried about heart disease, you can do these things even if you don't have this test.
• A calcium scan can give your doctor more information about your risk for heart disease. A high score might prompt your doctor to start or change treatment to help you avoid a heart attack.
• People who are at medium risk for heart disease will get the most benefit from this test. Medium risk means that you have a 10% to 20% chance of having a heart attack in the next 10 years, based on your risk factors. You can be at medium risk and not have any symptoms of heart disease. Check your risk with this Interactive Tool: Are You at Risk for a Heart Attack?
• You could get a high score from the test even if your arteries are not blocked. That could lead to other tests or treatments you don't need.
• Not all blocked arteries have calcium. So you could get a low calcium score and still be at risk.
• Most health insurance plans do not pay for this test. It can cost between $300 and $500.

Medical Information

What is a coronary calcium scan?

A coronary calcium scan is a screening test for people who have no symptoms of heart disease but may be at risk for getting it. The test uses computed tomography (CT) to check for calcium buildup in plaque on the walls of the coronary arteries. The coronary arteries wrap around the heart and supply it with blood and oxygen. Calcium in these arteries is an early sign of heart disease.

During the test, a CT scan takes pictures of your heart in thin sections. The result is a score based on the amount of calcium seen on the scan. The higher your calcium score, the higher your risk for a heart attack.

Most health insurance plans do not pay for coronary calcium scanning. The cost of the test can range from $300 to $500.

Another test, called CT angiography, can also tell how much calcium has built up in your arteries. This test costs more than a standard coronary calcium scan. It uses a special dye that is injected into a vein (IV) in your arm. CT angiography is best for people who already have symptoms of heart disease, and only if other tests are unclear.¹

Talk with your doctor if you want to know more about CT angiography. This Decision Point is about coronary calcium scanning.

Who should get a coronary calcium scan?

In most cases, the results from your physical exam and other tests will give your doctor enough information about your risk for heart disease. But your doctor may want you to have a coronary calcium scan if you have several risk factors. Risk factors are things that can increase your risk for heart disease, such as diabetes, high blood pressure, high cholesterol, and smoking.

You don't need to have your doctor refer you for a coronary calcium scan. But if you decide to have the test on your own, talk with your doctor first.

Coronary calcium scanning is most helpful in people who have no symptoms but who are at medium risk for getting heart disease.² Medium risk means that you have a 10% to 20% chance of having a heart attack in the next 10 years, based on your risk factors. Both the American Heart Association and the American College of Cardiology agree that people at medium risk can benefit from this test.³

To find out your risk, see the Interactive Tool: Are You at Risk for a Heart Attack? Or you can talk with your doctor about your risk for heart disease.

This screening test is not for you if:

• You don't have any risk factors for heart disease.
• You are at high risk for heart disease. (You should already be under a doctor's care.)

What do the results mean?

After the scan, you will get a test result that is a number. This is your calcium score. The score can range from 0 to more than 400. Any score over 100 means that you are likely to have heart disease. The higher your score, the greater your chance of having a heart attack.

People who score between 100 and 400 or higher, and who are at medium risk for heart disease, are 4 times more likely to have a heart attack in the next 3 to 5 years than people who score 0.¹

After you have had the test, talk with your doctor about the results and what they mean for you.

What are the benefits of a coronary calcium scan?

Many people only learn that they have heart disease when they have a heart attack. A coronary calcium scan is one way to find out if you have early heart disease before it gets worse. After you know your risk, you can make lifestyle changes such as eating a heart-healthy diet, getting more exercise, and quitting smoking. But if you're worried about heart disease, you can make these changes even if you don't have the test.

A coronary calcium scan can give your doctor more information about your risk for heart disease, especially if you already have risk factors. If your score is high, for example, your doctor may prescribe medicines to lower these risks. A high score may also lead to other tests and treatment that could help you avoid a heart attack.

What are the risks?

• You could get a high score from the test even if your arteries are not blocked. This could lead to extra tests that you don't need, or cause you to worry when there's no reason. But these kinds of results are most likely to happen in people who are at low risk for heart disease. So if you already know that you're at low risk, you shouldn't get this test.
• Not all blocked arteries have calcium. A low test score may make you feel safe even though you're still at risk.
• Over time and after many CT exams, there is a slight chance of cancer from radiation used during the test.

If you need more information, see the topic Coronary Artery Disease.

Your Information

Your choices are:

• Have a coronary artery calcium scan.
• Don't have a coronary artery calcium scan.

The decision whether to have a coronary artery calcium scan takes into account your personal feelings and the medical facts.

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about having a coronary calcium scan. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA=Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not to have a coronary calcium scan.

Check the box below that represents your overall impression about your decision.

Return to the topic Coronary Artery Disease.

References

Citations

1. Budoff M, et al. (2006). Assessment of coronary artery disease by cardiac computed tomography: A scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation, 114(16): 1761-1791.

2. Greenland P, et al. (2004). Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA, 291(2): 210-215.

3. Greenland P, et al. (2007). ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain. Circulation, 115(3): 402-426.