Experts Recommend Depending on Risk Factors That Fail 90% of the Time Instead of Having a Heart Scan

A news article from November caught my attention today in which critics argue against the usefulness of a coronary calcium scan, a quick, noninvasive test using a CT scanner that exposes a patient to less radiation than two chest x-rays and can detect cardiac plaque years, even decades, before the plaque shows up on a cardiac stress test.

Critics of a calcium scan argue that standard risk factors (measuring cholesterol and performing stress tests, for example) are effective enough to identify impending cardiac events. The problem with their “traditional risk factors,” as I discuss in great detail in Don’t Die Early, is that 90% of the heart attacks are not predicted by assessing traditional risk factors.

A stress test, for example, doesn’t typically reveal cardiac plaque unless an artery is 70% blocked, according to cardiologist Dr. William Davis in his book Track Your Plaque. Furthermore, only about 1/3 of heart attacks are caused by slowly forming obstructions, with the majority of them caused by nonobstructive plaque that ruptures suddenly.

So, while conventional medical wisdom advises every woman over age 40 to have a mammogram, health experts like Dr. Steven Nissen, a cardiologist at the Clevelenad clinic, advises against a non-invasive coronary calcium scan because “screening individuals without symptoms leads to unnecessary procedures.” I wonder if cardiologists who share Dr. Nissen’s opinion advise women not to have mammograms or a PAP smear. Or people over age 50 to have a routine colonoscopy. All of these assess the presence of disease in people who have no symptoms.

I argue that waiting until a person has cardiac symptoms and performing angioplasty, bypass surgery, or stenting, procedures that can easily cost 200 times more than a $200 calcium scan is an overwhelmingly bigger waste of resources and lives.

Which would you rather do:

Depend upon traditional risk assessment, with a 90% failure rate, to alert you to coronary artery disease. For most patients, this means that by the time plaque formation is severe enough to cause physical symptoms or show up on a stress test, your doctor is suddenly talking about rushing you to the cardiac catheterization lab as a prelude to angioplasty, stenting, or bypass surgery.

Have a noninvasive coronary calcium scan that exposes you to about the same radiation as two chest x-rays, takes less than five minutes, costs $49–$199, and detects coronary plaque a decade before it becomes severe enough to cause symptoms or show up on a stress test?

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