Every other week, the "Living Better Newsletter" provides the latest medical expertise on how to maintain and improve your health and well-being.
Dartmouth Health Writer Erica Houskeeper has a history of heart disease in her family. She recently sought advice from Dartmouth Health cardiologists on prevention that goes beyond the typical recommendations of maintaining a healthy lifestyle and monitoring cholesterol and blood pressure.
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November 26, 2024
How a calcium score can pinpoint evidence of plaque in your arteries.
My mother survived a heart attack at age 51, but my brother died from one at 59.
I was in eighth grade when I watched my mother get whisked away in an ambulance. After 10 days in the hospital, she went on to enjoy a long and active life.
Unfortunately, her youngest son—my older brother—was less fortunate. In August, he died of a heart attack while kayaking in Southern Vermont.
In a fog of crushing grief, I met with my doctor and asked, "Is there more I can do to prevent this from happening to me?"
For those with a family history of heart disease, the risks—such as smoking, a fatty diet and lack of exercise—are well understood, as is the importance of monitoring cholesterol and blood pressure.
But what other preventative and monitoring measures exist?
Knowing and measuring your risk
"The next level of heart disease prevention is understanding your unique risk," says Dartmouth Hitchcock Medical Center (DHMC) Cardiologist Mounica Yanamandala, MD.
Upon hearing the news about my brother, my primary care doctor ordered me a calcium score test. The test involves a CT scan that examines if and how much calcium—hardened plaque—is in your coronary arteries.
"I like the calcium score because it's a type of precision medicine where you can hone in on the individual patient," says Scott Rogge, MD, a cardiologist at Dartmouth Health's Southwestern Vermont Medical Center (SVMC).
"A calcium score tells us, 'This is you, your vessel,'" he adds. "And I think that hits home and resonates with patients."
How to interpret a calcium score
A calcium score of 0 means there is no evidence of heart disease. A score between 1 and 10 indicates minimal disease, 11 to 100 shows mild disease and 101 to 400 reveals moderate disease.
Results showing moderate plaque can prompt a stress test, a prescription for statins, aspirin therapy or in some cases, an echocardiogram, which is an ultrasound test that checks the structure and function of your heart.
If your score is low, you can benefit from taking a calcium score test every three to five years. But if you have an abnormal score, repeat tests down the line are not recommended as plaque levels can't be reversed, Rogge explains.
Another benefit of calcium score tests is that they help identify patients who lack classic risk factors. Those patients typically aren't considered for a traditional heart disease calculation test like an ASCVD Risk Estimator Plus (atherosclerotic cardiovascular disease), which takes into account risks like hypertension and type 2 diabetes.
"Calcium scores are helpful for younger patients or those who don't have diabetes, hypertension or high lipids," Yanamandala says. "Finding plaque in young individuals is important because plaque is associated with the development of heart disease and poor outcomes in the future."
Family and other heart disease risk factors
Even if you lead a healthy lifestyle, you may carry genetic risks for heart disease.
"Family history is certainly a concern for heart disease and not something to be ignored," Rogge says.
While no single gene causes heart disease, multiple genes can interact to increase your risk. These genes can also contribute to factors like high blood pressure, high cholesterol and inflammation.
For instance, Yanamandala says lipoprotein (a) is a marker of inflammation that runs in families and can increase your risk of developing heart disease.
Research also shows that people with lupus—which causes inflammation throughout the body—experience plaque buildup and have a higher risk of heart disease.
"It's this kind of knowledge that's inspired a whole area of work looking into inflammation and its association with heart disease," Yanamandala says.
Focusing on prevention
Heart disease is the leading cause of death in the United States. Every year, about 805,000 Americans have a heart attack.
"There's an entire field of cardiology dedicated to prevention," Yanamandala says. "Preventive cardiology is for people with a strong family history, high cholesterol, diabetes or who are concerned about their risk of heart disease."
My calcium score test, which was not covered by insurance, took less than 10 minutes to complete and cost $116 at SVMC.
Much to my relief, my test score was zero. It means my risk of having a heart attack is only 2% over the next decade.
But I'm staying laser-focused on prevention. I'll schedule another calcium score in five years, continue taking a statin to manage my cholesterol, eat a heart-healthy diet and exercise regularly.
And for extra peace of mind and prevention, I'll find a cardiologist.