There is still no definitive evidence from randomized controlled clinical trials to show that patients with elevated calcium scores who are treated to lower their risk actually experience a reduced rate of cardiac events. Researchers at Wake Forest School of Medicine have calculated that it would require a costly trial of about 30,000 people deemed to be at low-intermediate risk of a future heart attack to show such benefit.
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Two of our physician contributors weigh in
Adam Cifu MD
“I generally find calcium scores unhelpful,” said Adam Cifu, MD, and internist at the University of Chicago. “Often patients don’t need it. Either they are at low risk and the results are meaningless, or they’re at high risk and already maximally risk controlled and the results lead either to to anxiety or false reassurance.”
But Cifu adds that he will rarely order the test in very specific circumstances.
“Usually this is in patients without traditional cardiovascular risk factors. They have normal lipids but a worrisome family history. These then are low-to-moderate risk people in whom a high calcium score would make me more aggressive about modifying their risk factors with something like aspirin or a statin. It may not be an evidence-based approach, as there are no trials to fully support this, but it is reasonable based on previous studies.”
Christopher Labos, MD
Cardiologist Christopher Labos, MD agrees.
“It simply refines risk prediction,” said Labos. “If you had a medium risk patient and weren’t sure about whether you should start a statin or not, the calcium score could help tip the balance. If the calcium score was high that would help justify starting the medication.”
But he raises another point which highlights why Brody’s opening anecdote about her brother isn’t all that helpful.
“One of the main problems with calcium scans is even they’re completely normal, you still need to recommend the healthy lifestyle changes. So you haven’t really gained anything.”
