Evaluating the health of your coronary arteries is clearly key in determining your risk factors of heart disease, suffering a heart attack or stroke. Here are four important tests to consider when assessing arterial health and heart-disease risk.
Tests for Assessing Risk Factors of Heart Disease
Electron-Beam Computed Tomography (EBCT)
Electron-beam computed tomography, or EBCT, is a sophisticated, noninvasive screening procedure for measuring hardened plaque in coronary arteries. EBCT is also proving to be a reliable way to assess heart attack risk factors in people with no (or few) other known risk factors.
Although all the significant risk factors of heart disease are not yet known, the amount of calcium in coronary arteries is certainly one of them. For example, measuring calcified plaque in coronary arteries was shown to be a better predictor of substantial heart attack risk than any of the other cardiovascular disease risk factors identified in the famous Framingham Heart Study: high blood pressure, high cholesterol levels, obesity, cigarette smoking, diabetes and physical inactivity.
More specifically, research shows that a calcium score greater than 1,000 places an individual in at least the 75th percentile of risk (and perhaps in the 90th percentile or higher) for sudden death due to heart attack. Although there has been considerable controversy over the significance of coronary calcification from organizations like the American Heart Association, I concur with the research cited above and strongly recommend EBCT as a screening tool for hidden, undiagnosed or silent heart disease.
I consider any EBCT scan score over 100 to be a concern. A person with a score of 100 is at three times higher risk of sudden death than someone with a score of zero. A score of 1,000 or more raises your risk to 12 times that of someone with a score of zero. This test is invaluable for people who have heart disease symptoms or who could benefit from some improvement in lifestyle habits. Insurance may or may not pay for the scan, which costs approximately $400 to $500.
64- or 128-Slice Coronary CT Scan
A test for detecting arterial plaque that is even more advanced than EBCT is called the 64- or 128-slice coronary CT scan. This new technique is the noninvasive equivalent of putting a camera inside the coronary arteries and assessing plaque and calcification status. (Note: "Slice" refers to a particular viewing angle, not actual slicing of the arteries.) The slice method provides previously unobtainable visualization of the coronary arteries, with much less radiation and risk than the former gold standard—the coronary angiogram (see Angiogram below). If your cardiologist orders a standard, invasive angiogram for you, ask if a 64- or 128-slice coronary CT scan can be done instead.
Intimal Medial Thickness (IMT) Analysis
One of the latest and greatest screening tools available to cardiologists today is ultrasound imaging of the carotid artery. The measurements obtained from pictures of these crucial arteries to your brain are expressed as carotid artery intimal medial thickness, or IMT for short. Increased IMT is now considered a reliable, independent risk factor of heart disease and stroke.
I highly recommend IMT analysis because of its consistent ability to identify soft, transient plaque. Identification of this soft plaque is one of the newer ways to predict who‘s at risk for heart disease, including sudden death. This advantage of measuring soft plaque helps me identify an important risk factor that could otherwise be totally missed. You see, it‘s been observed that people with soft plaques in the artery to the brain are more likely to have soft plaques in the heart as well. They need aggressive lifestyle changes and identification of other risk factors of heart disease.
Another advantage of the carotid artery scan is that you don‘t get the radiation exposure you get with angiograms. IMT is a safe and inexpensive method to help predict heart disease, as well as determine who really needs more invasive tests.
A coronary angiogram, or cardiac catheterization, is the “gold standard” for evaluating the presence and extent of obstructive coronary heart disease. This invasive procedure is done while you‘re awake after local anesthetic is injected into the groin area (to access the femoral artery) or the bend in the arm (if the brachial artery is used). Usually, we only use this test after a noninvasive procedure indicates the need. Angiograms are also used to evaluate heart valves, especially if surgery is being considered.
More Dr. Sinatra Advice on Heart Disease Tests
What other heart disease tests should you consider? Get information on the array of heart disease tests I use when evaluating and treating my own patients.
Undergoing heart disease testing but unsure what your scores indicate? Get my Sinatra Smart Zone values for a wide array of heart health tests to ensure optimal heart health.
Want to read detailed questions and answers about different heart disease tests? Check out the Q&A section of my Heart Disease Tests Health Center.