In my last post, I discussed what a heart scan score, or coronary calcium score, means.

You may recall that coronary calcium serves as an indirect gauge, a "dipstick," for the amount of atherosclerotic plaque present in the three coronary arteries. Unlike "risk factors" like high LDL cholesterol, high blood pressure, or c-reactive protein, a heart scan score tells you that coronary atherosclerotic plaque, the stuff of heart attack and heart disease, is present and how much.

So, say you have a heart scan score. Perhaps it's even a high value, such as 500. What now?

First of all, don't panic. The vast majority of people who have heart scans are without symptoms. The score signifies that you have some amount of "silent" plaque not causing symptoms. (If you have symptoms of chest pressure, abnormal breathlessness, or similar symptoms, that changes the situation. This will need to be discussed with your doctor and a cause sought, including exploring whether heart disease is the cause underlying these symptoms. An evaluation typically begins with a stress test, a provocative test to relate the potential cause-plaque-with the potential effect-chest pain or other symptom, since symptoms can come from other sources, as well, such as acid reflux, stomach ulcers, or gall stones.) 

Even if symptoms are not present, taking preventive action is important. Heart scan scores increase at the average rate of 30% per year if no preventive action is taken. If allowed to progress at that rate, potential for developing symptoms and potential for heart attack both escalate. 

What having a heart scan score does NOT mean is that procedures like heart catheterization, stents, or bypass are necessary. There is only one reason to take a person who has no symptoms, even passes a stress test, into the hospital for a procedure: to make money. Heart procedures pay doctors and hospitals very richly; prevention does not. Just having silent plaque should never be the sole reason to justify a major heart procedure. Rarely, someone who has no symptoms yet has a major abnormality detected by stress testing might benefit from proceeding onward to big procedures. But the vast majority of people who have no symptoms of heart disease yet have a heart scan score should not be put through heart procedures, regardless of score. 

Conventional guidelines, such as the Adult Treatment Panel-3 (ATP-3; viewable at the National Heart, Lung, and Blood Institute website, the standard guidelines (supposedly) used by your doctor to treat cholesterol values, do not incorporate heart scan scores very neatly into their advice. ATP-3 acknowledges the power of heart scans to detect hidden coronary plaque and to clarify prediction of potential for heart attack, but the guidelines do not recommend widespread screening. (One of their reservations is the "high cost," despite the fact that, in Milwaukee, Wisconsin, where I live, I can get a heart scan for $69 to $129. Because insurance doesn't like to pay for screening tests, it is largely self-pay. But I would hardly call that a "high cost.") The guidelines also fall short on recommending what course of action to take.