Coronary Artery Calcium Scoring - What is it, and who should have it done?

Coronary Artery Calcium (CAC) Scoring is done by a CT scan of the heart, looking for calcium plaque build up in the coronary arteries. This is a screening test, which means it is done on people who feel well - no chest pain, no problems breathing, no known heart disease. However, it is not a test that is recommended for everyone.

I find this test most helpful in patients who are at a higher risk for heart disease based on their cholesterol results or family history, yet aren’t certain they want to start taking a statin medication (such as Crestor, Lipitor). In these patients, having additional data to gauge heart disease risk helps in making the decision on how aggressively to treat.

There are some potential down sides to getting this test done. For one, a CT scan exposes a patient to radiation (though a small amount, about the same as a mammogram). Further, though the scan is intended to evaluate the heart, it will show the entire chest. This brings the risk of incidental findings, which I and most doctors dread, because it often leads to unnecessary testing, procedures, and cost. This is one reason why it’s always important to think critically about ordering tests. One good question to ask is, will this test change what I plan to do?

So if you have high cholesterol or other risk factors for heart disease, talk to your primary care about your personal risks and benefits of Coronary Artery Calcium Scoring!