When someone close to us or beloved public figures die suddenly in their fifties (or even younger) from a heart attack, it suddenly raises our awareness of the deadly danger posed by undiagnosed heart disease. And indeed, statistics show that 50 percent of those who die from coronary artery disease (CAD) had normal cholesterol readings and no prior symptoms.
But how do you know if you're at risk, and how bad that risk really is? Here are five new heart tests that show impressive results in detecting heart disease early and predicting future risk of heart attack and stroke.
Calcium is one of the main components in the plaque that builds up inside coronary arteries, narrowing and stiffening them and obstructing blood flow to and through the heart. A CAC score of zero is considered ideal; a score over 400 indicates severe atherosclerosis. Although CAC scanning is still one of the lesser-known heart tests, a study in the New England Journal of Medicine a few years ago determined that the CAC test was a "strong predictor" of heart attack and fatal heart disease. The researchers followed close to 7,000 people, testing them for CAC, then followed them for more than three years, correlating the data with the number of fatal or life-threatening coronary events. Those whose scores ranged from 100 to 300 were seven times more likely to die of a heart attack or other heart ailment than those with low CAC scores, and those with scores over 300 were even more at risk.
How it's done: Scans for coronary artery calcium are done via computed tomography, otherwise known as a CT or CAT scan. Unfortunately, CAC scanning, like any other CT scan, isn't without risk. Research by the National Cancer Institute and Columbia University found that the average range of radiation exposure from having such a screening test every five years would cause 42 additional cases of cancer among 100,000 men and 62 additional cases among 100,000 women. Some doctors therefore advise holding off on CAC scanning until other tests show elevated risk.
Who should get it: The American Heart Association (AHA) now recommends a CAC test for people over age 40 with risk factors for heart disease. Recent research also shows CAC tests are particularly useful as an incentive for treatment. Two Canadian studies published in 2012 found that having a higher-than-recommended CAC score doubled peoples' likelihood of sticking to a statin regimen and motivated 40 percent of those studied to lose weight.
How it's different: CAC scores are considered the strongest predictor of future coronary events in people who are otherwise asymptomatic, according to the American Heart Association (AHA). A study published in the August 2011 issue of The Lancet found that CAC was a better predictor of heart disease than any other measure and can be used effectively to decide who should take statins and who's less likely to benefit.
Cost: $300 to $500; sometimes covered by insurance if ordered by a doctor as indicated by heart disease symptoms or "medium risk" of heart disease based on an assessment of risk factors. Check with your doctor and insurer first.7