Dr . Sam Yared , Senior Physicians Speaker Series Chair , introduced Dr . Henry Sadlo , cardiologist with UofL Health on Tues ., March 5 . He is a graduate of the UofL School of Medicine and did his residency in internal medicine and fellowship in cardiology at Emory University in Atlanta , Georgia . He specializes in coronary artery disease , chronic high blood pressure and aneurysms , and treating heart valves , genetic heart disease and heart failure . Over the last decade , his main focus has been in preventive cardiology . There are three types of prevention : primordial , secondary and primary ; in this presentation Dr . Sadlo focused on primary prevention .
In 2014 when he started at UofL , he noticed a need for a screening program for coronary disease , the No . 1 killer of both men and women . Soon , the coronary artery calcification ( CAC ) screening program was up and running within just a month . Family history is the most important risk factor , he said , but others include diabetes , smoking , high blood pressure and weight . The CAC takes into account all of these factors .
The amount of calcium present in the coronary arteries is scored according to the Agatston scale :
• 0 – No identifiable calcium deposits
• 1-10 – MINIMAL calcified plaque
• 11-100 – MILD calcified plaque
• 101-400 – MODERATE calcified plaque
• 400 + – ADVANCED coronary plaque
While patient scores can be all across the board ( and yes , it is possible for some even age 70 and older to score a 0 ), the highest score Dr . Sadlo has seen personally is 6,900 .
Johns Hopkins and MESA ( The Multi-Ethnic Study of Atherosclerosis ) came up with a risk calculator that incorporates the CAC score and family history to determine a patient ’ s 10-year coronary heart disease risk with a major event . The inclusion of the CAC score can sometimes double the chances of a patient ’ s risk .
In some cases , a patient may have no symptoms even after receiving mild or moderate coronary calcium scan scores . However , every patient with a symptom – whether it be chest pain , shortness of breath , unexplained fatigue – needs a functional test of some sort . In those with a score over 3,000 and with shortness of breath , Dr . Sadlo recommends the patient get a heart cath . In his years
14 LOUISVILLE MEDICINE
Senior Physicians Speaker Series : Preventive Cardiology
by KATHRYN VANCE
1 : Red arrow over the circumflex coronary artery without calcification .
2 : Red arrow directly over the left and tear descending coronary , which is ABNORMAL .
of experience – having seen around 35 scores over 3,000 – the pre-test probability is about 90-95 % of obstructive , flow-limited coronary disease , either by a fractional flow reserve in the cath lab or a nuclear stress test . In patients with a score under 400 who are asymptomatic , he does not recommend stress testing . For those in the advanced category , he will begin discussions about doing some kind of functional test , but informs them it is not mandatory , and is rather a case-by-case , patient-physician decision .
Looking forward , Dr . Sadlo believes that men over 40 and women over 45 should be recommended to do CAC periodically ( generally , every three to five years ). He compared it to annual mammographs for women once they reach a certain age , noting that this test has the same amount of radiation and should be recommended and covered in the same way . He also said that calcium scans can result in incidental findings that may go undetected otherwise . Some incidental findings that he ’ s seen include pulmonary nodules , thoracic aneurysms , mediastinal masses and bone findings like schwannomas . Also , while all patients will receive their CAC score , the radiologists within the UofL program also look at the ascending and descending aorta for calcified plaque , which significantly increases stroke risk .
To close , Dr . Sadlo reminded the attendees that sometimes , despite doctors ’ and patients ’ best prevention efforts , you can have an acute plaque rupture with any amount of plaque . “ Do not sit at home and ignore chest pain !”
Kathryn Vance is the Communications and Event Coordinator at the Greater Louisville Medical Society .