GETTING TO THE HEART OF MEDICINE
PREVENTIVE CARDIOLOGY: FOCUS ON CORONARY
CALCIUM IMAGING
AUTHOR Henry Sadlo, MD, FACC
died unexpectedly...”
I see this way
too often in the paper. In
a majority, the most likely
cause is acute plaque rupture,
leading to arrhythmia/acute
myocardial infarction.
I always wonder “A63-year-old,
if this individual could have been saved, if they had known about
their coronary artery disease, five, 10 or 15 years earlier.
Knowing your coronary artery health early can, for most patients
(not all), be a strong a motivator for preventive cardiology, and gets
people to work harder on aggressive risk factor modification and
healthier lifestyles (that we should be already following anyway, right,
Dr. Mandrola?). Knowing early can help people to adopt more of a
plant-based, healthy heart diet. Knowing can get people moving—
increasing aerobic exercise of moderate intensity to at least 150
minutes/week. Just as important is taking aggressive high intensity
statin therapy, to slow down the progression of atherosclerosis.
I try to get low-density lipoprotein (LDL) cholesterols under 70,
ideally, for patients with documented coronary artery disease, and
perhaps an LDL under 50 for diabetics, as some in the European
heart societies have already adopted. LDL lowering with statins has
been shown for over three decades to reduce the risk of myocardial
infarction and stroke in at-risk individuals.
PERSONAL INTEREST
My personal interest in preventive cardiology, and coronary calcium
imaging, stems from the fact that my own father, at 72, with
no warning, had a heart attack. Tests showed a previous silent
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myocardial infarction (MI) and advanced three-vessel coronary
artery disease. Fortunately, he was saved by the good Lord and Dr.
Layman Gray’s multi-vessel bypass. He lived another 11 years with
the help of modern surgery.
Knowing that genetics is a very strong risk factor led to my
interest in coronary calcium imaging, or CAC scanning (CAC).
Ten years ago I spent a week at Johns Hopkins Cardiology, learning
about CAC, and the more detailed CT coronary angiogram procedures
(CTA). The CAC involves very low dose radiation, about
one millisievert, about the same as a mammogram.
CAC impressed me as an inexpensive screening test, a simple
CT scan, to measure the burden of calcific coronary artery disease
(CAD): mild, moderate or advanced. A score of zero (no calcified
plaque) brings a very favorable prognosis. We should all remember
our elders pointing out the clearly demarcated, heavily calcified coronary
arteries on numerous patient’s chest films at the Department
of Veterans Affairs as, “not a good sign.”
THE BASICS
In 2014, our group started a Preventive Coronary Calcium screening
program at the University of Louisville, with the help of Dr.
David Dunn, Dr. Greg Postel, radiologist Dr. Garth Beache, and
Mike Goode, RT. I am thankful that today we have multiple skilled
radiologists and a very helpful technical staff to get each patient
detailed interpretations, with breakdown of scores in the four major
territories: left main, left anterior descending, left circumflex and
right coronary artery. The score of calcified plaque in each artery
is added up, and a total score is generated.