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Good news on heart disease

Newer CT scans can help doctors identify risks earlier.

When my dad was in medical school back in the late 1950s, a doctor's capacity to diagnose coronary disease was limited. Physicians had to rely on symptoms and information they could gather using their stethoscopes. And while the patient's history and physical condition remain critical parts of a heart evaluation, over the past several decades, we have developed and refined tools and techniques that make diagnosing heart disease possible at an earlier stage. In fact, one such tool is so sensitive that physicians still are trying to determine how best to use the technology. I am talking about the newer CT scans that show coronary artery calcification, a condition that can be associated with blockages in the coronary arteries.

This technology can help us find coronary disease early on, even in patients who don't have any symptoms. Once identified, doctors can take more aggressive approaches to curb patients' risk factors. Here's the basic idea: Addressing high blood pressure, high cholesterol, high blood sugar and cigarette smoking at this early stage stands to have a greater effect on patients' lives than waiting to do so until later. However, finding heart disease at a very early, asymptomatic stage may cause undue stress in otherwise healthy individuals, because calcification does not always mean patients will have heart attacks.

A new study published in the "Journal of the American College of Cardiology" was conducted at Walter Reed Army Medical Center in Washington, D.C. Researchers studied more than 1,600 healthy men, ages 40 to 50, who got routine checkups and, as part of the study, CT scans of the heart. The scans showed that approximately 22% of them had coronary artery calcification. Over the next three years, those who had calcification present were 12 times more likely to have coronary events than those with no calcification. More studies need to be conducted specifically on minorities and women, but this initial information gives us pause. Perhaps by assessing coronary artery calcification, doctors may be able to identify people who are at risk for future heart attacks, even when they still are relatively young.

Does this mean we all need to have CT scans of coronary arteries? No. It just means that today's technology can help doctors identify potential heart risks in a way my father's generation could not. Using this test to determine who needs more aggressive heart risk management may be appropriate for some. But the best way to determine whether this technology may help you is to talk to your doctor.

Tedd Mitchell, M.D., is medical director of the Wellness Program at Dallas' Cooper Clinic.