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JEY100 Tue, Jan-19-16 12:24

Coronary Artery Calcium Score
It is becoming more common to see the recommendation that if you are worried about cholesterol numbers, have a CT Coronary Artery Calcium Score done. The history of the resistance to its use was part of the movie 'The Widowmaker.' Dr. William Davis has used it for years, now it is accepted by the NIH and AHA as a useful test.

Dr. Jeffrey Gerber had his done, here is his review of the procedure.

The question of cost was started on another thread.
My previous posts were:

Here's what my Radiologist's office has to say about coverage...likely to vary by state. In Texas it is mandatory thanks to one legislator who pushed for it.

Once you find out how it works in your state, call around to various radiology labs to find the cheapest. Our state and BC have a big push to shop price...they are putting common procedures on a website. Get out of high cost areas and go to the rad lab of a small town hospital and maybe cut the price dramatically. Or not. Duke! had the cheapest hospital colonoscopy in the Triangle, way cheaper than the private gastro I used ten years ago.

At one local hospital, a CAC is $225, you do need a doctor's order to have one, and BC/BS does not cover it because they still consider it an "investigational service or procedure". The privately owned Radiology practice I use charges $350 (umm...need to check my Mammo prices ) Now to check a few other hospitals as it is not on that BC price checker, since it is not a covered service.
But possible checking other CT heart procedures will direct me to other cost effective solutions.
. [Edit, this didn't work well, price for stents and the heart procedures on the price checker are all over the place, and not related to the Radiologist's prices]

Havenít done a thing since those original posts, until now. (DH has doctor appointment tomorrow). Found a community health service down on the coast that charges $125 and $149 at a radiologist in Charlotte. Helpful info about the test at

Now to find a place without the road trip, but I have a base line price....

Edit a few minutes later. $150 right in our town. :thup: A private imaging service I have not heard of before, But googled Radiology near Raleigh to find it.

2/10th of a mile and $200 separate the two private radiology practices in town. :)

khrussva Tue, Jan-19-16 12:53

I'm thinking of having one done in February (heart month). My doctor wrote me up a prescription for a local lab that she says typically has a special during heart month. I haven't started shopping price on it, but I will be soon. I'll post what I find.

JEY100 Wed, Jan-20-16 06:01

:thup: Oh, what a good idea. Will call back that bright receptionist (who knew the price off the top of her head...try getting any price info out of any hospital!) and ask if there might be a special next month. Definitely need a doctor's order in this state. Thanks Ken, knowing what the going price is around the country will be helpful. So many CT scanners now, the price has supposedly dropped, along with the dose of X-ray needed.

Liz53 Wed, Jan-20-16 08:11

I had a CT scan done over 5 years ago, maybe closer to 10 now. At the time it was $250, none of it covered by insurance. I bet the price has dropped dramatically by now, will also be curious what it runs.

My doctor urged me to get it because 1) they had a new machine and they were recommending everyone get it (at least she was upfront, they needed to pay for the machine) and 2) because it would give me a more accurate view if I should be worried about blocked arteries (both parents died of heart disease). I already had lowish cholesterol (thanks to LC) but my zero score gave me real peace of mind that there was not something serious lurking.

Ken you seem like the perfect candidate since you've been a bit concerned about your cholesterol since eating LC.

JEY100 Mon, Jan-25-16 15:12

What a good idea. Will call back that bright receptionist (who knew the price off the top of her head...try getting any price info out of any hospital!) and ask if there might be a special next month. Definitely need a doctor's order in this state. Thanks Ken, knowing what the going price is around the country will be helpful. So many CT scanners now, the price has supposedly dropped, along with the dose of X-ray needed.

:thup: :thup: Great Tip, Ken

$99 for :rheart: :rheart: month.

Saved $250 over my usual radiologist.
Doctor will fax order to this Diagnostic Imaging service, they will call us to make a Feb appointment.

JEY100 Tue, Jan-26-16 06:53

Excellent interview with Dr. Malhotra on the "Fat Summit" on cholesterol, heart disease, statins, etc. He mentioned this alternate Risk Calculator (from UK in cm and kilos).

It's Treatment threshold is 20% Not the 10% in US that triggered my DH's doctors advice based only on his age and a slightly high LDL. His fantastic Trig/HDL ratio is ignored. This UK and the US calculator both use HDL and total, but not Trigs.

JEY100 Sun, Jan-31-16 11:38

Dr. Bernstein on the CAC and statin side effects:

In May 15, he said the radiation was not insignificant...need to look into this more.

Also Direct Labs February specials are all Heart related...including the Cardio IQ , another version of a lipid panel that gives particle numbers and extra info.

JEY100 Mon, Feb-01-16 11:42

"Description of Cardio IQ:

This panel directly measures your standard lipid panel in addition to your lipoprotein subfractions. LDL exists as small, dense molecules and large, buoyant ones and evidence suggests that more small particles greatly increase the risk of heart disease. This test also measures your Apolipoprotein B and Lipoprotein(a).

This is a good test for people who are already on cholesterol lowering medications."


EDIT: Here is the average Radiation dose...not bad, but as Dr Bernstein said...once every ten years would OK.

JEY100 Thu, Feb-04-16 03:43

Article on the CAC today on MedPage:

CAC Named Best Heart Risk Screen in T2DM
ACC report offers algorithm to gauge risk in asymptomatic patients

Coronary artery calcium imaging, followed by a functional stress test if the calcium score is high, may be the best way to determine cardiovascular risk in asymptomatic patients with type 2 diabetes, according to a report from the American College of Cardiology (ACC).
New evidence suggests that diabetes is not necessarily a coronary heart disease risk equivalent as was previously thought -- 25% to 30% of patients with diabetes are actually at low cardiovascular risk, said lead author of the report, Matthew Budoff, MD, of the University of California Los Angeles, and colleagues on the ACC's Imaging Council.

A diabetic patient's actual risk depends on other factors including gender, the presence and extent of atherosclerosis, additional risk factors, clinical symptoms, and chronic kidney disease, Budoff and colleagues said in the Journal of the American College of Cardiology: Cardiovascular Imaging.
"New guidelines have started to acknowledge the heterogeneity in risk and include different treatment recommendations for diabetic patients without other risk factors who are considered to be at lower risk," they wrote. "Furthermore, guidelines have suggested that further risk stratification in patients with diabetes is warranted before universal treatment."
"By properly evaluating the level of coronary heart disease risk, physicians will know when to prescribe more aggressive and less aggressive treatment strategies for their patients," Budoff said in a statement. "While more recent data indicates the risk of coronary heart disease for people with type 2 diabetes is less than was previously believed, it is still critical for physicians to properly assess risk and provide the appropriate strategies of care."
To help doctors better assess cardiovascular risk in patients with diabetes, Budoff and colleagues reviewed the available evidence on noninvasive testing for risk-stratification in asymptomatic diabetes patients, including coronary computed tomography, radionuclide imaging, echocardiography, and other tests......

The article goes on about statins and the JACC is paid journal for cardiologists, but the interesting point is that the ACC is now accepting the CAC as a good screening tool

JEY100 Wed, Feb-10-16 06:07

The final conclusion... :thup: :thup: :thup:

This test was a snap, not even ten minutes, clothed except for top shirt, and results were back a few days later. Only a score of 1 for a 67 yo man who had a high stress job many years and has followed LCHF for past five years!

(Almost) unbelievable, the doctor's note suggested that this test shows little calcified plaque, but not newer plaque in process (what test shows a problem before it happens? :lol: maybe your cholesterol will go up in the future?) and with the new AHA risk assessment cholesterol lowering medication may be considered. Even the doctor couldn't bring himself to say he would prescribe statins at this point, but he CYA'd his chart.

I of course cornered the poor technician for a discussion on radiation dose. The test results include dose now, and she gave it to me after the scan. CT's are measured in DLP and CTDI, and that can be converted to Milliseverts.
The newest CT machines use a much lower dose than previously (and thanks to some lobbying, a state law requires imaging centers to use the lower dose machines by x date) and armed with the actual dose, and nifty conversion tables, this proved out. Where the estimate for a CAC was 3 in the above link, my DH's exposure (it will vary by person) was a little less than half that. So that's about three times a mammogram now, which is still exceedingly low. The tech also explained that the CAC exposure is focused only on a small rectangle over the left chest (my concern is right chest). So although she may have been doing a sales job for their $99 special, I was assured enough to go ahead myself.
Read up on this test, watch the WidowMaker, and consider it if a doctor starts using that S Word. Very reassuring.

Nancy LC Wed, Feb-10-16 10:35

Janet, this is fascinating. Thanks for posting it! I was thinking of waiting until 65 for one, but maybe I should get one now (57).

indylm Thu, Feb-25-16 17:52

Well worth getting the test. It found my heart disease.

Meme#1 Thu, Feb-25-16 18:14

Must save this thread :thup:

JEY100 Fri, Feb-26-16 05:18

Glad this thread popped up again, a reminder to get a doctor's order for this. The $99 special is for both heart month and next (Feb and March at our imaging center) so it had dropped down my to-do list.
Indylm, sure the CAC alerted your doctors to much more than just the cholesterol levels. Better to develop a targeted treatment plan for you and your FH.

indylm Fri, Feb-26-16 05:36

Absolutely Janet!!

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