Coronary calcium test could help clarify heart disease risk – and control cholesterol

当医生在考虑如何处理病人的胆固醇时, 一个关键的计算是病人未来患心脏病的风险. 但如果这种风险是不确定的呢?

New cholesterol guidelines released Saturday suggest it can help to have a coronary artery calcium test when risk status for people 40 to 75 years old is uncertain to determine who will benefit from statins.

也被称为CAC测试，它涉及一种称为CT扫描的快速x射线. It takes cross-sectional images of the vessels that supply blood to the heart muscle, 检查钙化斑块的形成, 哪一种是由脂肪组成的, cholesterol, 血液中的钙和其他物质. This calcium is different from the calcium in bones and isn't related to too much calcium in a diet.

The measurement can help a doctor identify who is at risk for heart disease before a person has signs or symptoms.

"A coronary artery calcium score can help refine decision-making about whether someone needs a medication to reduce their risk," said Dr. 唐纳德-琼斯, a cardiologist and chair of the Department of Preventive Medicine at Northwestern University in Chicago.

The new cholesterol guidelines now have the benefit of more scientific studies that show the difference a CAC score can make in homing in on a person's future risk of cardiovascular disease – and whether to start on cholesterol-lowering drugs such as statins.

The test isn't recommended universally for everyone but is most helpful for those whose risk falls in an intermediate zone.

The guidelines lead doctors through a process – using a calculated formula and taking into account risk factors such as diabetes, cholesterol levels and high blood pressure – to place a patient in four classifications of risk: low, borderline, 中级和高级.

对于中度或部分边缘性患者, the guidelines suggest doctors have an in-depth discussion about the potential benefits of statin drugs, 考虑到所有的风险因素. If uncertainty remains whether to use a statin, doctors can consider delving further with a CAC test.

The test isn't always covered by insurance but can range in cost from about $100 to $400. 它涉及的辐射量相当于乳房x光检查. The guidelines recommend the screening be done in facilities that have up-to-date technology that delivers the lowest radiation possible.

"It's been demonstrated to be able to help (doctors) make better decisions and target those people who may need medication to reduce risk or identify people with a CAC score of 0 who may be able to avoid medication,劳埃德-琼斯说, 指南撰写委员会的成员. “这是一个令人信服的成本效益案例. 我们的期望是保险应该开始包括它, 而不是作为一种普遍的筛选测试, 但是对于那些中等风险的人."

1到99分表明钙开始积累, 然后就变成了临床判断, said Dr. Scott Grundy, chair of the guideline writing committee and professor of internal medicine at the University of Texas Southwestern Medical Center and Veterans Affairs Medical Center in Dallas. "If your score is above a 100, then those people should probably be taking a statin."

他说，CAC的新建议是在该领域的争议中提出的. “并不是每个人都这么考虑周到. So, we tried to develop the ideas in a more reasonable way based on the data that's available. 证据越来越多，我们想把它用在合适的人身上."

According to the new guidelines, here are some groups where CAC testing may be useful:

– People reluctant to begin statin therapy and who want to understand their risk and potential benefit more precisely.

– People concerned about restarting statin therapy after stopping treatment because of side effects.

– Men ages 55 to 80 or women 60 to 80 with few risk factors who question whether they would benefit from statin therapy.

– People ages 40 to 55 with an estimated 10-year risk for developing heart disease between 5 percent and 7.5%，以及增加患心脏病几率的风险因素.

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