HEALTHBEAT: Much-advertised heart calcium tests generate big controversy

Tuesday, May 14th 2002, 12:00 am
By: News On 6

WASHINGTON (AP) _ Russell McKenna knew his cholesterol was low and had no other signs of a bad heart, but when he spotted a Chicago hospital's ad urging people to stop by for a quick heart-disease test, he thought, ``Why not?''

Now he's sorry: A bad score from what McKenna later learned is a highly controversial test plunged him into a spiral of anxiety and doctor visits that generated $4,000 in bills insurance won't pay _ only to conclude he's at low risk for a heart attack after all.

More and more hospitals and testing clinics are advertising fast CT scans to spot calcium that stiffens heart arteries. Proponents call the painless, 15-minute test an easy way to tell if arteries are clogging.

But wait, says the American Heart Association _ don't get this test unless your own doctor prescribes it.

Calcium scans can help doctors determine how aggressively to treat someone already known to have high cholesterol or some other risk factor, the AHA says.

But there's no proof yet that this $400 high-tech exam is better than a $70 cholesterol test as a routine screening tool to predict who's at risk of a heart attack, critics stress.

Calcium in the arteries signals heart disease but doesn't actually cause a heart attack. So doctors don't know what to do with patients like McKenna who have lots of calcium, which by itself can't be treated, but no other risk factor that needs treating.

``Precisely the wrong people are selecting themselves to get the test,'' says Dr. Philip Greenland, chair of preventive medicine at Northwestern University Medical School and an AHA spokesman. ``It's not one that we would yet advise people to be getting on their own.''

Proponents disagree vehemently.

``Wherever there's calcium, there's plaque,'' the actual artery-clogging stuff, says Dr. Stuart Rich of Chicago's Rush-Presbyterian-St. Luke's Medical Center, who pioneered offering scans without a doctor's referral.

He argues measuring calcium is as good as, if not better than, cholesterol testing, and that it can spot early disease before other risks arise.

It's one of cardiologists' thorniest debates, hashed out in the current issue of the journal Preventive Cardiology.

And it's one that both sides hope a new National Institutes of Health study will settle. The study is tracking how early heart disease develops in about 6,500 Americans _ and also should show just how well calcium scans and certain other new imaging tests predict heart attacks, says Dr. Diane Bild of NIH's National Heart, Lung and Blood Institute.

``There are many studies that have shown people with higher coronary calcium levels are at higher risk for having heart attacks,'' Bild says. But ``perhaps we don't need to put these people in a scanner and expose them to radiation and charge them $400'' if simpler tests are as good.

``I hope we can shed light on it.''

A mix of calcium and fats build up in artery walls to cause heart disease. Calcium is very common _ by age 30, one in four people has some, Rich says.

But while artery-hardening calcium indicates disease is present, a heart attack actually occurs when a soft kind of ``unstable plaque'' breaks open in the artery wall and causes blood to clot.

CT scans can't see unstable plaque, only hard calcium. So why get one?

Most experts agree calcium testing can help doctors decide how aggressively to treat someone with, say, borderline high cholesterol. A picture of gunky arteries may also bolster the avoid-the-doughnuts message.

But the heart association opposes routine screening until there's more proof it works.

Rush's Rich argues for screening, saying lots of calcium suggests lots of plaque, even if he can't tell which kind.

Another caveat: Somebody with high cholesterol but no calcium isn't off the hook, because they may have unstable plaque, ``which is even worse,'' cautions Dr. Gerald Pohost of the University of Southern California.

And, as McKenna discovered, doctors don't know how to react to a bad calcium score. One ordered a stress test, which he passed, while another wanted an angiogram even though $4,000 of exams already had found no further reason to worry.

``I made a mistake. I should never have responded to this advertising,'' McKenna says. Insurance won't pay because his own doctor didn't order the initial calcium test, he adds: ``I feel that this is a scam.''