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Coronary artery calcium testing: A call for universal coverage.
Naghavi, Morteza; Maron, David J; Kloner, Robert A; Berman, David S; Budoff, Mathew; Superko, H Robert; Shah, P K.
Affiliation
  • Naghavi M; Society for Heart Attack Prevention and Eradication (SHAPE), Palo Alto, CA, United States of America.
  • Maron DJ; Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.
  • Kloner RA; Cardiovascular Research at Huntington Medical Research Institutes, Cardiovascular Division, Dept. of Medicine, Keck School of Medicine of University of Southern California, Pasadena, CA, United States of America.
  • Berman DS; C Cedars-Sinai Heart Institute and David Geffen School of Medicine UCLA, Los Angeles, CA, United States of America.
  • Budoff M; Harbor UCLA and Los Angeles Biomedical Research Institute, Torrance, CA, United States of America.
  • Superko HR; Cholesterol, Genetics, and Heart Disease Institute, Carmel, CA, United States of America.
  • Shah PK; Oppenheimer Atherosclerosis Research Center, Cedars Sinai Medical Center, Los Angeles, CA, United States of America.
Prev Med Rep ; 15: 100879, 2019 Sep.
Article in En | MEDLINE | ID: mdl-31193256
ABSTRACT
Heart attacks kill more Americans than all cancers combined. Fatal heart attack victims have no symptoms until minutes before they die, hence early detection of high-risk asymptomatic individuals is needed. Even though heart attacks kill and cost more than cancers, as a nation we spend over 20 times more on screening for asymptomatic cancer than for asymptomatic atherosclerotic cardiovascular disease (ASCVD), the underlying cause of heart attacks. Currently, payers only cover screening for risk factors of ASCVD such as blood pressure and blood cholesterol. This approach tends to miss high-risk and over-treat low-risk individuals. Although treadmill stress testing with ECG is not indicated for ASCVD detection in asymptomatic individuals, it is done often, and frequently leads to misleading conclusions or unnecessary downstream diagnostic procedures. For example, former President Clinton had passed his treadmill stress tests for several years during his presidential annual checkup but had a heart attack shortly after his presidency. This common practice is a waste of our limited resources. Instead, a more accurate risk assessment using coronary artery calcium (CAC) testing is available; and has just been adopted by ACC/AHA guidelines, however payers do not cover it. CAC is measured non-invasively with a 5-minute CT-scan of the heart, and costs less than $200, whereas cancer screening with colonoscopy and mammography costs over $3000. There is an opportunity to save lives and dollars if CAC testing is covered for appropriately selected individuals. Texas has already passed HB1290 to mandate CAC coverage. Other states must step up and take actions.
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Full text: 1 Database: MEDLINE Type of study: Guideline / Risk_factors_studies / Screening_studies Language: En Year: 2019 Type: Article

Full text: 1 Database: MEDLINE Type of study: Guideline / Risk_factors_studies / Screening_studies Language: En Year: 2019 Type: Article