Coronary artery calcium testing: A call for universal coverage

Fig. 1. A schematic view of a dangerous coronary atherosclerotic plaque. This figure illustrates various molecular and cellular players in the development of a high-risk atherosclerotic plaque inside the wall of a coronary artery. Permission obtained from Society for Heart Attack Prevention and Eradication.

Fig. 2. Heart disease death map: South and West have the highest rates. Age-adjusted heart disease death rates in ≥35 years old by county and quintile ranking (8).

Fig. 3. Of 136,905 patients hospitalized with CAC, 77% had normal LDL levels below 130 mg/dl. Red shows percentage of patients with a normal LDL cholesterol level but experienced a heart disease event (11).

Fig. 4. Disparity between the burden of the disease (cardiovascular and cancer) versus the investment made in related preventive screening. Screening test coverage for primary prevention of cardiovascular disease is <10% of the coverage for screening for primary prevention of cancer. Based on data from the National Center for Health and Statistics.

Fig. 5. United States Estimates and Overlap of CAC and Lung Scan Eligible Patients The number of eligible patients in the United States is estimated at 33 million for CAC scanning (yellow) and 7 million for lung scanning in green. Excluding lung scan eligible patients who have established coronary disease (5.3%, unpublished data from the I-ELCAP database) yields an overlap of 6.6 million lung scan patients who would be expected to benefit from CAC scanning. Adapted with permission from: (Hecht HS. Coronary artery calcium scanning: past, present, and future. JACC Cardiovasc Imaging.)

Fig. 6. In 2006 the SHAPE Task Force proposed the SHAPE Guideline(Naghavi et al., 2006) which is based on noninvasive detection of atherosclerosis using coronary artery calcium scoring. The higher the burden of atherosclerosis the higher the risk, and the more intensive therapy needed. The “Intermediate Risk” category is the focus of SHAPE Guideline and results in the majority of ASCVD events.

Fig. 7. Trend: Heart Disease, Texas vs U.S. This figure shows reported CVD* in Texas vs. U.S. before and after passing Texas SHAPE Law HB1290. It is unclear whether this figure demonstrates a causal relationship or a random association. (48) *Percentage of adults who reported being told by a health professional that they have angina or coronary heart disease.