Oprah does it again!

CT heart scans featured on Oprah

It’s the second time in the past year that Oprah featured CT heart scans on her show.
Did she help or hurt the cause?

The March 27, 2006 episode of the ever-popular Oprah Winfrey Show once again featured CT heart scans. The audience was wowed with fabulous views of coronary arteries generated on CT heart scan devices. Four audience members chosen at random had scans, two of whom had unsuspected heart disease detected.

During the show, Dr. Mehmet Oz, a cardiac surgeon, declared that "What makes this technology so cool," Dr. Oz says, "is you can actually go beyond calcium which is just a symptom."

Whoaaaa! Calcium is just a symptom? If this is right, should we all throw out our calcium scores and start over with a CT coronary angiogram?

We think what Dr Oz means is that calcium is only a component of plaque, not a full measure of plaque itself. That is indeed accurate. Calcium comprises 20% of total plaque volume and therefore represents a highly accurate surrogate measure of total plaque.

Is coronary calcium an accurate measure? It’s the best we have short of intracoronary ultrasound, which requires an invasive procedure involving catheters being threaded down your arteries for cross-sectional images to be made—not for you and me in a prevention program.

Dr. Oz proclaims that CT coronary angiography (or 64-slice CT, as it’s becoming known, though wrongly) is superior. Is this true?

Our view: It’s different, though not better. It does show the contents of your artery, calcium and all, including softer elements. That’s a great plus. (In our center in Milwaukee, we’ve been doing CT coronary angiograms for around 6 years and it does offer some advantages in selected cases.)

The problem with these scans is that they are non-quantitative. You’re told such information as “You have a 20% blockage in the right coronary, a 30% blockage in the left anterior descending artery, and a 40% blockage in the circumflex.” In other words, the information provided by a CT angiogram is similar to the information from a heart catheterization. What it does not provide is an accurate measure of the lengthwise extent of plaque in your arteries.

This is important because if you’re going to use CT heart scans for long-term control, or reversal, of your coronary plaque, a CT angiogram is nearly useless. The results are too crude for repeated measurement, not to mention the huge dose of radiation required for the test, similar to that of conventional heart catheterization. The cost of CT angiograms also makes them impractical for repeated use, since they cost anywhere from $1800 to $4000. As they pointed out on Oprah’s show, “These tests expose you to about 160 Chest X-Ray radiation and are more expensive than Carrie Bradshaw's shoe collection.”

Remember: Any plaque in your coronary arteries is important, since any plaque can “rupture” like a little volcano and cause heart attack. In general, we’re not looking for 90% blockages in people without symptoms. But we do need a safe, precise, low-risk, and inexpensive way to quantify plaque—any plaque. That’s what your heart scan score does and does it very well.

Did Oprah and Dr. Oz help or hurt the cause? They’ve undoubtedly raised awareness of the dangers of hidden heart disease in women. That’s great. They’ve also publicized the phenomenal power of CT scans, whether coronary calcium scoring or angiography, for easily detecting hidden heart disease. That’s also a tremendous public service.

But, as always, we need to be able to see beyond the media hype. Your heart scans remains the easiest, most accurate, and least expensive method to quantify hidden coronary plaque. It’s also wonderfully suited to repeated measurement for those of us who wish to stop or reverse our plaque growth—that’s the Track Your Plaque program.
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Copyright 2006, Track Your Plaque.