Medical History for Larry Feldhaus

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LIFETEST Guidelines

My results of 108 put me in the 50th percentile of men my age.

Lifetest Cardiac Imaging Heart Disease Test

LIFETEST FACTS

Based on risk factors like smoking, high cholesterol , high blood pressure, sedentary lifestyle, and family history, statistics can tell a person what their chances are for heart problems, But statistics are impersonal. Most people react ambiguously when told by their doctor, "You have a one in ten chance for heart disease" . People need to know conclusively whether or not they have a problem. The Lifetest scan not only tells you, the report shows you a picture of your heart.

"Knowing that coronary calcium is present by seeing images of their own arteries appears to provide a powerful motivation to patients to stop smoking and change diet and exercise habits." says Randolph E. Patterson, MD, Director of Cardiovascular Imaging Emory Heart Center and Professor of Medicine (Cardiology) and Radiology, Emory University School of Medicine.

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Coronary Calcification Score Guidelines
Score

ASYMPTOMATIC PATIENTS

0

This patient has no identifiable coronary atherosclerosis.
>0 to 9 Based on current data, most of these patients do not clearly have coronary artery disease, do not have coronary obstruction and are not at high risk for a coronary event in the near future. However, some patients' scores within this category still exceed the 75th percentile for their age and sex, and in these patients stress testing should at least be considered to rule out obstructive coronary atherosclerosis. Standard risk factor modification should be considered for all patients in this group. However, more aggressive guidelines should be used in patients whose calcium score exceeds the 75th percentile for their age and sex.
10 to 100 These scores indicate early coronary disease, but the patient is not at high risk for a coronary event in the next several years. Standard risk factor modification is warranted. The younger the patient the more aggressive should be the risk modification and consideration of stress testing, especially if their score exceeds the 75th percentile for age and sex.
>100 to 400 These patients clearly have coronary artery disease. They are at moderately elevated risk of developing coronary events in the next 1-2 years. A stress test is warranted to look for obstructive coronary atherosclerosis and risk factor modification following NCEP guidelines for secondary prevention should be implemented.
>400 to 1000 These patients have advanced coronary atherosclerosis, and are at high risk of coronary events in the next 1-2 years. They have a relatively high chance of manifesting obstructive coronary artery disease. The chance of present coronary obstruction increases proportionally to the total score and number of calcified vessels. Stress testing is warranted, probably combined with nuclear or echocardiographic imaging to increase sensitivity for detecting ischemia. Risk factor modification should include secondary prevention guidelines.
> 1000 More than 95% chance of having significant obstruction now. Consider cardiology consultation and aggressive risk factor modification following secondary prevention guidelines.
SYMPTOMATIC PATIENTS
(including those with atypical symptoms which could be angina)

The chances of having an important coronary obstruction at a given calcium score are much higher than in asymptomatic patients. These patients often have soft plaque, and may have calcium scores that are low or even zero in the presence of coronary obstruction. More aggressive diagnostic measures are warranted if the diagnosis remains in doubt, if the patient cannot walk more than 9 minutes on a stress test with the standard Bruce protocol, or if the patient fails to respond to medicine therapy.

Coronary Artery Calcium Score Percentiles

BACKGROUND: Research suggests that the greatest prognostic significance of Coronary Artery Calcium (CAC) may reside in the age a nd sex percentiles of Calcium Scores (CS). However, in the current literature there is a paucity of sizeable databases that show the normal distribution of CS in the population at large.
METHODS: We reviewed the CS of 1,628 consecutive patients referred for Electron Beam Computed Tomography (EBCT) imaging by primary care physicians. The individual CS's were arranged by percentiles according to age and sex. Data for 879 men and 749 Women was collected.
RESULTS:

MEN AGE
Percentile 35-39 40-44 45-49 50-54 55-59 60-64 65-69 > 70
25th% 0 0 0 0 6 33 35 60
50th% 0 0 5 18 46 103 152 247
75th% 4 11 46 125 204 416 616 616
90th% 22 51 160 350 457 989 1100 1452

Women

25th % 0 0 0 0 0 0 0 10
50th% 0 0 0 0 0 3 15 103
75th% 0 1 2 12 22 101 102 375
90th% 6 7 16 78 128 248 327 876
Calcium Scores

CONCLUSIONS: This data shows the normal distribution of CS in a large cohort of patients referred by primary care physicians for an EBCT. Research findings show that the percentile allocation should be taken into consideration when attempting to predict the significance of an individual CS. Detailed analysis of the entire database shows an exponential growth of CS in older age groups, suggesting that distribution of CS percentiles in smaller age ranges may be more appropriate after age 57.


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