By Dr. Arthur Agatston, Dr. Oren Mechanic. Full article in MedPage Today.
Rob is 52. He exercises daily, eats well, and has only borderline cholesterol. The standard risk calculator puts him in a reassuring category and he'd prefer to defer a cholesterol-lowering medication, such as a statin.
His coronary calcium score is 220 — a clearly elevated plaque burden for a man his age. Genetics account for roughly half of cardiovascular risk, and the calculator could not see his, whereas the scan could.
Rob paid out of pocket, however many patients can't afford it. Dr. Arthur Agatston and I have a new piece in MedPage Today arguing that the coronary artery calcium score — a $100, ten-minute test that detects coronary plaque directly — deserves a Medicare national coverage determination.
After 35 years of evidence and new guideline recommendations, the clinical case is strong for certain populations. What remains is reimbursement.
The patients at highest risk of heart attacks are the ones least likely under current policy to get a calcium score.
What excites me most? There is a strong path forward that addresses prevention, opportunistic diagnoses, and AI-enabled scalability from a calcium score!
The guidelines have caught up. Coverage for the calcium score is the next step.
