Preventing Cardiovascular Disease: Calcium Scan vs CT Angiography

March 28, 2024
5 min read
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Preventing Cardiovascular Disease: Calcium Scan vs CT Angiography

Cardiovascular disease (CVD) is a leading cause of death worldwide, with millions of people affected by it every year. It is a complex disease with various risk factors, such as smoking, hypertension, high cholesterol, and obesity, among others. Early detection of CVD is crucial for prevention and treatment, and imaging tests such as the calcium scan and CT angiography (CTA) can help identify people at risk. Let’s explore the differences between calcium scan and CTA, their benefits and drawbacks, and how they can help prevent CVD.

Calcium Scan

A calcium scan is a non-invasive imaging test that uses low-dose X-rays to measure the amount of calcium in the coronary arteries. Calcium in the arteries is a sign of plaque buildup, which can narrow the arteries and increase the risk of heart attack and stroke. A calcium score is calculated based on the amount of calcium detected in the scan, which can range from 0 to over 1,000.

One of the advantages of the calcium scan is that it is low in radiation and very inexpensive, costing a few hundred dollars. It also doesn't require contrast dye, which some people may be allergic to or have adverse reactions. However, most insurance companies don't cover it, and patients have to pay out of pocket.

The amount of calcium detected in the scan is strongly related to the amount of plaque in the arteries, and therefore, it can help identify people at risk of CVD. However, it's worth noting that an elevated calcium score is not always a predictor of adverse events, especially in intense athletes who may have increased calcium due to their training regimen.

CT Angiography

CT angiography is a more advanced imaging test that provides more detailed information about the coronary arteries, including the presence of blockages or stenosis. It uses contrast dye and high-dose X-rays to create 3D images of the arteries.

Compared to the calcium scan, CTA provides more information about the arteries' structure and function, making it a valuable tool for diagnosis and treatment planning. However, it is more expensive, costing $2,000-2,500, and carries a higher radiation dose than the calcium scan. Most insurance companies don't cover it, and patients have to pay out of pocket.


CT angiography can also be used in combination with other tests, such as CT fractional flow reserve (CT FFR) and fat attenuation index (FAI), to provide a more comprehensive assessment of the arteries.

CT FFR is a non-invasive test that measures blood flow through narrow or blocked arteries and helps identify people who need invasive procedures such as stents. FAI measures the characteristics of the fat around the plaque and predicts how much inflammation is around the plaque due to the fat content.

Blood Pressure and Cardiovascular Disease

High blood pressure (hypertension) is a major risk factor for CVD and is defined as blood pressure above 120/80 mmHg. Recent studies have shown that even mildly elevated blood pressure can increase the risk of adverse events, and blood pressure should not be considered a normal process of aging.

Ambulatory blood pressure monitoring (ABPM) is a gamechanger in medicine since patients usually get their blood pressure checked in-office 1-2 times a year, which may not accurately reflect their true blood pressure. ABPM provides more accurate and reliable readings, enabling better management of hypertension.

The Best BP Management Medication

According to Dr. Weiss, a thiazide diuretic is the best medication for managing blood pressure. Thiazide diuretics are effective

The best way to prevent cardiovascular disease is with early detection and the management of risk factors. Two imaging tests that can help with early detection are the calcium scan and CT angiography. While both have their pros and cons, the calcium scan is a more cost-effective and low-radiation option. Managing blood pressure is also crucial, and recent studies have shown that keeping it below 120/80 can significantly reduce the risk of adverse events. Thiazide diuretics are the preferred medication for blood pressure management, but ACE inhibitors and ARBs may be more suitable for certain subpopulations. Overall, it's important to address the four risk pillars of smoking, hypertension, ApoB, and metabolic health to prevent atherosclerosis and related complications

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