Dr. Wy, why should I get a CAT scan of my heart like they advertise on TV? It sounds like a scam!

Ask Dr. Wy…

Richard Wyderski, MD, FACP

Dr. Wy, why should I get a CAT scan of my heart like they advertise on TV? It sounds like a scam!

I’ve recently written about using the PREVENT calculator to estimate one’s 10-year risk of heart attack or stroke and checking a lipoprotein(a) level that if high doubles that estimate. But can we measure how much cholesterol is in our heart arteries? Yes, we can! The best tool we have is a CT scan of the heart that measures the amount of calcium in them.

This scan had been around for decades but hasn’t been commonly used. It’s now one of the methods recommended by the American Heart Association and American College of Cardiology in their 2026 guidelines to help people decide how to treat their cholesterol. A coronary artery calcium (CAC) score of 0 means there’s no plaque buildup. If it’s 1-100, there’s mild buildup, 101-300 moderate, and more than 300 severe. As you might guess, a higher CAC score means a higher risk.

You might think that a “mild” score means a person isn’t at risk, but that isn’t correct. Heart attacks and strokes occur because a soft cholesterol plaque breaks open and forms a clot, and it’s the clot that causes the heart attack. Statin drugs prevent plaques from getting worse, over years shrink plaques, and even make plaques less likely to form a clot. Statin drugs are not just one trick ponies!

Unless your CAC score is zero or your PREVENT risk is <5% with a CAC score more than 0, please strongly consider starting a potent cholesterol-lowering medication. We need all the stroke and heart attack prevention we can get!

 

Have a question for Dr. Wy? Please submit to [email protected]