Ask the doctor: Should I have an angiogram to confirm a worrisome calcium score?

Harvard Heart Letter

Q. I have had CT scans of my coronary arteries as part of several annual physicals. They show my arteries have a lot of calcium — I am now in the 89th percentile for calcium scores. My stress tests and echocardiograms are normal, so are my blood pressure and cholesterol, and I feel fine. Should I have an angiogram to confirm the calcification?

A. I am all for people knowing what is going on with their bodies. But repeated expensive tests, especially those that unnecessarily expose you to radiation and other harmful side effects, aren't the way to go about it. From what you told me, you are a healthy person at low risk of heart disease. Unless there is something else worrisome about your medical history, you aren't a good candidate for the CT calcium scans you have had, let alone an angiogram.

I rarely order CT calcium tests for my patients, and when I do it is because someone is in the gray zone for beginning aggressive treatment of atherosclerosis. I'm assuming that so far, the tests haven't prompted you or your doctor to begin any treatment plan. If your first or second scan made you change your ways — give up smoking, lose weight, start exercising, adopt a healthier diet, and ease stress — then perhaps they were worth it. Otherwise, they were a hassle for you, exposed you to extra radiation, cost money, and didn't fulfill any useful purpose.

The main reason to have an angiogram is to locate a blockage that is causing chest pain or other symptoms. This is done in preparation for opening or bypassing the blocked artery. But if you aren't having any symptoms, you shouldn't be undergoing angioplasty or bypass surgery. So what's the point of having an angiogram, especially since it can cause complications?

You already know that your arteries are full of calcium. That's a signal you have atherosclerosis. If you are really worried about having a heart attack or stroke, start making whatever changes you can to fight it. More tests won't help.

— Richard Lee, M.D.
Associate editor, Harvard Heart Letter