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  • Q&A with Australian Health Practitioners

    Why is early detection screen for Heart disease not mandatory?

    As heart disease is still the number one killer in Australia, why is early detection screening from the age of 35 not mandatory in the same way as pap smears and mammograms?
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  • 4

    Thanks

    Dr Jason Kaplan

    Cardiologist (Heart Specialist)

    Dr. Jason Kaplan is a specialist adult cardiologist and physician. Dr. Kaplan studied Medicine at UNSW and graduated with Honours in 1999 then completed his … View Profile

    In actual fact it should be. The government supposedly does not pay for preventative health services, however with fairly inexpensive screening tests we are able to detect early signs of heart disease before they cause clinical symptoms. The right age is probably about age 45 for men and 50 for women, however there will be people who need to be screened earlier due to lots of cardiovascular risk factors. If you are really concerned about your risk, ask your doctor about Coronary Calcium scoring or Measurement of Carotid Intima Media thickness. 

  • Roger Jennings

    HealthShare Member

    Hello, I was hoping to get an idea of what prequisites the patient would require in order for calcium scoring to be approved of by a GP (to get a referral). I've asked 2 different GPs at 2 different practices and they both unquivocally say ‘sorry, no’. The first said I'd have to be having chest pain and the second waffled on about only being able to do the typical lipid screen.

    I have, what is typically considered to be, high cholesterol and an ApoE profile of E4/E4. But that doesn't seem to be enough reason to consider calcium scoring. I don't understand.

  • 3

    Thanks

    Dr Richard Beatty

    GP (General Practitioner)

    Brisbane GP With Special interest in Complex Medical, Men's health, antenatal, paediatrics. Skin Cancer Clinic Designated Aviation Medical Examiner Specific interests in Vasectomy, Dermatology & … View Profile

    The closest such test is the Coronary artery calcium scoring costs that approximately $150 and takes just a few minutes at a radiology or cardiology facility. Your GP Can refer you directly for the test but it is not medicare rebated.
    The test is an indirect measure of the amount of atheroma of the coronary arteries - in other words, it indirectly measures the amount of plaque (furring) inside the coronary vessels. The plaque becomes calcified and so the amount of calcium in the coronary vessels is a measure of the amount of plaque in the coronary vessels.

    The usual way to establish risk of future heart disease is by measuring the blood pressure, blood cholesterol, and then putting the figures into an algorithm along with risk factors such as age, smoking etc. This risk score is useful and should be done first - but the score is coarse, and the risk can be made more accurate using coronary artery calcium scoring.

    There is a radiation dose involved of 1 to 2 mSV which is the same as the background radiation that we experience over the course of 1 year. It is not a huge dose but is worth knowing about.

    What about having another heart test instead - such as a stress echocardiogram or CT Coronary angiography? The key difference is that these two look tests for areas of the heart where there is inadequate blood supply from coronary vesssels (flow -limiting areas). On the other hand, CT Artery calcium scoring just measure the amount of atheroma (plaques) and does not indicate if they are causing reduced flow.

    The important point, though, is that most heart attacks are caused by thrombus forming on plaques and not by areas of reduced blood flow.

    In other words, it would appear that CT artery calcium scoring is better than the other tests at identifying which patients are at greater risk of a heart attack. Given that the test is over more than 3 times cheaper than the other tests, this is good news!

    The test is just another option available but is particularly useful for patient's whose risk of heart disease is not definitely high, not definitely low, but in the middle. I think the government should pay for this for patients in specific risk groups who are referred by their GP. Having said that, every patient is eligible to see their GP for standard risk-scoring which is a good start.

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