Should You Have an EBCT?

What if an X-ray could help diagnose heart disease or predict risk? Some researchers think it can. Using electron beam computed tomography (EBCT), a type of CT scan, doctors can examine artery walls for calcium deposits; a lot of calcium indicates a lot of plaque. In people with CHD symptoms, the degree of arterial calcification is a stronger predictor of heart attack risk than high cholesterol, age, family history, diabetes, high blood pressure, or smoking. Even in people without symptoms, studies find that calcification indicates CHD, prompting preventive measures.

However, whether EBCT adds much value to other, less expensive screening tests is debatable. If, for example, someone has high cholesterol, high blood pressure, and diabetes, do they need EBCT to know they’re at high risk? And if they have no cardiovascular risk factors to modify (in other words, their cholesterol and blood pressure are fine, they don’t have diabetes, and they don’t smoke), they need EBCT to give them a clean bill of health?

If someone has a strong family history of CHD but no clear risk factors, it might be worth an EBCT to tease out any hidden problem. And there’s another potential benefit of EBCT: A picture may be worth a thousand words in terms of motivation. Someone seeing their abnormal arteries with their own eyes may be more inspired to make lifestyle changes than someone who is simply told their cholesterol is high. But that can work both ways; in one study of post menopausal women, normal calcium scores were less likely to change the subjects’ unhealthy behaviors.

The bottom line is the test has predictive value and may help clarify risk of CHD. But it’s not clear yet who should have it or whether it’s cost effective. There’s no reason to go on your own to one of the many screening centers offering EBCT; only have the test if your doctor recommends it.

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