Preventive Screening using the Coronary Artery Calcification Scan

Coronary artery calcification (CAC) scan (sometimes referred to as the mammogram of the heart) is a Computed Tomography (CT) scan of the heart that detects and measures the amount of calcium present in the walls of your coronary arteries. Results of a coronary artery scan can indicate the presence and level of clinical atherosclerosis for improving the targeting of preventive measures. A panel of expert cardiologists led by the head of preventive cardiology of Stanford Medicine, Dr. David Maron, presented to the Right Care Initiative 2015 Summit the following algorithm and data to guide the use of coronary calcium as a marker of Coronary Heart Disease to improve outcomes.

The following algorithm is a recommendation from that panel:

CAC Expert Panel – (Presentation) (Video Part 1 | Part 2 | Part 3)

Right Care Initiative Research Team Coronary Artery Calcium Brief: Coronary Artery Calcium Heart CT Screening for Early Detection of Atherosclerotic Plaque: Measuring Heart Attack Risk to Determine Need for Preventive Medication

Coronary Artery CT Scans are available for $200 or less at many leading medical centers including the following in three major metro areas where the Right Care Initiative is active (Sacramento, Los Angeles, and Santa Clara Counties):

3 Preventive Cardiology programs at major medical centers have taken a leadership role in lowering the barrier to receiving the Coronary Artery Calcium preventive screening (CT Heart Calcium Score) by offering it along with a preventive cardiology visit to patients for a low cash price to receive this precision prevention information for understanding patients’ actual risk profile: Stanford Health Care, LA BIOMED (affiliated with UCLA), and UC Davis Medical Center. Contact information is below.
Stanford Preventive Cardiology Clinic Appointment Line: 650-725-5909
LA BIOMED Medical Center Appointment line: (310) 222-2773; HTTPS://LABIOMED.ORG/MATTHEW-J-BUDOFF-MD
UC Davis Health Referrals for CT Coronary Calcium:
- To Schedule appointments: Call 916-734-0655 or fax request to 916-734-2254. Include on fax or be prepared to provide on telephone: Full name, address, Date of Birth, telephone #, emergency contact (optional), Any Relevant Existing Diagnosis, Exam Requested: CT Coronary Calcium Scoring. Bring to test appointment: ID, Debit, Credit, or ATM card.
In Wisconsin, Gundersen Health System:
- CT Clinical Manager — Imaging Scheduling (608) 782-7300 ext. 53666

Additional Literature on Guidelines, Treatment and Recommendations for Asymptomatic Adults and CAC Scores

Cardiovascular Risk Calculators:

Astro-CHARM – 10-Year ASCVD Risk Calculator with Coronary Artery Calcium
American College of Cardiology atherosclerotic cardiovascular disease (ASCVD) risk calculator tool:

Supplemental Information:

Irish Heart Disease Awareness’ video Widowmaker (discusses evidence-base for using the CAC scan for proactive screening similar to a mammogram for the heart, but with much less frequency): Irish Heart Disease Awareness – Heart Attacks, The Facts
- Studies Featured:
  - The St. Francis Heart Study (Treatment of Asymptomatic Adults With Elevated Coronary Calcium Scores With Atorvastatin, Vitamin C, and Vitamin E)
  - The EISNER Study (Early Identification of Subclinical Atherosclerosis by Noninvasive Imaging Research)
  - The Courage Trial (Optimal Medical Therapy with or without percutaneous coronary intervention (PCI) for Stable Coronary Disease)
  - 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
  - 2013 European Society of Cardiology Guidelines on the Management of Stable Coronary Artery Disease

Right Care Initiative Lectures:

11th Annual Right Care Initiative Clinical Performance Improvement Leadership Summit

Lifetime Achievement Award for Leadership of CARDIA Study Illuminating Importance of Coronary Artery Calcium Plaque in the Young for Triage
- Stephen Sidney, MD, MPH, Director of Research Clinics & Senior Research Scientist, Kaiser Permanente Northern California Division of Research (Presentation) (Video: Part 1, Part 2)

8th Annual Right Care Initiative Leadership Summit

Precision Medicine for Early Detection and Treatment of Coronary Artery Disease for People without Symptoms – Preventive Cardiology Expert Panel (Presentation) (Video Part 1 | Part 2 | Part 3)
- Panel Introduction & Patient Story
  - Warren Barnes, JD, M. Divinity, Regulatory Consultant, UC Berkeley School of Public Health; retired chief of legal for DMHC; and co-founder Right Care Initiative
- Panel Chairman: David J. Maron, MD, FACC, FAHA, Clinical Professor of Medicine, and Director of Preventive Cardiology, Stanford University School of Medicine
  - Arthur Agatston, MD, Medical Director of Wellness and Prevention, Baptist Health
  - Daniel S. Berman, MD, Chief, Cardiac Imaging and Nuclear Cardiology, Cedars Sinai
  - Mathew Budoff, MD, Professor of Medicine, UCLA; Endowed Chair of Preventive Cardiology and Cardiology Program Director, LA Biomedical Research Institute
  - Mary Ann Champagne, RN, MS, Clinical Nurse Specialist, Stanford Medical Center
  - Michael V. McConnell, MD, MSEE, Professor of Medicine (Cardiovascular) and of Molecular and Cellular Physiology and of Electrical Engineering, Stanford University
  - Morteza Naghavi, MD, Founder, Society for Heart Attack Prevention & Eradication
  - Ian S. Rogers, MD, MPH, Clinical Assistant Professor of Medicine, Stanford University
  - *Expert panelists participating in absentia:
    Vice Chairman: *James K. Min, Professor of Medicine, Weill Cornell Medical College,
    *Prediman Krishan Shah, Professor of Medicine and Cardiology; Director, Oppenheimer Atherosclerosis Research Center; Director, Atherosclerosis Prevention and Treatment Center, Cedars Sinai Medical Center
    *Leslee Shaw, PhD, Professor of Medicine (Cardiology), Emory School of Medicine

LA University of Best Practices:

May 20, 2016

“Coronary Calcium Scoring for Risk Stratification and Guidelines”
- Matthew Budoff, MD, FACC, FAHA, Endowed Chair of Preventive Cardiology Professor of Medicine, Director, Cardiac CT, Harbor-UCLA Medical Center, Torrance, CA. (Presentation)

Sacramento University of Best Practices:

May 11, 2020

Mother-Daughter Patient Story (Presentation | Video)
- Riya Pulicharam, MD, National Medical Director for Population Health, Healthcare Partners

September 9, 2019

- Groundbreaking Findings from the CARDIA Study & Impact of Coronary Artery Calcium on Adults (Presentation)
  - Stephen Sidney, MD, MPH, Director of Research Clinics, Kaiser Permanente Northern California Division of Research
- The Role of Physical Activity in Cardiometabolic Health: Appropriate Dosing for Exercise as Medicine (Presentation)
  - Robert Sallis, MD, FAAFP, FACSM, Clinical Professor of Family Medicine, University of California, Riverside, School of Medicine; Co-Director, Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA
- Agenda; Bios
- Videos:
  - Introductions: Part 1
  - Dr. Sidney: Part 1, Part 2
  - Dr. Sallis: Part 1, Part 2
  - Around the Room Discussion: Part 1, Part 2

January 8, 2018

Coronary Calcium Scanning for Prevention Action (Presentation)
- William J. Bommer, MD, Executive Committee, American College of Cardiology, CA; Division of Cardiovascular Medicine, UC Davis

Silicon Valley University of Best Practices:

November 27, 2018

A Scientific Convening on Coronary Calcium’s role in ASCVD Precision Medicine
- Co-Chair Vision, Welcoming Remarks
- Family Perspective on Coronary Calcium Screening
  - Victoria Dupuy – Founder & Executive Director, No More Broken Hearts Foundation; Along with Survivors (Presentation)
- Coronary Calcium Testing at the Stanford Preventive Cardiology Clinic
  - David J. Maron, MD – Director, Preventive Cardiology; Clinical Prof. of Medicine, School of Medicine, Stanford University
- Evidence for Finding and Treating Atherosclerosis Before Patients are Symptomatic
  - Matthew Budoff, MD – Prof. of Medicine, Endowed Chair of Preventive Cardiology, School of Medicine, UCLA; Program Director, Division of Cardiology Los Angeles Biomedical Research Institute; Steering Committee Member, Director CT Reading Center, Multi-Ethnic Study of Atherosclerosis (MESA) Trial
- US Preventive Services Task Force’s Insufficient Evidence Recommendation & Next Steps
  - Doug Owexns, MD, MS – Prof., School of Medicine, Stanford University; Incoming Chair, US Preventive Services Task Force (Supplement 1, Supplement 2, Supplement 3)
- Payer Perspective
  - Scott Flinn, MD – Regional Medical Director, Blue Shield of California; Former Co-Chair, San Diego Right Care University of Best Practices (while Arch Medical Group CMO); Former U.S. Navy Medical Officer
  - Carol Zaher, MD, MPH, MBA – Board Certified Cardiologist & Medical Director, Health Net California Medical Management, Centene; Los Angeles University of Best Practices Co-Chair, Right Care Initiative
- Moderated Around-the-Room Q &A, Planning & Action Discussion: Silicon Valley Quest to Get to Zero Preventable Heart Attacks, Strokes & Diabetes Deaths and Disabilities
  - Robert Kaplan, PhD – Right Care Initiative Technical Expert Group; Adjunct Prof., School of Medicine & Research Director, Clinical Excellence Research Center, Stanford University; Former Chief Science Officer US HHS AHRQ; Retired, Associate Director, National Institutes of Health
  - David J. Maron, MD – Director, Preventive Cardiology; Clinical Prof. of Medicine, School of Medicine, Stanford University

Last Updated: 6/18/20

Coronary Calcium Resources

Preventive Screening using the Coronary Artery Calcification Scan

Right Care Initiative Lectures: