I am returning from a conference on heart attack and stroke prevention and was reviewing some of my notes on the goal of earlier diagnosis and treatment of arterial disease, also known as atherosclerosis. One feature of atherosclerosis is that the vast majority of plaques become calcified. Calcified arteries can be identified on most X-ray studies, even routine chest X-rays. CT imaging is particularly good at showing this pathology. Calcified arteries as a sign of atherosclerosis caught the public attention a few years back when whole body CT scans on 4,000 year old mummies demonstrated abnormalities in almost half. So much for atherosclerosis being a disease of modern society.
Earlier detection of atherosclerosis, even if serendipitous on a chest CT or mammogram, can lead to a more thorough evaluation and treatment plan as was taught at my weekend course and my preventive cardiology clinic.
Are radiologists looking for incidental arterial calcium? A recent survey of radiologists indicated that the vast majority of these specialists do mention incidental calcified arteries on chest CT scans in their reports. The survey also revealed that about half of the radiologists provided an estimate of the amount of calcium (e.g. mild, moderate or heavy).
Of note, calcium can be found in arteries outside the heart and chest and provide additional clues to early atherosclerosis. Indeed, in the study of 4,000 year-old mummies, calcium was noted in the aorta, iliac, femoral, and carotid arteries in addition to the heart. Many had calcification in multiple arterial systems. I routinely review reports of scans of the neck, abdomen and legs for mention of arterial calcification in patients without knowledge of arterial disease.
Mammography has the potential to reveal silent aging of arteries as an incidental finding. In a recent review of the correlation between arterial calcium in the breast on mammography and heart artery calcification, heart disease was twice as common in those with breast artery calcium. In addition, the cardiac risk factors of diabetes mellitus and chronic kidney disease were also more common in women with calcified arteries on mammography. Even dental scans using cone beam technology can reveal calcified arteries in 30% of subjects tested.
The incidental finding of arterial calcium is not a benign observation. Arterial disease remains the number one killer of men and women and the ability to evaluate and intervene before symptoms or death is an opportunity not to be missed. Incidental arterial calcium on chest CT scans predicts overall and cardiovascular death and researchers recommended "active reporting" to permit earlier diagnosis, preventive measures, and medication if needed.
I have recommended previously a more widespread use of coronary artery calcium scans for the detection of silent atherosclerosis. I would also recommend that after a mammogram, X-ray or CT scan of any other part of the body, you ask if any comments about calcified arteries appeared in the report. In my experience, the comment may be buried in the body of the report and not show up in the conclusions so a careful review is necessary. The incidental finding of calcified arteries is serious vascular disease and warrants a complete evaluation and treatment plan including considerations of diet, exercise, stress management, prescription drugs and supplements.
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