By GEOFFREY COWLEY
WHEN YOUR CHOLESTEROL IS IN the stratosphere
and slicing bread makes your chest ache, you know you have a problem.
Unfortunately arterial disease doesn't always present such clear warnings. For
some 150,000 Americans a year, the first and only sign of clogged arteries is a
fatal heart attack. Are you headed for trouble despite your seeming good health?
A new test-the Ultrafast CT scan-could make finding out a lot easier The new
scan can detect heart disease at its earliest and most treatable stages. And
because the procedure is quick, cheap and noninvasive, it could become as common
as mammography, and equally effective at saving lives. The surest way to measure
arterial blockage is through invasive procedures such as coronary angiography
and intravascular ultrasound. But no one would suggest using those tests to
screen healthy people. They cost $3,000 to $5,000 and involve threading a
catheter from the groin up into the chest to examine the vessels that feed the
heart. The new scanning procedure, developed by Imatron Inc. of South San
Francisco, Calif., costs only $350 to $500 and is far less tricky. The patient
simply lies on a table for five minutes with a doughnut-shaped scanner
surrounding his chest. Like a conventional CT scan, the device uses beams of
electrons to create interior images. But because it works at least seven times
faster than a conventional CT scan, the pictures it generates aren't blurred by
the motion of the heart and blood. By analyzing images of the coronary arteries,
a technician can determine how much calcium they contain and that score provides
a good indication of how badly they're clogged. If the blockage looks severe, a
cardiologist will perform the more invasive tests before prescribing angioplasty
or bypass surgery. "To pinpoint a blockage, you still need an angiogram,"
says one specialist. But if the Ultrafast scan reveals, say, a 20 percent
blockage in a seemingly healthy person, that person can attack the problem -
with drugs or through diet and exercise before it attacks his heart. Only 40
U.S. clinics currently offer the Ultrafast CT scan, and because it's so new, few
insurers cover the cost. But that's likely to change as researchers confirm its
diagnostic power in one ongoing study, doctors at New York's St. Francis
Hospital have run the test on 1172 symptom-free volunteers and followed them for
periods of three to four years. The latest results, to be presented in Atlanta
this week at a meeting of the American College of Cardiology, suggest that the
Ultrafast CT, scan gauges heart-attack risk 10 times more reliably than a
cholesterol test. "The accuracy is unprecedented," says Dr Alan Guerci,
director of research at St. Francis. "Our findings suggest this could
become the primary screening tool for coronary artery disease." Mass
screening of healthy adults would be a costly proposition, even at $400 a head.
But if people acted on the results, the effort could be well worth the money.
