Greetings, Dr. Roach Despite having Type 2 diabetes, I am an 81-year-old man who weighs 122 pounds and is 5 feet, 2 inches tall. Thanks to metformin, I have maintained an A1C level between 6.3% and 6.8% for the last five years. I walk for 15 minutes (about a mile) five times a week on a treadmill and do stretching exercises for 25 minutes. I don’t experience any shortness of breath or chest pain.
Due to age and diabetes, two of my acquaintances in comparable circumstances did the nuclear stress test; one of them required triple bypass surgery, and the other required two stents. Because of the obstructions, neither had any previous symptoms.
For the first time in my life, I made the decision to see a cardiologist. To rule out any potential obstructions, he suggested the nuclear stress test. In less than fifteen minutes, the test was completed, and all results were normal. He did, however, also suggest the calcium score test.
When I spoke with my primary care physician, he advised me to start with the calcium score test. In the event that it suggests an issue, he next suggests the stress test. Even if the results of my stress test were normal, should I still undergo the calcium score test? — K.
ANSWER: A person can be assessed for heart artery blockages using a stress test or a CT calcium score. If a guy has diabetes at age 81, he is likely to have blockages.
Many cardiologists advise treating you as if you already had artery blockages, and the majority of experts do not suggest screening testing. The right drugs, which effectively lower your risk of heart attack and mortality, will be prescribed by them. Nonetheless, there are some circumstances in which screening makes sense.
A calcium score test and a stress test are complementary assessments. The stress test looks for variations in heart blood flow during activity and during rest, which suggests a blockage is likely. In contrast to a standard stress test that solely examines the ECG, the nuclear component refers to a radioactive dye that improves the test’s capacity to determine the diagnosis. A stress test, however, is unable to identify tiny obstructions that do not impede blood flow but have the potential to burst and result in a heart attack.
The calcium score checks the heart blood vessel wall for calcium. Not all calcified blood arteries have blockages, but the majority do, particularly in a person your age. One of the best indicators that a heart attack is unlikely is a negative calcium score.
A calcium score test and a stress test together provide more information than either test alone. In addition to the expense, a CT calcium score has the drawback of requiring a small additional radiation dosage. The majority of experts would advise medicine, such as an aspirin or statin, to lower your risk if your calcium score was not zero. They will also give you even more strict guidance on diet, exercise, and maintaining optimal blood pressure and blood sugar levels.
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