Matthew Budoff, MD: The Clinical Utility of Coronary Calcium Scoring

In a presentation at The 6th Annual Heart in Diabetes in Philadelphia, Matthew Budoff, MD, Harbor-UCLA Medical Center highlighted the use of coronary calcium scoring for risk stratification.

In an interview with HCPLive, Budoff discussed the controversies and clinical utility surrounding coronary calcium scanning. His talk focused on how a calcium score may differentiate patients at high risk, with elevated amounts of plaque, from those at very low risk, with no plaque.

"We also talked a little bit about the implications if you're on a statin, where it doesn't really affect the predictive power of coronary calcium," Budoff said. "That's a misconception that I'm trying to correct."

Budoff noted that a big benefit of coronary calcium is that it promotes compliance, as well as improved behaviors overall. By letting people know they have coronary calcium building up, it is better to be preventive and patients are more likely to respond, according to Budoff.

"It helps me a lot in practice and not only deciding, should I put them on a statin or not, should I maybe use aspirin or not, but getting the patient to buy in and do what I'm asking them to do," he added.

He additionally discussed the problem of noncompliance, noting the adage that you cannot make an asymptomatic patient feel better and in fact, statins can make these patients feel worse.

However, Budoff said the patient needs to be shown that there is plaque in their heart that needs to be addressed before it ruptures. This may ultimately benefit them through the early stages of perceived side effects of the drugs and help them stay on the right therapy.

"The risk prediction for coronary calcium is just as good if patients have diabetes or not," Budoff said. "It really doesn't matter if a patient with diabetes has a score of zero, there's still more risk. If a patient with diabetes has a high score, there's still a very high risk."

Budoff pointed out that when patients have an elevated score, clinicians need to be aggressive ith both statins and aspirin. Although the risk benefit of aspirin is neutral to no benefit without a calcium score, aspirin has a huge risk benefit for patients with an elevated calcium score.

"I would encourage people to follow the guidelines and use aspirin and primary prevention when the calcium score is above 100," Budoff said.