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A normal nuclear stress test in the presence of heavy plaque burden is common in asymptomatic patients with multiple risk factors. Early detection saves lives and reduces the future need to utilize expensive cardiovascular healthcare resources.

A nuclear stress test detects advanced disease when an artery has developed more than 60% obstruction of the lumen and significant blood flow reduction during exercise. The vast majority of heart attacks are due to plaque rupture of an artery with only mild narrowing are not detectable by nuclear stress test.

Ultrafast cardiac CT for coronary artery calcification is a simple 30 second test that requires NO intravenous injection of any isotope or contrast and no special patient preparation.

Many asymptomatic patients with 2 or more risk factors with normal nuclear stress may have subclinical disease and are, in fact, at high risk not low risk.

Because 650,000 of the 1,100,000 hearts attacks that occur in the US annually are first heart attacks, and because preventive treatment is highly effective, the ability to detect as many of these asymptomatic patients as early as possible is an important diagnostic tool for primary prevention. Cardiac CT for coronary calcium score is just that tool.

Nuclear stress test only detects the presence of heart disease when the obstruction has exceeded 60% - in the late stage.

Ultrafast Cardiac CT detects, localizes and quantifies calcification the plaques. In most cases, coronary artery calcification is detectable many years before significant obstruction develops and gives preventive therapy a good head start.

Coronary calcium score is considered both a surrogate marker of overall plaque burden but it is also considered just the tip of the iceberg. If the calcium score is zero, the total plaque burden is very low and there is nothing much hidden underneath. A zero calcium score in asymptomatic patients is predictive of low prevalence of noncalcified plaques and very low incidence of obstructive plaques. However, low calcium score of between 1 to 100 is not predictive of low prevalence of noncalcified plaques (66%, a 10 fold increase from 6.5%) or very low prevalence of obstructive plaques (8.7%, a 17 fold increase from .5%).

Without optimal medical therapy and aggressive lipid management, coronary calcium score increases annually at the rate of 30% to 45% depending upon the number of risk factors present. The goal is to reduce the annual increase to less than 15% per year - a marker of plague stabilization and reduced event rate.

The above slide demonstrates the potency of advanced cholesterol therapy in inducing plaque regression after just three years of treatment.