Cross Section of a Coronary Artery

A Coronary Calcium Scan Predicts Risk of Death in Obesity

We say it over and over again. Obesity is a very heterogeneous disease. This simply means that different people can have very different experiences with it and face very different risks. At a time when treatment options are multiplying, some with a very high price tag, it’s important to know who has the most urgent need for treatment. New data in Obesity suggests a tool that might be quite powerful for knowing this. A coronary artery calcium scan seems to do an excellent job of predicting the risk of death in obesity.

What Is It?

This test is simply a CT scan of the heart that provides the basis for a calcium score. This is a measure of how much calcium has built up inside a person’s coronary arteries. It costs between $100 and $400 to have one of these scans. The primary risk is the exposure to small amounts of radiation – about the same as a mammogram.

The most common calcium score is called an Agatston score, named for Arthur Agatston, the cardiologist who developed it. Incidentally, he also developed the South Beach Diet.

A Study of Outcomes in 9,334 Persons with Obesity

Mortality by CAC Score in ObesityThe new study in Obesity uses data from the CAC Consortium – a retrospective cohort of persons with no prior cardiovascular disease at baseline. Ellen Boakye and colleagues studied a sample of 9,334 persons with a mean BMI of 34.5 and age of 53 years. Two-thirds of them were men.

The power of these scores to predict all-cause mortality is impressive. Persons with the highest scores (≥300) had roughly five times the risk of death from any cause during the study, which had a mean follow-up time of 11 years. Even when considering only people with moderate to severe obesity, the predictive value remained significant.

So What?

Right now, insurance companies and employers are suffering from sticker shock because of high costs for highly effective new obesity medicines. Quite naturally, there’s an impulse to identify the patients who might benefit most. The authors of this study think they have a promising tool in the coronary calcium score:

“We have demonstrated in this study that coronary artery calcium, which is cost-effective and measured noninvasively using a cardiac-gated CT scan, can serve as an effective risk stratification tool among individuals with obesity.”

Click here for the study.

Cross Section of a Coronary Artery, photomicrograph by Qwerty Binary, licensed under CC BY-SA 3.0

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August 4, 2023