Silent Heart Plaque Tests May Find Hidden Heart Disease Early
Silent heart plaque tests can help find signs of plaque buildup in the heart’s arteries. Plaque doesn’t always cause symptoms; it can go unnoticed for years, and it can lead to serious heart problems. Most risk assessments often miss it. New tests help find hidden plaque buildup before people experience symptoms or serious events.
MDVIP’s physicians take a proactive approach to heart health. They use advanced medical screening and diagnostic tests to help prevent, diagnose, and treat heart disease. Learn about the kinds of tests used to find hidden plaques, what they look for, and what to expect if you need one.
What is a silent heart plaque test?
There isn’t one single test for hidden plaque in the arteries. Instead, doctors use different tests to determine whether someone has plaque buildup and, if they do, to what extent. These tests are typically imaging scans. They look for plaque, calcium, changes to the walls of the arteries, and artery narrowing—all things that routine blood tests can’t show.
What are the types of silent heart plaque tests?
Doctors use three tests to detect silent plaque buildup: a coronary artery calcium score, a cardiac CT, and a CIMT. A care provider may start with one test and order more if they need more information.
Coronary Artery Calcium Score: A common silent heart plaque test.
The most common silent heart plaque test that doctors use is a coronary artery calcium (CAC) score.
What happens during the procedure:
This is a CT scan; it takes about one minute. Patients don't need an IV. Instead, electrodes are attached to your chest. Patients lie on a table and go through a CT scanner that looks at calcium buildup in the heart.
What it measures:
The calcium buildup is a marker of how much cholesterol or plaque buildup is in the heart’s arteries.
Considerations:
- This test exposes patients to a small amount of radiation.
- The drawback of the coronary artery calcium score alone is that it doesn’t show cholesterol or plaque buildup that doesn’t have calcium.
- Other tests can help physicians distinguish between calcified plaque and non-calcified plaque.
Cardiac CT: A layer-by-layer image of the heart and its blood vessels
Physicians can see non-calcified plaque in the heart with cardiac CTs. Most people who have heart attacks fall into a group of patients who have plaque buildup in the arteries without any symptoms. Most people who have had a heart attack don’t have significant blockages, but they have more non-calcified plaque.
Non-calcified plaque can create a bigger risk for causing a heart attack. A study of nearly 25,000 adults aged 50-64 showed people with silent heart plaque had a 66 percent higher risk of having a first heart attack or of death than people who didn’t have non-calcified plaque.
What happens during the procedure:
Like coronary artery calcium scoring, this is a CT scan. You may be asked to avoid certain foods and drinks the day before the test. On the day of the procedure, you may have electrodes attached to your chest and may have an IV of a special dye to provide contrast for the image. After preparation, you’ll lie on a table and go through a CT machine. The test takes about ten minutes.
What it measures:
Cardiac CT, or computed tomography, is an imaging test. It’s considered the gold standard for screening and detecting silent plaque build-up in the arteries. It uses X-rays to create 3D images of the heart, valves, and blood vessels. It helps detect calcium buildup in the heart and helps physicians recognize if the plaque is calcified or non-calcified.
Considerations:
- Cardiac CT isn’t used to screen for silent heart plaque. It’s also not appropriate for everyone; one reason is that it exposes you to small amounts of radiation.
- Cardiac CT scans commonly use contrast dye to visualize the coronary arteries. Contrast dye may cause an allergic reaction or affect kidney function in high-risk patients.
- Let the technician know if you are pregnant, if you have ever had a reaction to contrast dye or you’re allergic to it, or if you have kidney disease.
- Before the day of the test, tell them what medications you’re taking. They may ask you to pause some medications.
CIMT
A CIMT, or carotid intima-media thickness test, is an ultrasound. It uses sound waves to examine the carotid arteries, the major blood vessels located on each side of the neck. The test helps physicians gauge the thickness of the artery walls.
What happens during the procedure:
This is an imaging test. It’s non-invasive and takes about 15 minutes. For the procedure, wear an open-necked shirt and remove your jewelry. You’ll lie on a table while a technician applies gel and uses a handheld ultrasound probe to scan the arteries located in the neck. There’s no exposure to radiation during this test.
What it measures:
A CIMT looks at how thick the walls of the arteries are in the carotid artery of the neck. It can show the extent of any plaque buildup. If a CIMT shows thicker layers within the artery walls, it could suggest an increased risk of heart disease.
Considerations:
CIMT scans arteries in the neck and gives physicians clues about how well the arteries supply oxygenated blood to the heart and other parts of the body. However, it doesn’t scan the heart directly.
Types of Silent Heart Plaque Tests
| Test Type | What it Examines | What it Can Show | Limitations |
| Coronary artery calcium (CAC) score | Coronary arteries | Calcified plaque | Doesn’t show non-calcified plaque |
| Cardiac CT | Coronary arteries | Calcified and non-calcified plaque | Isn’t meant as routine screening for everyone |
| CIMT | Neck arteries | Artery wall thickness and plaque buildup | Doesn't show plaque in the heart |
Should I talk to my doctor about getting a silent heart plaque test?
Yes, you should. Every patient’s situation is different, but as a physician, I generally recommend imaging tests because they help determine whether someone has silent heart plaque, or what doctors call “subclinical atherosclerosis”. This is a type of heart disease. Cholesterol builds up in the arteries, but there are no symptoms such as chest pain or trouble breathing. People with silent heart plaque also haven’t had a major heart event. But this hidden artery disease can increase the risk of heart attacks, strokes, and death, even when plaque buildup isn’t enough to limit blood flow. Moreover, a coronary artery calcium score or a CIMT also helps physicians determine how aggressive their prevention management should be. Physicians can follow guidelines for different outcomes and tests.
Plaque can build up in arteries over years without causing symptoms, and it’s common. A recent study of more than 16,000 adults aged 18 to 70 found that 57 percent had silent artery plaque, including 1 in 13 of participating young adults between ages 18 and 29. Silent heart plaque is more common among middle-aged and older people. The REACT Study showed that 90 percent of participants in their 60s and 70s had hidden artery plaque.
Because this kind of hidden artery disease can develop without symptoms, one of the first steps in preventing or treating it is for a doctor to order a silent heart plaque test such as a CAC scoring test, cardiac CT, or CIMT.
Potential Candidates for Cardiovascular Imaging Tests
| Test | Who May Benefit? | Why It May Be Ordered |
| Coronary Artery Calcium |
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| Cardiac CT |
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| Carotid Intima-Media Thickness (CIMT) |
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|
Who is a potential candidate for a CAC scoring test?
The American College of Cardiology recommends coronary artery calcium (CAC) scoring for some men over 40 and some women over 45. Specifically, CAC scoring is helpful:
- For people who have borderline or intermediate risk of having a heart attack or stroke in the next ten years;
- To help a care provider decide if a patient should start taking a statin;
- If there is uncertainty about someone’s actual risk of heart disease or related health events
Who is a potential candidate for a cardiac CT?
Cardiac CT isn’t meant to screen for disease, but to give care providers more information. This test isn’t appropriate for everyone.
Care providers order cardiac CT when a patient who’s 65 or younger may have limited or blocked blood flow to the heart’s arteries, or when a patient has chest pain.
Increasingly, cardiac CTs are being used for subclinical atherosclerosis (though insurance typically doesn’t cover the test for that purpose). As a physician, I think of it for patients who have risk factors such as type 2 diabetes, HIV, inflammatory conditions such as rheumatoid arthritis, a history or habit of smoking, a strong family history of early heart disease, or a family history of high cholesterol.
Who is a potential candidate for a CIMT?
A care provider may order an ultrasound of the arteries in your neck, or CIMT, to screen for silent heart plaque if you have some risk factors for heart disease. This could include:
- A history of early heart disease in your immediate family
- Women under 60 who have two heart disease risk factors such as high blood pressure, high cholesterol, excess weight or obesity, prediabetes or type 2 diabetes, or other factors
- Adults under 60 who have one major risk factor for heart disease and who aren’t sure whether they should be taking medicine to prevent heart disease or a heart event.
What do the results from a silent heart plaque test mean?
A radiologist or another healthcare professional will interpret your results and share them with your provider.
A CAC score is between 0 and 400. A zero means there is no evidence of coronary artery disease, and a score of 400 means there is extensive coronary artery disease.
Cardiac CT or CIMT may show hidden plaque. These tests can also show other signs of heart disease, such as narrowing of arteries. Both the cardiac CT and CIMT are detailed images and don’t produce scores like the CAC score. But they’re valuable because they show signs that you may need preventive care or treatment; your provider will review the results with you and recommend next steps.
What happens after a positive result from a silent heart plaque test?
Your care plan depends on your overall risk, test results, your care provider’s guidance, and what you’re comfortable with. In general:
- If your physician recommends it, start medication
- Your physician may want additional tests
- Follow a healthy lifestyle
A test result that shows someone has silent heart plaque doesn’t mean that a serious heart event is going to happen soon, or that it’s unavoidable.
Your provider may prescribe medication to manage your silent heart plaque risk
Whenever someone has either a higher risk or they have silent heart plaque, the care provider may want to be more aggressive with their treatment. That might include medications that help control cholesterol and lower inflammation, such as statins.
Established and new treatments are available to help manage heart health if a silent heart plaque test tells your provider that you need more preventive steps. (Prescriptions are up to your care provider’s advice.)
Statins
Statins remain the first-line medication for lowering LDL (bad) cholesterol and reducing heart disease risk. Statins have been around for about 40 years and are extremely effective in reducing cardiovascular events. This is the first step for most doctors.
There are many ways to start statins to help minimize side effects. Some patients are prescribed a lower dose or take them every other day. Your doctor may raise the dosage over time and work with you to recommend the best approach.
Other medications to manage silent heart plaque
Sometimes, a doctor will combine certain medications with a statin. One example is Zetia® (ezetimibe), which helps decrease LDL cholesterol.
If someone is still at risk, meaning their LDL and other biomarkers are not low enough, a care provider might consider an injectable medication such as Repatha® (evolocumab) or another PCSK9 inhibitor, a class of medications that helps the liver clear LDL from the blood.
Healthy habits can help manage silent heart plaque
People can also change their habits to help prevent hidden artery disease, including:
- Eating a healthy diet
- Quit using tobacco
- Get good sleep regularly
- Keep your weight within a healthy range
- Control cholesterol
- Manage blood sugar
- Manage blood pressure
Are silent heart plaque tests covered by insurance?
When silent heart plaque tests are used for screening or preventive care, your insurance may not cover them. Medicare and Medicaid do not. Currently, many insurance carriers only cover a cardiac CT scan when a patient has symptoms like chest pain. Check with your insurance provider for more information.
If you have a Health Spending Account or Flexible Spending Account (HSA/FSA), you may be able to use it to pay for screening tests.
Some facilities offer discounted pricing for cash pay or during American Heart Month in February.
How do MDVIP-affiliated doctors support patients who are worried about silent heart plaque?
If your goal is to lower your risk of a heart attack or stroke, work with a doctor whose approach is to look beyond common risk factors such as cholesterol panels. MDVIP’s Wellness Program includes advanced heart-health tests and screenings that are not included in traditional primary care exams.
That's one of the big things MDVIP offers when it comes to hidden dangers like silent heart plaque. The MDVIP Wellness Program offers heart-health biomarker screenings and tests for risks like inflammation. We’re also looking to add a test for lipoprotein(a), an inherited dangerous particle linked to a higher risk of serious disease. Some MDVIP-affiliated doctors already test for silent heart plaque using imaging devices. We’ve partnered with companies that offer CIMT and are developing deeper relationships with companies that offer cardiac CT scans to improve availability to members.
MDVIP continually educates affiliated physicians, keeping them current on the latest in preventing, detecting, and managing serious diseases. MDVIP-affiliated physicians offer unrushed visits and use the time to develop strong doctor-patient relationships, helping you understand your health and your options.
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