EP396: The St Luke's Health CAC Pilot Data

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction Dr. Warrick Bishop is a cardiologist, author, and CEO of the Healthy Heart Network who is passionate about helping people live well for as long as possible. In this episode, he presents findings from a pilot program using coronary artery calcium (CAC) scoring through the PRIME (Patient Resourced Initiation of Medical Engagement) health platform, conducted in partnership with St Luke's Health insurance in Tasmania. The episode focuses on how CAC scoring can bridge the gap between perceived risk and actual cardiovascular risk, potentially transforming preventative cardiac care. Key Takeaways: Coronary artery calcium scoring revealed that 31% of asymptomatic participants had calcium scores over 100, indicating they were at risk and warranted cholesterol-lowering therapy and aspirin—despite having no perceived health problems beforehand. There is no correlation between what people believe their cardiovascular risk is and their actual risk as revealed by coronary artery calcium scoring, indicating a significant gap in risk perception. High-risk participants (20% of the cohort with scores over 400) had risk levels equivalent to those who had already suffered heart attacks, strokes, or required stents or bypass surgery. The number needed to scan to initiate therapy was only 3 patients, and only 25 scans were needed to potentially avert a major cardiovascular event within 5 years—demonstrating high clinical efficiency. Coronary artery calcium scoring is cost-effective; scanning 100 people ($30,000 total) only needs to prevent one acute heart attack or angina episode ($30,000-$40,000 per episode) to break even financially. The PRIME health platform showed poor initial engagement (100 participants from 5,000 emails), but those who participated successfully completed the process without needing to see a GP or specialist. High-risk individuals identified through CAC scoring demonstrated improved lifestyle behaviors in follow-up assessments at 3, 6, and 9 months, suggesting the scoring has motivational impact on patient behavior change. Coronary artery calcium scoring serves as a transformative, precise diagnostic tool that provides actionable insights for personalized risk management and lifestyle intervention. Cardiologists have been slow to adopt cardiac CT imaging, preferring traditional treadmill testing, which has hindered broader implementation of this preventative technology in clinical practice. Further expansion of CAC screening through private health insurers and similar platforms could save lives and reduce cardiovascular events at a population level, though more research is needed to validate long-term outcomes.