Inherited conditions such as familial hypercholesterolaemia (FH) or high lipoprotein(a) [Lp(a)] can increase the risk of coronary heart disease. These conditions may lead to early plaque build-up in the coronary arteries, even in people who feel well. In some cases, non-invasive scans can help to provide a personalised picture of risk and guide treatment decisions.

A coronary artery calcium (CAC) score is a quick and painless scan that looks for calcium in the coronary arteries, which is a sign of plaque build-up. It is sometimes used in people without symptoms but with risk factors for heart disease, to help doctors decide whether treatments should be started. However, in younger people (e.g. less than 40-45 years), calcium may not be present even if there is plaque build-up. This means that the calcium score could be zero despite early heart disease. In these cases, other scans can be considered to provide more information.

A CT coronary angiogram (CTCA) is a more detailed heart scan that uses contrast dye to show both calcified plaque and soft plaque that hasn’t hardened yet. It also allows doctors to assess whether any of the coronary arteries are narrowed due to plaque build-up. The CTCA is most commonly used in people with chest pain or other symptoms that may be related to the heart. While it is not routinely used to screen for heart disease in people without symptoms, it may be considered in certain situations.

In addition, a carotid ultrasound is another non-invasive scan that looks at the arteries in the neck for signs of plaque build-up. While it doesn’t look at the heart, it can provide information about overall artery health and cardiovascular risk.

At the moment, Medicare (MBS) does not cover the cost of CAC or CTCA scans for people without symptoms. This means there may be some out-of-pocket expenses. These scans are best used as part of a broader conversation with a doctor about heart health, family history, and strategies to prevent heart disease.