Cardiologists throughout the metro area have been besieged with calls in the past weeks from middle-aged people, mainly men, to see whether they could have clogged arteries like former President Bill Clinton. And some of them are prescribing a test that is likely to get a nod of approval from the American Heart Association in November, a scan that measures calcium in the arteries. Doctors believe that a buildup of calcium can be an important sign that arteries are clogged.

The 58-year-old famous consumer of junk food experienced chest pains Sept. 3 that sent him to the hospital, where doctors found serious blockage in four arteries. Clinton underwent quadruple bypass surgery three days later; he is recovering well.

The scare that thousands of people got from Clinton's surgery was not just because they felt his pain. Many were worried about their own heart health. Traditional heart health measurements, such as cholesterol and triglyceride levels, do not reflect whether a person has clogged arteries, only whether a person might be at some degree of risk for heart attack.

While calcium scans have been around for years, the AHA has been reluctant to endorse them. At $250 to $400 per peek, some physicians have feared that doctors might prescribe the pricey test to enrich their coffers. Also, not everyone needs the tests, and the AHA and others worry that health care costs could be driven up unnecessarily.

And the tests have not been shown to save lives, even though there is strong evidence that they can indicate clogged arteries.

Most doctors believe that they should be ordered only for people at intermediate risk --- such as a middle-aged person with one known risk factor like family history of heart disease or high cholesterol.

The tests differ from whole body scans, which also have been around for several years, because new technology gives a much more detailed image of the heart. It also saves patients from exposure to X-rays.

Insurance companies do not reimburse for the tests, but many hope that will change if the AHA officially endorses them.

Cost is not an issue for many, especially those with a family history of heart disease or those who have reached the age and stage of life when friends are dying from it.

Early Monday morning, Tim LeMay went in for a scan at North Atlanta Scan Associates in Dunwoody. LeMay, who does irrigation work, was worried because he has high cholesterol and because he had chest pains recently that were bad enough to force him to stop work for the day. His doctor recommended a scan.

The procedure was painless. LeMay, 51, lay on a gurney and was hooked up to an electrocardiogram. The gurney slid LeMay's chest into the scanner, which looks sort of like a sliced-off version of an MRI scanner. He held his breaths for several seconds, and the machine took images of his arteries.

It revealed what could be serious calcification.

"I am really glad I came in," LeMay said. "I wanted to know more than what I was getting. I had the treadmill test 18 months ago, and it said everything was OK."

Now, LeMay will discuss the results with his cardiologist.

Bill McGowan, 61, of Alpharetta, had his calcium scan before news broke about the former president. Even though he'd already had his yearly physical exam, he was impressed with what he had been reading about whole body scans. He decided to have the calcium scan, just in case.

"It showed three arteries with blockage," McGowan said. "My cardiologist said I was a walking time bomb."

The best news for McGowan was that he did not need to have surgery. Doctors caught his blockage soon enough so that all that was required has been drug therapy with a statin and lifestyle changes.

"It was probably the best investment I ever made," McGowan said.

But the tests are not foolproof, doctors said, and the scans need to be read with the utmost expertise. Not all patients with high calcium scores have blockage, and not all patients who suffer heart attacks have calcification.

"Are our guidelines foolproof? That's kind of the golden question, and I don't think they are," said Dr. Stephen Frohwein, an Atlanta cardiologist. "If you have no calcium, it doesn't mean you're off the hook."

Frohwein said the most important message in the wake of Clinton's surgery is not that all patients should have heart scans or other tests that could indicate heart disease.

Instead, it's important that doctors "dig a little deeper" with their patients. Patients with diabetes and those who are glucose intolerant need to be managed very aggressively, Frohwein said. That possibly means a wider range of testing, he said.

Primary care doctors should pay close attention to good and bad cholesterol levels and triglyceride levels, Frohwein said. Doctors sometimes miss emerging heart disease because they fail to put together certain clues, he said.

For example, a person with intermediate levels of LDL, or bad, cholesterol, might appear to be fine and not receive treatment because the levels fell into the borderline category. But if that person has low HDL, or good, cholesterol, the person still could have a problem.

"It's really important to have these tests performed in conjunction with your primary care physician," Frohwein said.

Copyright 2004 The Atlanta Journal-Constitution