About $3.6 trillion is what the United States spent on health care in 2013, 3.7 percent more than 2012. Projections for 2014 anticipate a further increase of 6.1 percent. This expanded insurance coverage is made possible by the Affordable Care Act. The extra dollars are also needed to cover treatment for preventable, chronic illness much of which stems from obesity.

Heart disease is the leading cause of death for both men and women in the United States. It claims almost 600,000 lives, or 1 in 4 deaths each year. The economic loss, which combines the cost of health care services, medications and lost productivity, is estimated at $108.9 billion per year.

Despite heightened public awareness, widespread efforts to facilitate lifestyle change and extensive conventional health care, the numbers remain staggering. Part of the problem is that blockage in the coronary arteries of the heart can go undetected and symptom-free for years, until a heart attack strikes.

To catch up with heart disease before it catches up with us, we spend billions of dollars testing cholesterol, blood sugar, blood pressure and body weight. The problem is that conventional medicine measures risk factors for blocked plumbing in the heart but not the plumbing itself. Direct imaging is done with an angiogram, but it is expensive and the procedures carry some risk, so it is offered only when there is a strong indication to do it like chest pain. What would save huge money is a totally safe, noninvasive and inexpensive way to directly image the plaque burden of the coronary arteries.

A technique like this does not yet exist. There are, however, three noninvasive tests available today: ultrafast CAT scan (CT), CAT scan angiography and cardiac MRI.

The first facility in Hawaii to offer advanced cardiac screening was Holistica Hawaii, located in Hilton Hawaiian Village from 2000 to 2007. It failed because the study was not covered by insurance.

Ultrafast CT measures the amount of calcium in the coronary arteries. Although there is a fairly strong correlation between "calcium scores" and the amount of blockage in the heart, some patients with very high cholesterol levels have very few plaques, while others with stellar labs show impressive calcifications. The American Heart Association recently included calcium scoring in its recommendations for use in asymptomatic patients at intermediate risk of cardiac events and in asymptomatic patients over 40 years old with diabetes mellitus.

CT coronary angiography (CCTA) is another CT-based technique that uses iodine containing contrast dye to visualize the heart and coronary arteries. Current data show that it may be used to rule out coronary artery disease in low-risk patients. However, there remains controversy over the proper indications, due to poor quality of research on this method.

Both Ultrafast CT and CCTA are X-ray-based modalities and carry some risks. In a recent article in The , Rita Redberd, professor of medicine at the University of California, San Francisco, reported that overuse of radiation was estimated to be responsible for 3 percent to 5 percent of all future cancer cases. As nearly 1 in 10 Americans undergo a CT scan once a year, caution is advised.

Cardiac MRI (CMR) is a radiation-free alternative using instead a strong magnetic field. The radio frequency is tissue-specific and allows the machine to distinguish between various types of organs and structures. It is so sensitive that it may even detect a scar on the cardiac muscle. CMR is widely used to assess cardiac function after a heart attack. Unfortunately, it is not very useful at detecting plaques in the coronary arteries, so it is not the best preventive screening tool for asymptomatic patients.

A technique that easily identifies patients with coronary plaques would greatly improve public health and reduce the national cost of health care. Both CT and MRI techniques are constantly improving but not yet there. Until a safe, inexpensive and sensitive test becomes available, we will still have to settle for repeatedly measuring and managing risk factors such as cholesterol.

Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.