Heart Study Changes the Way Heart
Disease is Identified and Treated
Cholesterol not as important as thought,
coronary-artery calcification, is a much better
tool to gauge a person’s heart health.
A patient’s calcification score stacks up
against other risk factors in terms of predicting
the development of coronary artery disease in
otherwise healthy people.
Nearly a decade after launching what’s known
as the Spokane Heart Study, its lead investigator
is preparing to publish findings that could change
the way the world looks at heart-disease risk.
For instance, people who have high cholesterol
but don’t have symptoms of coronary-artery
disease might be glad to know that cholesterol
is “not that important” a predictor
of who will develop the disease, says Dr. Harry
Mielke, chief investigator for the study and director
of the Health Research and Education Center at
Washington State University at Spokane.
What’s more, the Spokane study has shown
that many participants who were found to have
coronary atherosclerosis—a narrowing of
the arteries that feed the heart, and the underlying
cause of coronary-artery disease—didn’t
have any of the risk factors commonly associated
with the condition, such as high blood pressure,
a history of smoking, high cholesterol, or diabetes.
Instead, the Spokane Heart Study is looking at
whether another measurement, that of coronary-artery
calcification, is a much better tool to gauge
a person’s heart health.
Nationally, about 50 percent of the men and 63
percent of the women who die from coronary heart
disease had no symptoms of the disease before
their death, he says, citing American Heart Association
data. In many cases, the victims weren’t
even aware they were at risk for the disease,
he adds. Coronary heart disease is the general
term encompassing coronary-artery disease and
its symptoms, such as angina.
Mielke’s group uses electron beam computed
tomography imaging—a CT scan—to reveal
calcification in the plaque that can line the
coronary arteries, a condition that can be detected
even in its early stages, Mielke says. The level
of calcification then is scored using a range.
Someone whose score exceeds a certain level is
considered to be at risk for coronary-artery disease,
or CAD. Other studies have demonstrated the link
between the presence of calcification and CAD,
but the Spokane study is one of the longest-running
looks to date at how a patient’s calcification
score stacks up against other risk factors in
terms of predicting the development of coronary
artery disease in otherwise healthy people.
Mielke is writing up the study’s findings
regarding coronary calcification as a predictor
of the disease, and plans to submit them to medical
journals by the end of the year. The Health Research
and Education Center already has presented those
findings at medical conferences.
Dr. Pierre Leimgruber, a cardiologist with Spokane
Cardiology PS and a member of a physicians advisory
group that’s following the progress of the
Spokane Heart Study, says the study has great
potential to change the way heart disease is prevented
and treated.
“I think that the Spokane Heart Study has
the potential of being a modern-day Framingham
study,” Leimgruber says, referring to a
groundbreaking, long-term look at heart-disease
risk on which many current assumptions are based.
The Spokane study could have “a significant
impact even on the national scene.”
The practice of using calcium as a measure of
heart-disease risk has become more accepted, but
the Spokane Heart Study could be a breakthrough
in the use of the measure as a predictor of future
heart disease, Leimgruber says.
The mean age of the about 1,000 participants in
the Spokane Heart Study is 52, and Mielke believes
the subjects will begin to experience cardiac
events, such as angina, arrhythmias, and even
heart attacks and death “very shortly.”
If the Spokane Heart Study is successful in proving
that coronary-artery calcification is a good predictor
of disease risk, people could start receiving
CT-scan screenings for calcification as they age—every
five years after age 50, for example, Mielke says.
As a screening tool, the CT scan is relatively
inexpensive—especially compared with an
angiogram, which is the current “gold standard”
in diagnosing coronary atherosclerosis. CT scans
also are quick and noninvasive, he adds.
If a CT scan revealed evidence of calcification,
a patient could be more alert to symptoms of coronary
artery disease, which some people now shrug off
as acid reflux or indigestion, and that person’s
doctor could develop a treatment plan earlier
in the disease process, Mielke says.
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