Sunday, July 30, 2006

New Early Heart Disease Detector

Heart attacks can happen out of the blue. Almost everyone knows someone who has, without warning, experienced a heart attack -- sometimes fatal -- as the first sign of cardiovascular disease. One minute you're feeling fine... then, wham!

According to George T. Kondos, MD, associate professor of medicine at the University of Illinois College of Medicine (UIC) in Chicago, this makes it all the more important to come up with new and better ways to predict risk. Dr. Kondos told me about one of the most promising new diagnostic tests for heart disease -- the heart scan, also known as a coronary calcium scan, which he began utilizing in 1983. This painless, noninvasive imaging procedure, similar but more advanced than a computed tomography (CT) scan, can quickly detect the presence of artery-clogging calcium in coronary arteries even before there is any outward sign of a problem. In combination with other health information, this can help better assess risk.

A Reliable Predictor
Dr. Kondos and his colleagues at UIC have scanned more than 90,000 people and found the test to be reliably predictive in people who otherwise have few risk factors or symptoms. For example, from January 1993 to December 1995, Dr. Kondos and his colleagues tested 5,635 self-referred men and women with no symptoms of heart disease. In the three and a half years following the scans, 224 participants required angioplasty or bypass surgery, had a heart attack or died. According to Dr. Kondos, the CT scan detected high amounts of calcium deposits in 95% of those who experienced cardiovascular events, in comparison with low amounts of calcium in 67% of those who did not. He notes that while treadmill-based stress tests -- a more common measure of cardiovascular risk -- detect more significant blockages, heart scans can pick up smaller potential blockages at an earlier stage. This means that you may be able to take more timely action to address small problems before they develop into big ones -- just the wake-up call you need to start paying more attention to your diet, maintaining a healthy weight and getting regular aerobic exercise to help reduce underlying inflammation. Of course, this is not to say that everyone should march right out and get a heart scan. Although scans are often aggressively marketed at many walk-in health facilities, Dr. Kondos emphasizes that these tests are intended for those at intermediate risk -- people who have a 10% to 20% risk of having a cardiac event in the next 10 years. If you're young and healthy and at low risk, you don't need one. Likewise, if you're at high risk, a heart scan is not going to be particularly useful since the treatment protocols for high-risk patients go beyond identification of early calcification. (Note: Your doctor will determine your risk profile based on a medical examination and your personal and family health history.)

For Those at Intermediate Risk
The bottom line? If you're at intermediate risk for cardiovascular disease -- a category that Dr. Kondos estimates fits 35% to 40% of the American public -- consider having a heart scan. In particular, he recommends this test for men over age 45 and women over age 50 who have one or more risk factors, including age, family history of heart disease, high blood pressure, high cholesterol, diabetes or smoking. If that's you, talk to your doctor about getting scanned. It's fast, easy and painless.

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