Most Americans know that heart disease is the number one killer of men and women. Most of us also know that the American diet and sedentary lifestyle are major contributors to the risk of developing heart disease. Doctors know that intercepting heart disease at its earliest detectable moment is the key to thwarting its risk of causing irreparable harm. The newest solution that identifies heart disease risk may lie in combining five simple already available tests.
Current standard strategies for detecting heart disease risk focus on recognizing family history and genetic predisposition (if present), and then monitoring blood pressure, cholesterol levels, risk or presence of diabetes, and smoking history. These five indicators help doctors to form an assessment profile of the patient. Results also guide intervention strategies.
High blood pressure (hypertension) is considered an early indicator and precursor to heart disease. An elevated LDL (bad cholesterol) or low HDL (good cholesterol) or elevated triglycerides are all considered harbingers of heart disease. Having prediabetes or diabetes is considered a risk factor for heart disease as well. In fact, patients who have diabetes are at higher risk of having a silent or asymptomatic myocardial infarction (heart attack). That means that the heart can sustain “silent” and permanent damage. Smoking has a direct impact on the circulatory system. It causes cumulative damage to the lining of your arteries, leading to a buildup of atheroma plaque, which ultimately narrows vessels. That’s a major risk factor for angina, a heart attack or a stroke.
Cardiologists at UT Southwestern Medical Center believe they have found a “broader and more accurate way” to assess cardiac risk factor. The results from a set of five currently available tests, in unison, can specifically and effectively identify people with few of the traditional heart disease risk factors, who still have a higher chance of developing heart disease. These individuals might normally not be identified as needing preventive strategies.
The following are the five tests that were singled out and how they offer important assessment information:
- A 12-lead EKG – This test can identify hypertrophy or thickening of the heart muscle, which is considered an early risk factor for heart disease.
- A coronary calcium scan – This “low radiation” test provides images of the heart and can capture photos of calcifications or plaque buildup in the arteries of the heart. If allowed to progress, the calcifications will impede blood flow to the heart.
- C-reactive protein blood test – This blood test indicates general inflammatory levels in the body. General inflammation in the body increases the risk of developing several acute and chronic diseases, including heart disease.
- NT-proBNP blood test – This blood test for the hormone NT-proBNP indicates stress on the heart.
- High-sensitivity troponin T level blood test – A troponin test is often used by hospitals to diagnose a heart attack, but this test is a more sensitive version that can indicate smaller amounts of damage to the heart. A person can have elevated levels without any overt cardiac symptoms.
The first four tests are readily available nationwide, and the fifth test should be available at many hospitals nationwide in the very near future.
The researchers developed this new risk screening recommendation based on data gleaned from two large studies, including the Dallas Heart Study and the Multi-Ethnic Study of Atherosclerosis (MESA). Both studies followed large numbers of subjects for more than 10 years. Part of this study’s funding came from NASA in an effort to find new, effective ways to screen astronauts for heart disease. The study also focused on identifying “early heart disease,” which is often missed. Current screening guidelines are more focused on finding individuals at high risk of a heart attack or stroke.
Grouping these five assessment tools together not only helps to identify asymptomatic or “less risky” individuals who may still develop acute heart disease or atrial fibrillation, but was also better overall compared to the more traditional screening tools, at catching individuals at higher risk for heart attack and stroke. Each test on its own has value, but merging the screening into a “five test approach” really offered new information and risk-management potential. The researchers acknowledge how their findings not only help NASA but may also help the general population.
Obviously the decision to use this new screening approach should be a consideration that your doctor and a cardiologist discuss with you. Diagnosis of heart disease should always have an individualized approach. If you are identified as having “early risk of heart disease,” then discuss prevention strategies with your healthcare team. Standard recommendations include:
- Stop smoking
- Adopt a heart-healthy diet (DASH or Mediterranean Diet)
- Lose excess weight especially excess abdominal fat
- Manage diabetes
- Begin a regular exercise regimen
- Reduce stress
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