This article describes a holistic guide to gauging heart attack risk. It considers the standard risk factors and includes newer methods to gauge the risk of a future heart attack. The traditional approach to heart attack risk assessment has involved the evaluation of factors that are associated with increased risk of a heart event. Among these traditional risk factors are age, smoking, diabetes and cholesterol levels. Nevertheless, these risk factors are associations that have been identified based on large subject populations. In other words, their predictive value pertains to an estimate of probability within large populations of people based on variables that may or may not have occur in an individual.
Measure your risk before an adverse heart event.
Fortunately, computed tomography or CT imaging is a relatively new method that is showing some promise in terms of predicting heart events in individual patients, which allows cardiologists to treat the risk before an adverse heart event. CT coronary angiography, is a procedure that may involve the injection of contrast dye, to gain detail about the structure of individual plaques in the heart or arteries. This provides an opportunity to make an assessment that relates to plaque-specific risk and therefore, it has important merit as another diagnostic tool in cardiology.
Know the health of your arteries.
Regardless of a patient’s cholesterol levels, the amount of exercise he/she undertakes (or not), or how healthy his/her diet is, it is important to know the health of that individual’s arteries, not the risk that a population of people, with the same characteristics, may have. To do this, the most information is obtained by using CT to look directly at the arteries. While there is substantial data that supports traditional methods of calculating risk, holistic heart evaluation means that it should be combined with CT imaging and other traditional predictive measures, such as blood pressure and blood sugar levels. The approach needs to be about the entire patient, their situation and their needs.
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Use cardiac CT imaging and traditional risk factors in combination.
The CT imaging is plaque-specific and may not necessarily agree with the risk assessment suggested by the traditional risk factors. A patient may have low-risk based on CT imaging, but the traditional assessment of high risk factors (such as elevated blood sugar levels, high blood pressure, cholesterol, triglycerides and lipoproteins), must be considered as well. The individual plaque (or plaques) may have a clear and specific impact on the risk for the potential development of a major adverse coronary event. However, the CT risk assessment for heart attack is plaque-specific and may not align with the risk assessment suggested by the traditional risk factors. Traditional predictors of a cardiac event do have some limitations, consequently, it is important to comprehend that both methods provide important diagnostic clues about heart health. They should be used in combination to determine decision-making about ongoing care and risk management of individual patients.
How to get the most comprehensive risk-evaluation.
The ability to combine the traditional diagnostic evaluation of an individual patient with the imaging of the arteries, allows the most comprehensive risk evaluation for an individual, not only for the immediate future, but also for possible longer-term cardiac problems. Cardiac CT imaging will lead to a conclusion that the features observed on the scan could be low-risk features, intermediate-risk features, high-risk features or very high-risk features. This information can then be measured against tradition risk calculation variables to achieve the most reliable prediction of an individual patient’s future heart health and most importantly, to ensure that the patient follows a treatment regimen that best reflects both their present and future heart health.
Author of this article:
Dr Warrick Bishop is a cardiologist, with special interest in cardiovascular disease prevention incorporating imaging, lipids and lifestyle. He is author of the book ‘Have You Planned Your Heart Attack?’, written for patients and doctors about how to live intentionally to reduce cardiovascular risk and save lives! Dr Bishop can be contacted via website.
