Silent Heart Disease
- The passing of television journalist Tim Russert provided a highly visible example of how standard clinical testing can miss patients at high risk of heart attacks and sudden cardiac death.
- More than half of patients having a heart attack would not be considered as candidates for intensive preventive therapy by the current clinical algorithms. In recent decades, advances in imaging technology have allowed for improved ability to detect and quantify atherosclerosis burden or silent heart disease, decades before a heart attack. The addition of anatomical parameters such as CAC and the presence of carotid plaques can substantially reduce the CVD risk underestimation.1
- Heart disease begins in childhood as atherosclerotic plaques and progresses silently for many decades. Autopsy studies of young adults dying from traffic accidents, homicides, and suicides have found atherosclerosis in 60% of individuals between the ages of 30 and 39 years age.
- The SHAPE task force suggests noninvasive atherosclerosis imaging in all asymptomatic men age 45-75 and women ages 55-75 to add information to conventional risk assessment tools.2 Although CIMT has some potential it is not ready for prime time in clinical practice. Adding coronary artery calcification score CACS≥100 would identify nearly 100% of the patients with silent heart disease.1
- The presence of any CAC, which indicates that at least some atherosclerotic plaque is present, is defined by an Agatston score more than zero. Like wise the presence of carotid plaque signifies that atherosclerotic process is underway.
- Since South Asians develop heart attacks at a significantly younger age they should be evaluated 10-20 years earlier than other populations and treated at a lower threshold.3
- The American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines’ published the 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adult in the December 14/21, 2010 edition of the Journal of the American College of Cardiology.4 This was immediately Welcomed by Dr. PK Shah, chairman of the SHAPE Scientific Board and director, Division of Cardiology at Cedars-Sinai Heart Institute and Medical Center in Los Angeles.
- According to ACCC /AHA guidelines it is reasonable to measure CACS or CIMT scanning for risk assessment of men 45-80 years of age and women 55-80 years of age who have a Framingham Risk Score of 6% or greater
- Since this not a class 1 recommendations most insurance may not cover the cost, which has however, come down to around $100 and therefore affordable to most subjects.
Sources
1. Sposito AC, Alvarenga BF, Alexandre AS, et al. Most of the patients presenting myocardial infarction would not be eligible for intensive lipid-lowering based on clinical algorithms or plasma C-reactive protein. Atherosclerosis. Jan 2011;214(1):148-150.
2. Shah PK. Screening asymptomatic subjects for subclinical atherosclerosis: can we, does it matter, and should we? J Am Coll Cardiol. Jul 6 2010;56(2):98-105.
3. Shah AS, Bhopal R, Gadd S, Donohoe R. Out-of-hospital cardiac arrest in South Asian and white populations in London: database evaluation of characteristics and outcome. Heart (British Cardiac Society). Jan 2010;96(1):27-29.
4. Greenland P, Alpert JS, Beller GA, et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. Dec 14 2010;56(25):e50-103.