A new study shows that coronary artery calcium (CAC) screening, an assessment tool that is not currently recommended for people considered at low risk, should play a more prominent role in helping determine a person's risk for heart attack and heart disease-related death, as well as the need for angioplasty or bypass surgery. CAC screening provides a direct measure of calcium deposits in heart arteries and is easily obtained on a computed tomography (CT) scan.
"We showed that by using only the traditional risk factors, we miss a significant percentage of individuals at high risk. We may also be over-treating a large number of people who can safely avoid lifelong treatment," says lead author Michael G. Silverman, M.D., who formerly worked at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and is now a cardiology fellow at Brigham and Women's Hospital in Boston.
In the study published online on Dec. 23 in the European Heart Journal, the researchers compared two approaches to risk assessment. One approach looked only at risk factors including cholesterol, blood pressure, current smoking and diabetes. The other used the direct measurement of atherosclerosis as seen on the coronary artery calcium score.
"Our study, using data from almost 7,000 adult participants in the Multi-Ethnic Study of Atherosclerosis (MESA), shows that coronary artery calcium screening provides an accurate, personalized assessment for those who, by traditional risk factors, are at either high or low risk of a heart attack or death from coronary artery disease," says Khurram Nasir, M.D., M.P.H., the study's senior author and director of wellness and prevention research at Baptist Health Medical Group in Miami. Nasir is also an adjunct faculty member at the Johns Hopkins University School of Medicine.
The MESA participants did not have evidence of heart disease when they joined the study between 2000 and 2002. They were assessed for risk factors and had a coronary calcium scan and were followed for a mean of 7.1 years for coronary heart disease events, such as heart attacks.
"We found that 15 percent of people believed to be at very low risk actually had high coronary artery calcium scores above 100 and were at relatively high risk of a cardiac event over the next seven years," says Roger Blumenthal, M.D., professor of medicine and director of the Johns Hopkins Ciccarone Center, who is a co-author of the study.
"On the other hand, 35 percent of study participants thought to be at very high risk and needing aggressive therapy with aspirin and statin medication actually had no coronary artery calcium and an extremely low event rate of the next seven years. For them, we can emphasize lifestyle modifications," says Blumenthal.
Nasir says the results may encourage a major paradigm shift in how physicians estimate heart disease risk for their patients. "Our study shows that coronary artery calcium testing holds promise as a frontline assessment for people before they develop heart disease symptoms. In the meantime, we believe that doctors should consider offering a coronary artery calcium scan to their patients to markedly improve risk prediction if they are unsure whether they should be on lifelong statin and aspirin therapy."
The study, "Impact of Coronary Artery Calcium on Coronary Heart Disease Events in Individuals at the Extremes of Traditional Risk Factor Burden: The Multi-Ethnic Study of Atherosclerosis," was supported by the National Institutes of Health grant numbers N01-HC-95159 to N01-HC-95166, N01 HC 95169, U01HL105270-03 to HMK and T32-HL-7227-36 to MGS.
For more information on the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease:
Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $6.7 billion integrated global health enterprise and one of the leading academic health care systems in the United States. JHM unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of The Johns Hopkins Hospital and Health System. JHM's vision, "Together, we will deliver the promise of medicine," is supported by its mission to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, JHM educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness. JHM operates six academic and community hospitals, four suburban health care and surgery centers, and more than 35 Johns Hopkins Community Physicians sites. The Johns Hopkins Hospital, opened in 1889, was ranked number one in the nation for 21 years in a row by U.S. News & World Report. For more information about Johns Hopkins Medicine, its research, education and clinical programs, and for the latest health, science and research news, visit http://www.hopkinsmedicine.org.Media Contacts:
Ellen Beth Levitt | EurekAlert!
Do microplastics harbour additional risks by colonization with harmful bacteria?
05.04.2018 | Leibniz-Institut für Ostseeforschung Warnemünde
Rutgers-led innovation could spur faster, cheaper, nano-based manufacturing
14.02.2018 | Rutgers University
Study published in the journal ACS Applied Materials & Interfaces is the outcome of an international effort that included teams from Dresden and Berlin in Germany, and the US.
Scientists at the Helmholtz-Zentrum Dresden-Rossendorf (HZDR) together with colleagues from the Helmholtz-Zentrum Berlin (HZB) and the University of Virginia...
Novel highly efficient and brilliant gamma-ray source: Based on model calculations, physicists of the Max PIanck Institute for Nuclear Physics in Heidelberg propose a novel method for an efficient high-brilliance gamma-ray source. A giant collimated gamma-ray pulse is generated from the interaction of a dense ultra-relativistic electron beam with a thin solid conductor. Energetic gamma-rays are copiously produced as the electron beam splits into filaments while propagating across the conductor. The resulting gamma-ray energy and flux enable novel experiments in nuclear and fundamental physics.
The typical wavelength of light interacting with an object of the microcosm scales with the size of this object. For atoms, this ranges from visible light to...
Stable joint cartilage can be produced from adult stem cells originating from bone marrow. This is made possible by inducing specific molecular processes occurring during embryonic cartilage formation, as researchers from the University and University Hospital of Basel report in the scientific journal PNAS.
Certain mesenchymal stem/stromal cells from the bone marrow of adults are considered extremely promising for skeletal tissue regeneration. These adult stem...
In the fight against cancer, scientists are developing new drugs to hit tumor cells at so far unused weak points. Such a “sore spot” is the protein complex...
In an article that appears in the journal “Review of Modern Physics”, researchers at the Laboratory for Attosecond Physics (LAP) assess the current state of the field of ultrafast physics and consider its implications for future technologies.
Physicists can now control light in both time and space with hitherto unimagined precision. This is particularly true for the ability to generate ultrashort...
13.04.2018 | Event News
12.04.2018 | Event News
09.04.2018 | Event News
19.04.2018 | Materials Sciences
19.04.2018 | Physics and Astronomy
19.04.2018 | Physics and Astronomy