Establishing Heart Disease Risk
There are several risk factors relating to heart disease including diet, smoking and genetics. Early diagnosis also plays a significant role in maintaining health and helping to avoid a life-threatening event such as a heart attack.
The problem is that many people ignore warning signs such as chest pains or feelings of fatigue until it is too late. Regular testing and understanding the risk that may be developing, especially when individuals reach middle age, can spot problems early and even reverse disease.
Cardiac Risk Score
Several different factors determine the risk of developing heart disease throughout life. These include blood pressure and cholesterol levels as well as lifestyle factors such as whether someone smokes, drinks, undertakes little exercise or maintains an unhealthy diet. Some factors can’t be controlled, such as age and gender.
All these factors can be combined to produce what is called a cardiac risk score. This is measured as a percentage:
- A score of 10% means an individual is at low risk of developing heart disease over the next ten years.
- A score of 10-20% means the individual is at intermediate risk of developing heart disease over the next ten years.
- A score over 20% means the individual is at high risk of developing heart disease over the next ten years.
The group someone who has been assessed finds themselves in will determine how aggressively their condition needs to be managed. For an individual assessed as high risk, that could mean taking medication and changing lifestyle habits relating to their condition such as improving their diet and getting more exercise.
The simplest physical test for heart health, especially for someone exhibiting chest pains, is an echocardiogram. This is a type of ultrasound that enables the physician to look at the heart and the surrounding blood vessels. This is non-invasive and involves placing sensors over the chest area and viewing the heart function on a screen.
In addition to an echocardiogram, an individual can have several blood tests to determine their heart risk. These include:
- A full lipid profile: This looks at fat levels in the blood and indicators such as cholesterol, HDL cholesterol, and triglycerides
- Apolipoprotein B/A1: These play a role in lipid metabolism and high levels of B and low levels A1 suggest an increased risk of heart disease.
- Homocysteine: This gives an indirect estimate of cell repair and levels should be relatively low unless an individual has heart disease.
- Highly Sensitive C-reactive Protein: This is a nonspecific marker of inflammation.
Other tests may also be carried out such as a full blood count, tests to measure electrolyte and blood sugar levels as well as checks for kidney and liver function.
Another important factor in determining heart disease risk is the condition of the individual’s arteries. Over time, fat can build up on the arterial walls, narrowing the blood flow and increasing the risk of a heart attack.
The screening measures how ‘stiff’ the arteries are and is carried out using ultrasound. There are various types including:
- Carotid ultrasound measures the blockages in the two main arteries serving the brain.
- Aortic ultrasound measures the size of the aorta.
- The ankle-brachial index uses blood pressure cuffs on the arms and ankles to measure peripheral artery disease.
A more invasive approach is to use a coronary angiogram where a catheter is inserted into the femoral artery and a dye is then flushed through to detect blockages.
Another method of determining the extent of coronary atherosclerosis is to use a CT scan and determine the coronary calcium score.
A score of zero means that there is no risk of developing heart disease at the moment. A score of between 100 and 400 means that there is moderate calcification and a much higher risk.
Above 400 and the risk is severe and this means the individual has a 50% chance of having a heart attack within the next ten years. This is a much more accurate indicator than measuring cholesterol levels or taking blood tests.
It’s a good idea for those approaching their middle age years to have a calcium scoring test at some point. Doing so can help identify coronary issues and means that their medical treatment and lifestyle changes can be implemented before something very serious like a heart attack happens.
The content above is based on the information featured in the three articles linked below.
The author of these articles is Dr Ross Walker, one of Australia’s most esteemed cardiologists and a member of the Miskawaan Medical Advisory board.