Heart disease is the leading cause of death in the U.S. for men and women. Typically doctors assess their patients for heart disease using the atherosclerotic cardiovascular disease risk score which provides an estimate of the risk of having a future heart event, such as a heart attack. But it doesn’t look at the actual disease that’s relevant in heart events. Viet Le, PA-C, who is an adjunct faculty in the Master of Physician Assistant Studies (MPAS) program at Rocky Mountain University of Health Professions (RMUoHP) and works at Intermountain Heart Institute Cardiology Research as a Cardiology Clinical Research Scientist is looking at coronary calcium, which indicates underlying heart disease. Le and the Cardiology Research team are using coronary calcium to show actual levels of disease.
What is a Coronary Artery Calcium Score
According to Intermountain Healthcare, “a coronary artery calcium score is a special CT scan that uses a very low radiation dose to detect calcium deposits in the coronary arteries. The presence of calcium indicates underlying heart disease called atherosclerosis — a build-up of fat, cholesterol, and other substances in the coronary arteries. Atherosclerosis can lead to heart attacks and damaged heart muscle.”
Looking Beyond Just the Risk Score
When you identify people at risk through the standard questions and risk score, explains Le, “all you’re saying is that you’re at risk for an event, such as heart attack, stroke, etc. But by looking into a coronary artery, you can actually see the level or burden of disease.” This allows doctors to make more personalized recommendations for improving heart health.
“It’s about personalized medicine. I’m not just looking at their risk as measured in a population. I also look at patients individually and ask, what is your risk? Do you need to be on medication?” Le said.
For example, someone who is estimated as being high risk based on risk factors alone might actually have no evidence of disease. But then someone who is estimated to be very low risk and therefore may not be prescribed appropriate medicine might actually have evidence of severe heart disease if you assess their coronary calcium.
The Intermountain Heart Institute Cardiology Research’s study hypothesizes they will be able to better identify those individuals who need to be treated who may not have been deemed to be at risk according to a calculated risk score based on risk factors alone. Alternatively, patients who might have been estimated to have a high risk by guideline-based risk score assessment but little to no coronary calcium won’t be unnecessarily treated and prescribed medication.
“Up to 50% of people will stop taking medication after a year, even though it reduces risk. By doing this coronary calcium study and treating patients individually rather than assessing them based on risk factors, we’re hoping those individuals with identified disease will be motivated to stay on their medications,” Le said. “Because they’ll know that they have evidence of coronary disease, it won’t just be a doctor saying that there’s a greater than 7% chance of having an event in the next 10 years. It is difficult for patients to process what that percent risk means and what to really do with it.”
Implications of the Research
The research has broad implications as it may personalize treatment, identifying those who have already developed coronary disease for risk-reducing medications, while avoiding medications in those who may have risk factors but no evidence of disease.
Purpose of a Heart-Healthy Lifestyle
Le notes that it is important to recognize that incorporating healthy lifestyle changes is not all about preventing disease to just live longer, but rather improving the quality of each day of our lives. “You’ll find people who are living what we believe are very healthy and athletic lives but who experience heart disease events, yet they survive and recover better because their baseline overall health is high. Then you’ll find people who are doing everything wrong health-wise and they don’t experience a heart attack or stroke.”
“Disease can happen regardless of what we do. The important thing is to have a high quality of life. Don’t live a healthy lifestyle just to prevent disease. Live a healthy lifestyle because it makes us feel better, improves the quality of life of each day. All the things we say that prevent disease or risk of disease (like exercise and eating healthy) are the things that improve the overall quality of life and make life enjoyable.”
— Stephanie Bentley, Institutional Communications Manager