Experts know a lot about heart disease—how to prevent it, how to diagnose it, and how to treat it. But two cardiologists at Johns Hopkins recently demonstrated that a popular heart attack risk-assessment tool may fail to find existing heart disease in as many as one-third of assessed women. This is significant because heart disease is the No.1 killer of American women. Cardiovascular deaths among men have been declining, but heart-related deaths among women remain relatively unchanged.
The best way to prevent deaths from heart disease is to never let it develop, which for most experts means starting lifestyle modifications and drug therapies in those people most likely to develop symptoms in the future. “The goal is to strongly consider therapies such as aspirin, cholesterol-lowering medications and, possibly, blood-pressure medications for individuals at higher risk,” says cardiologist Roger Blumenthal, MD, associate professor and director of the Ciccarone Preventive Cardiology Center at the Johns Hopkins University School of Medicine and Heart Institute.
Currently, experts use the Framingham Risk Estimate (FRE) as the main tool for gauging who’s most likely to suffer a heart attack in the next 10 years, based on blood pressure, cholesterol levels and whether a person smokes. What Blumenthal and his colleagues are questioning is why as many as one-third of women likely to experience a cardiac event score as “very low risk” on the FRE.
Testing the test
To validate FRE scores, the two cardiologists contrasted the “very low risk” FRE results with CT-scan measurements of calcium buildup in the same women’s arteries. Their findings:
About one-third of women classified as very low risk actually had coronary atherosclerosis, a hardening of the arteries that can cause heart attacks if not controlled with drugs, diet, exercise, and other lifestyle changes. One in eight women in the study had advanced atherosclerosis; another 6% had severe calcium buildup. “We wanted to verify if the Framingham score truly captured who was most at risk. It turns out to have underestimated a large number of those who should be considered for preventive therapies,” says Blumenthal.
What’s a woman concerned about her risk to do? CT scans aren’t practical for the entire midlife population, so Blumenthal and his colleagues searched for predictors that would classify women as high-risk for heart attack without additional testing. Their short list? Two or more of the following risk factors: obesity, smoking or metabolic syndrome, or a family history for heart disease. They recommend these women obtain a cardiac CT scan regardless of their FRE. The average age of women in this study was 50; if you’re a midlife woman curious about your likelihood of experiencing heart attack, talk with your health care provider about your own unique risks for a cardiovascular event. You may need to begin today to protect your heart for the future.
