Fit but still at risk

Recent research permits the identification of people with an elevated risk of heart attack - individuals who do not fit into the usual high-risk profile. LORETTA ANN SOOSAYRAJ  of New Straits Times, gets to the heart of the matter.

HIGH cholesterol, smoking, obesity, high blood pressure, diabetes, family history of heart disease – these are all the usual high risk factors that indicate an impending heart attack. Yet there are those seemingly healthy people who unexpectedly suffer from heart attacks.

Finally, a scan called the electron beam computed tomography (EBCT) is available which can detect the risk of a heart attack in apparently healthy adults who do not have the usual risk factors.

How does it work?

Atherosclerosis is the process of the thickening and hardening of the arteries. It starts with the build-up of soft plaque but with the passing of time, calcium becomes part of the build-up.

The EBCT scan detects calcium deposits in the coronary arteries. A higher calcium score may mean more advanced atherosclerosis and a higher risk of future coronary events such as a heart attack.

The EBCT Scan takes about 90 seconds, and costs US$600 (RM2, 280).

‘For people who are at risk because of a family history of early heart disease, this is an extremely good test to add to a regular exam," says Dr Jerel M. Zoltick, a US Army cardiologist who is also a consultant with the Office of the Surgeon General.

"The test had a correlation with standard risk factors in that the more risk factors you have, the higher your calcium score, however, there is a tremendous amount of variability among the individuals and their tendency to develop coronary disease," he said.

"Along with the standard risk factors, EBCT helps us to define a person's cardiovascular disease status."Referring to a group of individuals on whom the research was based, Dr Zoltick said that the traditional exercise stress test was not predictive of a coronary event,

"We were surprised by the high (calcium) scores in a group that was very physically fit and had undergone routine physical examinations," he said.

Individuals, with high total cholesterol and those with high low-density lipoprotein (LDL) - both risk factors for heart attack tended to have high calcium levels.

But there was some variance; not all those who had high calcium levels also had high cholesterol levels.

Low calcium scores, however, do not necessarily rule out atherosclerosis because the soft plaque in the artery that has not been calcified cannot be detected by the EBCT.

Individuals with a family history tended to have coronary artery calcification, but there was a wide variation in the calcium, he said.

"For these individuals, however, the scan has proven to be useful as it determines the level of risk as well as what further tests and treatment options to consider," he said,

But Zoltick also recognised the limited of this option for people who are at risk with no family history of heart disease.

The American Heart Association and the American College of Cardiology published a consensus statement last July concerning use of the EBCT, stating that it could help guide appropriate treatment for patients with coronary disease.

The writer can be contacted at Loretta@nstp.com.my