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Increased
screening may better predict those at higher
risk for Heart Disease
Newswise — Adding noninvasive imaging to
current risk-assessment protocols may
identify more people who are at risk of
developing heart disease, UT Southwestern
Medical Center researchers have found.
Researchers used data from the UT
Southwestern-led Dallas Heart Study to
determine whether using computed tomography
(CT) to scan patients’ hearts for calcium
deposits and blockages could identify more
people at high risk for heart disease and
who could benefit from cholesterol-lowering
therapy.
The recommendations by the Screening for
Heart Attack Prevention and Education
(SHAPE) task force are a proposed update to
the current guidelines, were updated by the
National Cholesterol Education Program Adult
Treatment Panel III (NCEP-ATP III) in 2004.
In findings published in today’s edition of
Archives of Internal Medicine, researchers
found that the additional imaging proposed
by the SHAPE task force did indeed increase
the number of patients classified at “high
risk.”
“We added imaging of coronary artery
calcium, as recommended by the SHAPE task
force, to determine if this strategy would
augment current risk assessment,” said Dr.
Jason Lindsey, an author of the paper and
cardiology fellow at UT Southwestern.
The efficiency of calcium screening
according to the SHAPE recommendations was
determined by the number of people who had
to be scanned before a single participant
was reclassified as either meeting or not
meeting individual cholesterol goals.
“In our sample of participants in the Dallas
Heart Study, we found that by applying SHAPE
recommendations compared with the current
guidelines (NCEP-ATP III) there was a 27
percent relative increase in the proportion
of patients who would need lipid-lowering
therapy,” said Dr. James de Lemos, associate
professor of internal medicine at UT
Southwestern and the study’s senior author.
SHAPE calls for a broader application of
atherosclerosis imaging than is currently
recommended. Whether increased imaging of
patients will be cost effective in the long
term remains to be seen, Dr. de Lemos said.
“We can’t say what would happen in terms of
clinical outcomes, but in terms of risk
assessment we can provide a model of how
these guidelines would impact treatment,”
Dr. de Lemos said. “We found that for every
seven people who had calcium imaging, one
needed to readjust cholesterol goals to
lower levels.”
Coronary calcium scans use computerized
tomography (CT) to scan the heart and look
for calcium deposits and blockages. The risk
of coronary heart disease increases with
higher calcium scores.
Calcium buildup can lead to atherosclerosis,
a metabolic and inflammatory disease that
causes plaque to accumulate in the arteries.
Dr. Scott Grundy, director of the Center for
Human Nutrition at UT Southwestern and an
author on the <em>Archives</em> paper,
served as chairman of the NCEP panel which
updated the guidelines for the clinical use
of cholesterol-lowering medications to
reduce the risk of cardiovascular disease.
Current NCEP guidelines identify three
categories of risk based on a person's
likelihood to develop cardiovascular disease
(heart attack and stroke) in the near
future: high risk, moderately high risk, and
lower to moderate risk. High-risk
individuals are those who have already had a
heart attack; cardiac chest pain (angina);
previous angioplasty or bypass surgery;
obstructed blood vessels to the arms, legs
or brain; diabetes; or a collection of other
risk factors that raise the likelihood of
having a heart attack in the next 10 years
by more than 20 percent.
The proportion of participants identified as
not meeting their cholesterol goals
increased with age, with the greatest net
increase among people ages 55 to 65 years
old.
The research was conducted as part of the
Dallas Heart Study, a multiethnic,
population-based study of more than 6,000
patients in Dallas County designed to
examine cardiovascular disease. The
multiyear study aims to gather information
to help improve the diagnosis, prevention
and treatment of heart disease.
Other UT Southwestern researchers involved
in the study were Dr. Raphael See, lead
author and internal medicine resident; Dr.
Mahesh Patel, internal medicine resident;
Colby Ayers, biostatistical consultant; Dr.
Amit Khera, assistant professor of internal
medicine; Dr. Darren McGuire, associate
professor of internal medicine; and Dr.
Scott Grundy, professor of internal
medicine.
The Donald W. Reynolds Cardiovascular
Clinical Research Center at UT Southwestern,
the American Heart Association and the
National Institutes of Health supported the
study.
Visit
http://www.utsouthwestern.org/heartlungvascular
to learn more about UT Southwestern’s heart,
lung and vascular clinical services.
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