October 4, 2024 – A hidden killer – plaque buildup in arteries – is coming into focus with latest research that might change the best way doctors assess patients' risk of a fatal heart attack or stroke.
The new study found that folks with hidden plaque buildup of their arteries – a condition called atherosclerosis – were rather more more likely to die throughout the 12-year study period than people whose arteries were clear. Researchers studied 5,700 people and located in a subgroup that increases in plaque buildup increased this risk more, regardless of individuals's risk aspects or other health conditions.
What does it mean if you happen to know your levels of cholesterol, your blood pressure, and your loved ones history, but you don't know the condition of your arteries? Your doctor could also be more likely to contemplate examining the blood vessels that provide your heart and brain.
“Our data and everything we've published says that imaging has more impact than risk factors, but when you put the two together, it's the most powerful tool,” said the study's lead creator, Valentin Fuster, MD, PhD, director of the Mount Sinai Fuster Heart Hospital in New York. “The future, in my opinion, is that we will do 3D ultrasound.”
“Seeing is knowing” was the title of 1 comment That got here with the brand new study published this month within the Journal of the American College of Cardiology.
“Patients' ability to recognize their own atherosclerosis is important,” said David Maron, MD, who co-authored the commentary. “It is incredibly effective in helping people change their behavior and agree to take medications to control cholesterol or blood pressure.”
The fight against a hidden murderer
Um half of the people In the US it’s believed to have hidden plaque but no symptoms. Atherosclerosis can begin early in life and speed up in midlife. It is considered one of the leading causes of death worldwide, but most victims don't understand it until they experience life-threatening symptoms resembling a heart attack or chest pain called angina.
“That's why we see so many heart failures, because I think we're too slow and too late in the game,” said cardiologist Quynh Truong, MD, MPH, professor of drugs and radiology at Weill Cornell Medicine in New York City. She was not involved within the study.
Public health officials and health care providers alike have struggled to implement comprehensive prevention efforts amongst younger people.
But as the brand new study shows, monitoring plaque buildup over time can assist predict the danger of early death – beyond the same old risk aspects.
These latest findings represent an interim step in a series of research studies on the danger of death from hidden plaque buildup, which scientists call subclinical atherosclerosis. The aim of collecting research results is to document how imaging techniques can assist diagnose arteriosclerosis earlier in life, when it’s more treatable and before health risks resembling a heart attack threaten.
The average age of the study participants was 69 years, and other people without symptoms of arteriosclerosis were chosen. Fuster said a companion study is already underway in younger people (ages 30 to 49) that may construct on the outcomes.
How checkups can change
Currently, healthcare providers determine your risk of atherosclerosis based on aspects resembling cholesterol and blood pressure levels, smoking status and age. Imaging is never really useful for people within the low-risk group, though they might have a single borderline risk factor, resembling: B. a rather higher cholesterol level.
“The interesting thing about this study is that they looked at even these patients with low risk scores. Their risk is so low that they don’t need to take medication,” Truong said.
Doctors can detect atherosclerosis using a coronary calcium scan, a CT scan that appears for calcium deposits in heart arteries and costs about $100. Ultrasound could also be more accurate in diagnosing atherosclerosis in younger people, but it surely is dear, not covered by insurance and never widely available, Maron said.
Within just a few years, nonetheless, people might have the opportunity to scan themselves with a transportable 3D ultrasound machine that sends the outcomes to their smartphone, Fuster said. Until then, the brand new study suggests more CT scans could prevent some deaths.
“When people don't have symptoms and don't feel sick, it's sometimes difficult to do something that changes their lifestyle,” said Maron, president-elect of the American Society for Preventive Cardiology and director of the Stanford Prevention Research Center.
“I'm trying to persuade based on evidence … along with a picture of her illness,” he said. “Usually the picture is enough.”
Who needs a scan?
Truong said that if a patient is willing to take a really small dose of a cholesterol-lowering drug called a statin and might get their LDL levels of cholesterol below 100 mg/dL, or ideally below 70 mg/dL, they probably don't need imaging.
“But if you have a patient who isn't willing to take medication, you need to start talking about it: 'Let's see if you've already had a disease,'” said Truong, who focuses on cardiac CT imaging has specialized.
Typically, Maron recommends calcium testing for many men over 40 and girls over 50. Sometimes he recommends an earlier examination, for instance for individuals with a powerful family history or poorly controlled cholesterol, blood pressure or blood sugar levels.
Manage your hidden heart threats
For people concerned about hidden risks, Maron recommends specializing in what he calls Life's Essential 8: food regimen, physical activity, not smoking, healthy sleep, weight control, and maintaining healthy cholesterol, blood pressure and blood sugar levels.
“Even LDL cholesterol, blood pressure and blood sugar remain 'hidden' if not measured,” Maron said. “So, start with Life's Essential 8. Then I think everyone should get a one-time measurement of Lp(a),” a lesser-known style of cholesterol that may impact your risk of problems together with your heart and your blood vessels.
The American College of Cardiology offers a Online calculator This estimates an individual's risk of atherosclerosis and provides potential advice on managing risk aspects, which could possibly be discussed with a healthcare provider.
“Right now there are millions of people walking around with cardiovascular disease or carotid disease and they don't know it,” Maron said. “And if they knew, they would take action because they don’t want to have symptoms, they don’t want to die from atherosclerosis.”