Nav: Home

Screening for heart disease may lead to prevention, better treatments

March 06, 2017

Through computed tomography (CT) images of the heart and other types of imaging, build-up of dangerous coronary plaques--which restrict the flow of blood to the heart--can be detected, even before a person develops symptoms of heart disease. Because of this, there is increasing interest in using these imaging techniques to screen for heart disease. According to a review published today in JACC: Cardiovascular Imaging, a simple CT imaging technique called a coronary artery calcium (CAC) scan--often referred to as a "calcium scan"--may be particularly useful when screening for coronary artery disease.

People are screened for many types of diseases, such as breast, colon and lung cancer, even when no symptoms are present. However, there is currently no consensus among physician groups regarding when to use cardiac imaging to screen for heart disease--even though heart disease is the leading cause of death in the U.S. Instead, a patient is typically assessed using a combination of historical data and a standard blood test to measure serum lipids and blood glucose levels to arrive at a risk score to help determine if they will have heart disease in the future. While these risk scores have been proven to be somewhat useful, increasing data indicates that a CAC scan is far more accurate for this purpose.

Coronary calcium builds up at the site of coronary plaque, so a CAC scan can be effective in detecting even minute amounts of CAC. The scan results are then recorded using a "CAC score," which represents the total amount of CAC in the coronary arteries. The higher the CAC score, the greater the risk for future heart disease.

"The CAC scan can detect heart disease even decades before the symptoms of heart disease may first appear," said the study's lead author, Alan Rozanski, MD, chief academic officer and director of the cardiology fellowship training program for the division of cardiology at Mount Sinai St. Lukes Hospital in New York. "Additionally, using current state-of-the-art scanners, CAC scans are associated with only very low radiation exposure, similar to that of a mammogram, and they are less costly than all other types of imaging. Given these advantages, there is increasing interest in determining whether the use of CAC scanning could lead to earlier and more effective treatment of heart disease."

Research has shown that in approximately 40-60 percent of cases, the first time heart disease is discovered is when a heart attack or death occurs.

"By using imaging for screening, we can detect problems early on, which gives the patient an opportunity to make lifestyle changes to help avoid developing heart disease--such as by improving nutrition, starting to exercise or quitting smoking," Rozanski said. "We believe this will not only help improve and save lives but that it can ultimately contribute to lower health costs since the earlier adoption of positive health habits can reduce patients clinical risk and potentially eliminate the need for more costly interventions later on."

To help understand the best type and methods of imaging to use for screening to prevent cardiac disease and learn more about the clinical outcomes related to screening, the researchers evaluated five clinical trials with 4,615 participants who were not showing signs of heart disease: one trial involved cardiac stress imaging, three involving CAC scanning and one involved non-invasive coronary CT angiography.

Collectively, the trials showed an important hurdle: because modern therapies have markedly reduced the frequencies for developing the most serious consequences of heart disease, such as heart attacks and sudden death, it may be difficult to prove that the use of imaging techniques reduce cardiac death, per se, in clinical trials. Instead, investigators may be increasingly interested to determine if CAC scanning and other screening techniques can improve the overall cardiac risk profile of patients without increasing medical costs. In one of the trials that were reviewed, the EISNER trial, the use of CAC scanning was shown to improve cardiac risk profiles without increasing overall medical costs, but more studies in this area are needed.

"There is now sufficient evidence to support the routine use of CAC scanning for screening in clinical practice" Rozanski said. "Importantly, the CAC score has become one of our most robust predictors of patient risk. Patients are at very low risk when the CAC score is zero and at high risk when the CAC score is highly elevated. Any degree of CAC abnormality, however, even a CAC score of one or above, is sufficient reason for patients to adopt more heart-healthy behaviors."
-end-
The American College of Cardiology is a 52,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, offers cardiovascular accreditation to hospitals and institutions, provides professional medical education, disseminates cardiovascular research and bestows credentials upon cardiovascular specialists who meet stringent qualifications. For more, visit acc.org.

The Journal of the American College of Cardiology is the most widely read cardiovascular journal in the world and is the top ranked cardiovascular journal for its scientific impact. JACC is the flagship for a family of journals that publish peer-reviewed research on all aspects of cardiovascular disease. JACC: Cardiovascular Interventions, JACC: Cardiovascular Imaging and JACC: Heart Failure also rank among the top ten cardiovascular journals for impact. JACC: Clinical Electrophysiology and JACC: Basic to Translational Science are the newest journals in the JACC family. Learn more at JACC.org.

American College of Cardiology

Related Heart Disease Articles:

Pacemakers can improve heart function in patients with chemotherapy-induced heart disease
Research has shown that treating chemotherapy-induced cardiomyopathy with commercially available cardiac resynchronization therapy (CRT) delivered through a surgically implanted defibrillator or pacemaker can significantly improve patient outcomes.
Arsenic in drinking water may change heart structure raising risk of heart disease
Drinking water that is contaminated with arsenic may lead to thickening of the heart's main pumping chamber in young adults, according to a new study by researchers at Columbia University Mailman School of Public Health.
New health calculator can help predict heart disease risk, estimate heart age
A new online health calculator can help people determine their risk of heart disease, as well as their heart age, accounting for sociodemographic factors such as ethnicity, sense of belonging and education, as well as health status and lifestyle behaviors.
Wide variation in rate of death between VA hospitals for patients with heart disease, heart failure
Death rates for veterans with ischemic heart disease and chronic heart failure varied widely across the Veterans Affairs (VA) health care system from 2010 to 2014, which could suggest differences in the quality of cardiovascular health care provided by VA medical centers.
Heart failure: The Alzheimer's disease of the heart?
Similar to how protein clumps build up in the brain in people with some neurodegenerative diseases such as Alzheimer's and Parkinson's diseases, protein clumps appear to accumulate in the diseased hearts of mice and people with heart failure, according to a team led by Johns Hopkins University researchers.
Women once considered low risk for heart disease show evidence of previous heart attack scars
Women who complain about chest pain often are reassured by their doctors that there is no reason to worry because their angiograms show that the women don't have blockages in the major heart arteries, a primary cause of heart attacks in men.
Where you live could determine risk of heart attack, stroke or dying of heart disease
People living in parts of Ontario with better access to preventive health care had lower rates of cardiac events compared to residents of regions with less access, found a new study published in CMAJ (Canadian Medical Association Journal).
Older adults with heart disease can become more independent and heart healthy with physical activity
Improving physical function among older adults with heart disease helps heart health and even the oldest have a better quality of life and greater independence.
Dietary factors associated with substantial proportion of deaths from heart disease, stroke, and disease
Nearly half of all deaths due to heart disease, stroke, and type 2 diabetes in the US in 2012 were associated with suboptimal consumption of certain dietary factors, according to a study appearing in the March 7 issue of JAMA.
Certain heart fat associated with higher risk of heart disease in postmenopausal women
For the first time, researchers have pinpointed a type of heart fat, linked it to a risk factor for heart disease and shown that menopausal status and estrogen levels are critical modifying factors of its associated risk in women.
More Heart Disease News and Heart Disease Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

In & Out Of Love
We think of love as a mysterious, unknowable force. Something that happens to us. But what if we could control it? This hour, TED speakers on whether we can decide to fall in — and out of — love. Guests include writer Mandy Len Catron, biological anthropologist Helen Fisher, musician Dessa, One Love CEO Katie Hood, and psychologist Guy Winch.
Now Playing: Science for the People

#543 Give a Nerd a Gift
Yup, you guessed it... it's Science for the People's annual holiday episode that helps you figure out what sciency books and gifts to get that special nerd on your list. Or maybe you're looking to build up your reading list for the holiday break and a geeky Christmas sweater to wear to an upcoming party. Returning are pop-science power-readers John Dupuis and Joanne Manaster to dish on the best science books they read this past year. And Rachelle Saunders and Bethany Brookshire squee in delight over some truly delightful science-themed non-book objects for those whose bookshelves are already full. Since...
Now Playing: Radiolab

An Announcement from Radiolab