Entries in Arteries (2)


Calcium Scores the Best Predictor of Heart Attack Risk

Comstock/Thinkstock(CORAL GABLES, Fla.) -- Joanne Leahy, 59, of Fort Lauderdale, Fla., followed her cardiologist's recommendation and had a computer tomography, or CT, scan to check her heart attack risk because of her family history of heart disease.

The procedure, called coronary artery calcium scoring -- or CAC -- checks for calcium buildup in the arteries. It rates heart attack risk and gauges the benefit of certain heart treatments, such as statins.

"It's quick, painless and an indicator of heart attack," Leahy said Dr. William O'Neill, her cardiologist and chief medical officer at the University of Miami Health System, told her at the time.

Doctors generally use a blood test to check for high levels of C-reactive protein, which can signal artery inflammation and is a potential predictor of a heart attack.

But Leahy's doctor went straight to the CAC scan as his first line of defense.

A study published Thursday in the Lancet now throws some data on O'Neill's confidence. The study suggests that screening for calcium buildup in coronary arteries, called atherosclerosis, may be a better method than a C-reactive protein test, which measures the amount of C-reactive protein in the blood, for not only predicting heart attack risk but whether a patient might benefit from statin therapy.

Researchers looked at 950 patients with no symptoms of heart disease and found that patients with the presence of calcium -- even those with low cholesterol levels -- had twice the risk for heart attack or stroke and four times the risk for heart disease than those with a calcium score of zero.

Statins, cholesterol-lowering medications, are prescribed to prevent or treat plaque buildup that could cause heart attacks. But many are prescribed statins because of such risk factors as age, high cholesterol, diabetes or a family history of heart attacks.

O'Neill said that given the study findings, "You have to ask if they [those with no calcium] should be treated with statins."

While calcium scanning is helpful in seeing whether atherosclerosis has started, for many, calcium presence in the arteries does not necessarily indicate heart disease or even a looming heart attack. Studies have yet to show that calcium scans have reduced the risk of heart attack or death from heart disease.

Some experts do not support calcium scanning, saying that a patient may be exposed to high levels of radiation at extra out-of-pocket expense.

Some experts said that since recommended heart attack prevention methods such as taking statins, losing weight or controlling blood pressure don't treat the calcium buildup, the test could lead to potentially unnecessary procedures.

CAC may benefit adults who could be at an immediate risk of a heart attack within the next 10 years, according to American Heart Association guidelines. Those risk factors include obesity, prediabetes or a family history of heart disease.

Future guidelines for primary heart disease prevention should even include CAC for high-risk patients with normal cholesterol levels, said the association.

The Lancet study was actually a substudy of a previous trial by the researchers, who looked at C-reactive protein levels in asymptomatic patients.

In an accompanying editorial, German doctors said the case made for testing CAC over C-reactive protein was so strong that they now use CAC for treatment in their clinic.

The University of Miami hospital, where Leahy works, offers CAC scans to all of its employees over the age of 50. Still, some experts said that even if a calcium score could help some patients get on such preventive therapies as statins, it's premature to suggest that all would benefit from the findings of the test.

"For a call that everyone should have one, I think we need a randomized trial to show that it is beneficial to screen and then treat differently before it could be recommended for the public," said Dr. Christopher Cannon, a cardiologist at Boston's Brigham and Women's Hospital.

Copyright 2011 ABC News Radio


Transfer of Heart Attack Patients Between Hospitals Not Fast Enough

Thinkstock Images/Getty Images(DURHAM, N.C.) -- Heart attack patients who need urgent percutaneous coronary intervention, or widening of heart arteries clogged by plaque, are often transferred from one hospital to another, as 75 percent of U.S. hospitals do not have the capabilities of performing this procedure.  If this transfer has to take place, the American College of Cardiology recommends that it be done in 30 minutes.  A study finds that achieving this transfer time is a rare event, and it’s costing lives.
Researchers at the Duke University Medical Center analyzed almost 15,000 patients who were transferred from one hospital to another in order to receive percutaneous coronary intervention.  The average transfer time turned out to be more than double the recommended time period -- 68 minutes.  Furthermore, only 11 percent of the patients were actually transferred in 30 minutes or less.  Slower transfer times had a deleterious effect on patient survival as the in-hospital mortality rate for patients with transfer times over 30 minutes was 5.9 percent compared to the 2.7-percent mortality rate for patients transferred in under 30 minutes.  

The authors conclude that because of the clear health benefits in achieving the 30-minute recommended transfer time, “further attention and improvement of this performance measure will translate into substantial improvement in…clinical outcomes for transferred…patients.”

The Duke University Medical Center analysis is published in the Journal of the American Medical Association.

Copyright 2011 ABC News Radio

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