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November 8, 2004
TRADITIONAL RISK FACTORS FAIL TO IDENTIFY WOMEN AT HIGH RISK OF HEART DISEASE
(Abstract Oral Sessions #3657, Room 352, Ernest N. Morial Convention Center.)
Traditional risk factor scoring fails to identify most women at high risk of coronary artery disease, according to an analysis by Johns Hopkins researchers. However, more women die of heart disease than do men, but women develop it on average 10 years later.
“A key tool in preventing heart disease is to first identify those who are most likely to develop the condition, many years before symptoms start,” said the study’s senior author, cardiologist Roger Blumenthal, M.D., an associate professor and the director of the Ciccarone Preventive Cardiology Center at The Johns Hopkins University School of Medicine and its Heart Institute. Blumenthal is also a spokesman for the American Heart Association. “What we now know is that you can identify more women at risk of heart disease when you add measures of lifestyle factors, such as physical activity, habits and body weight, to traditional risk factor assessments, including age, blood pressure, smoking and high blood cholesterol levels.”
Drs. Khurram Nasir, Erin Michos and Blumenthal led a study that evaluated the risk of heart disease in 2,447 women with no early signs of heart disease. All the women were older than 45, the age at which most women develop coronary artery disease. When the researchers used traditional risk factor scoring with the Framingham Risk Estimate (FRE), 90 percent of the women tested were classified as very low risk (defined an FRE of less than 10 percent risk of heart attack within the next 10 years). Current guidelines suggest no need for aspirin or cholesterol-lowering therapy for such a low FRE, while also recommending no further cardiac risk assessment for five years. The remaining 10 percent qualified for some kind of therapy. However, subsequent assessment of coronary artery calcification, using electron beam CT scans, showed that twice as many women, 20 percent, actually had advanced atherosclerosis. In these cases, the heart’s arteries have become hardened and narrowed due to the buildup of fat and calcium deposits, and treatment should include aspirin and therapies to lower cholesterol levels. The FRE score only captured 16 percent of these cases and erroneously classified 84 percent as being at very low risk of developing heart disease over the next 10 years.
Traditional Rick Factor Assessment Markedly Underestimates Subclinical Atherosclerosis Risk in Asymptomatic Women. Khurram Nasir, Joel Braunstein, John Rumberger, Matthew Budoff, Erin Michos and Roger Blumenthal.