December 19, 2005

Heart disease risk tool fails in women: study

By Karla Gale

NEW YORK (Reuters Health) - A commonly used method for
assessing heart disease risk appears to underestimate women's
risk for significant atherosclerosis (hardening of the
arteries) when they have a family history of early heart
disease, investigators at Johns Hopkins Medical Institutions

Study chief Dr. Roger S. Blumenthal told Reuters Health,
because the so-called Framingham risk estimation or "FRE"
weighs age so strongly and doesn't take into account family
history or increased waist circumferences or lack of exercise,
"we think that it misses a lot of women who should be more
aggressively treated with medication and lifestyle changes."

The Baltimore-based research team used CT scanning to check
for a build-up of calcium deposits on artery walls, an early
sign of atherosclerosis, in 102 women ages 30 to 59 years who
had siblings with coronary heart disease occurring before age

Only two of the subjects had FRE scores indicating an
intermediate risk of having a cardiovascular event -- that is,
a 10 percent to 19 percent risk over 10 years.

However, 32 percent had significant silent or "subclinical"
atherosclerosis, with high coronary artery calcium scores above
the 75th percentile for their age and gender, the team reports
in the American Heart Journal.

In terms of actual coronary artery calcium scores, 12
percent had a score above 100, indicating moderately high heart
disease risk; and 6 percent had scores above 400, indicating
extensive hardening of the arteries.

"These women almost surely should be on aspirin and
cholesterol lowering therapy," Blumenthal said. "If we relied
only on FRE we would miss them."

He recommends for patients with a family history of
premature heart disease that their physician either incorporate
imaging studies, such as cardiac CT, or measure blood levels of
CRP, a marker of inflammation, along with standard blood work
for blood sugar and lipids.

The additional advantage of an imaging study, he pointed
out, is that "you have more ammunition to help motivate them to
exercise more days/week and more vigorously, improve their diet
and accept a more aggressive medical regimen."

"Our hope," he added, "is that investigators will update
FRE to incorporate family history, since we now know that for
these patients the risk is double what the current equation

SOURCE: American Heart Journal, December 2005.