Women's Heart Risk Linked to Coronary Calcium
About 5 percent of women considered at low
risk for heart disease still face potential cardiovascular
problems because of calcium buildup in their arteries, finds a
study in the of Archives of Internal
Medicine.
 "Previous studies have demonstrated that
calcium is predictive of coronary artery disease in other
populations," says study lead author Dr. Susan G. Lakoski, at
the Wake Forest University School of Medicine in Winston-Salem,
North Carolina. "We traditionally have the question of looking
at low-risk people."
The standard method of measuring heart risk
is the Framingham risk score, which is based on findings of a
major decades-long study of residents of a Massachusetts town.
The score includes such factors as age,
cholesterol levels, diabetes, smoking, and obesity, but not
calcium.
Dr. Lakoski and her colleagues used
computerized tomography (CT) scans of the chest to measure
coronary artery calcium in 3,601 women between 45 and 84 years
of age. Women with diabetes and women older than 79 years of age
were excluded from this group.
Ninety percent of the women were considered
"low risk," because their Framingham scores indicated they had
less than a 10 percent chance of a cardiac event in 10 years.
High risk is a test score of 20 percent or higher.
Over an average of the next 3.75 years, 24
of the low-risk women had heart events - such as heart pain or a
heart attack - and 34 of the women had a so-called
cardiovascular disease event, including heart events, stroke, or
death, the study found.
Women with the highest calcium scores were
especially at risk, says Dr. Lakoski.
"They had an 8.6 percent risk of a coronary
event," she says.
Dr. Lakoski says it is probably too early
to consider routine testing of coronary artery calcium to gauge
heart risk for women. The number of study participants was
small, and further research is needed.
Still, Dr. Suzanne Steinbaum, director of
Women and Heart Disease at Lenox Hill Hospital in New York City,
called the study findings important.
"The risk of heart disease in women is
often underestimated, because they develop heart disease later
than men, often at age 65,” she says. “By measuring calcium, we
can show that they might actually be at higher risk, and that is
important because they can benefit from preventive measures."
Heart-risk estimates for women based on
traditional risk factors might be misleading because of societal
changes, says Dr. Steinbaum.
"Younger women are developing heart disease
earlier than we originally thought," she says. "This is where
calcium might be an important modality in classifying risk."
A test for coronary artery calcium is
easily done, notes Dr. Steinbaum, but health insurance companies
currently do not pay for it.
While there are no known measures to reduce
coronary artery calcium, a woman who knows of its presence can
still take preventive measures, explains Dr. Lakoski.
"She needs to offset it with lifestyle
measures that affect risk factors that are modifiable, such as
cholesterol," she says.
Always consult your physician for more
information.
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The symptoms of coronary heart disease will
depend on the severity of the disease. Some persons with CAD
have no symptoms, some have episodes of mild chest pain or
angina, and some have more severe chest pain.
If too little oxygenated blood reaches the
heart, a person will experience chest pain called angina. When
the blood supply is completely cut off, the result is a heart
attack, and the heart muscle begins to die.
Some persons may have a heart attack and
never recognize the symptoms. This is called a "silent" heart
attack.
Symptoms of coronary artery disease may
include:
-
heaviness, tightness, pressure, and/or pain in the chest
- behind the breastbone
-
pain radiating in the arms, shoulders, jaw, neck, and/or
back
-
shortness of breath
-
weakness and fatigue
In addition to a complete medical history
and physical examination, diagnostic procedures for coronary
artery disease may include any, or a combination of, the
following:
-
electrocardiogram (ECG or EKG) - a test that records the
electrical activity of the heart, shows abnormal rhythms
(arrhythmias or dysrhythmias), and detects heart muscle
damage.
-
stress test (usually with ECG; also called treadmill or
exercise ECG) - a test that is given while a patient walks
on a treadmill to monitor the heart during exercise. A
stress test may be used to detect coronary artery disease,
and/or to determine safe levels of exercise following a
heart attack or heart surgery.
-
cardiac catheterization - with this procedure, x-rays
are taken after a contrast agent is injected into an artery
- to locate narrowing, occlusions, and other abnormalities
of specific arteries.
nuclear scanning - radioactive material is injected into
a vein and then is observed using a camera as it is absorbed
by the heart muscle. This indicates the healthy and damaged
areas of the heart.
Always consult your physician for more
information.
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American Heart Association
American Heart Association - Cholesterol
Archives of Internal Medicine - Coronary Artery Calcium
Scores and Risk for Cardiovascular Events in Women
Classified as "Low Risk" Based on Framingham Risk Score
National Heart, Lung, and Blood Institute - Guide to
Physical Activity
National Heart, Lung, and Blood Institute (NHLBI)
NIH - Heart Disease in Women
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