YOUR RISK OF HEART AT­TACK

Great Health Guide - - CONTENTS - Dr War­rick Bishop

Check the lat­est in­for­ma­tion & tech­nol­ogy to mea­sure your risk of heart at­tack

This ar­ti­cle de­scribes a holis­tic guide to gaug­ing heart at­tack risk. It con­sid­ers the stan­dard risk fac­tors and in­cludes newer meth­ods to gauge the risk of a fu­ture heart at­tack. The tra­di­tional ap­proach to heart at­tack risk as­sess­ment has in­volved the eval­u­a­tion of fac­tors that are as­so­ci­ated with in­creased risk of a heart event. Among th­ese tra­di­tional risk fac­tors are age, smok­ing, di­a­betes and choles­terol lev­els. Nev­er­the­less, th­ese risk fac­tors are as­so­ci­a­tions that have been iden­ti­fied based on large sub­ject pop­u­la­tions. In other words, their pre­dic­tive value per­tains to an es­ti­mate of prob­a­bil­ity within large pop­u­la­tions of peo­ple based on vari­ables that may or may not have pre­dic­tive value for the in­di­vid­ual.

MEA­SURE YOUR RISK BE­FORE AN AD­VERSE HEART EVENT.

For­tu­nately, com­puted to­mog­ra­phy or CT imag­ing is a rel­a­tively new method that is show­ing some prom­ise in terms of pre­dict­ing heart events in in­di­vid­ual pa­tients, which al­lows car­di­ol­o­gists to treat the risk be­fore an ad­verse heart event. CT coro­nary an­giog­ra­phy, is a pro­ce­dure that may in­volve the in­jec­tion of con­trast dye, to gain de­tail about the struc­ture of in­di­vid­ual plaques in the heart or ar­ter­ies. This pro­vides an op­por­tu­nity to make an as­sess­ment that re­lates to plaque-spe­cific risk and there­fore, it has im­por­tant merit as an­other di­ag­nos­tic tool in car­di­ol­ogy.

KNOW THE HEALTH OF YOUR AR­TER­IES.

Re­gard­less of a pa­tient’s choles­terol lev­els, the amount of ex­er­cise he/she un­der­takes (or not), or how healthy his/ her diet is, it is im­por­tant to know the health of that in­di­vid­ual’s ar­ter­ies, not the risk that a pop­u­la­tion of peo­ple, with the same char­ac­ter­is­tics, may have. To do this, the most in­for­ma­tion is ob­tained by us­ing CT to look di­rectly at the ar­ter­ies. While there is sub­stan­tial data that sup­ports tra­di­tional meth­ods of cal­cu­lat­ing risk, holis­tic heart eval­u­a­tion means that it should be com­bined with CT imag­ing and other tra­di­tional pre­dic­tive mea­sures, such as blood pres­sure and blood su­gar lev­els. The ap­proach needs to be about the en­tire pa­tient, their sit­u­a­tion and their needs.

USE CAR­DIAC CT IMAG­ING AND TRA­DI­TIONAL RISK FAC­TORS IN COM­BI­NA­TION.

The CT imag­ing is plaque-spe­cific and may not nec­es­sar­ily agree with the risk as­sess­ment sug­gested by the tra­di­tional risk fac­tors. A pa­tient may have low-risk based on CT imag­ing, but the tra­di­tional as­sess­ment of high risk fac­tors (such as el­e­vated blood su­gar lev­els, high blood pres­sure, choles­terol, triglyc­erides and lipopro­teins), must be con­sid­ered as well. The in­di­vid­ual plaque (or plaques) may have a clear and spe­cific impact on the risk for the po­ten­tial de­vel­op­ment of a ma­jor ad­verse coro­nary event. How­ever, the CT risk as­sess­ment for heart at­tack is plaque-spe­cific and

may not align with the risk as­sess­ment sug­gested by the tra­di­tional risk fac­tors. Tra­di­tional pre­dic­tors of a car­diac event do have some lim­i­ta­tions, con­se­quently, it is im­por­tant to com­pre­hend that both meth­ods pro­vide im­por­tant di­ag­nos­tic clues about heart health. They should be used in com­bi­na­tion to de­ter­mine de­ci­sion-making about on­go­ing care and risk man­age­ment of in­di­vid­ual pa­tients.

HOW TO GET THE MOST COM­PRE­HEN­SIVE RISK EVAL­U­A­TION.

The abil­ity to com­bine the tra­di­tional di­ag­nos­tic eval­u­a­tion of an in­di­vid­ual pa­tient with the imag­ing of the ar­ter­ies, al­lows the most com­pre­hen­sive risk eval­u­a­tion for an in­di­vid­ual, not only for the im­me­di­ate fu­ture, but also for pos­si­ble longer-term car­diac prob­lems. Car­diac CT imag­ing will lead to a con­clu­sion that the fea­tures ob­served on the scan could be low-risk fea­tures, in­ter­me­di­ate-risk fea­tures, high­risk fea­tures or very high-risk fea­tures. This in­for­ma­tion can then be mea­sured against tra­di­tion risk cal­cu­la­tion vari­ables to achieve the most re­li­able pre­dic­tion of an in­di­vid­ual pa­tient’s fu­ture heart health and most im­por­tantly, to en­sure that the pa­tient fol­lows a treat­ment reg­i­men that best re­flects both their present and fu­ture heart health.

Dr War­rick Bishop is a car­di­ol­o­gist, with spe­cial in­ter­est in car­dio­vas­cu­lar dis­ease pre­ven­tion in­cor­po­rat­ing imag­ing, lipids and life­style. He is au­thor of the book ‘Have You Planned Your Heart At­tack?’, writ­ten for pa­tients and doc­tors about how to live in­ten­tion­ally to re­duce car­dio­vas­cu­lar risk and save lives! Dr Bishop can be con­tacted via web­site.

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