Knowing your risk for a heart attack — what’s in the numbers?
dubai — Heart disease is the leading global cause of death. Every year, over 17 million people die of heart disease, and this number is expected to reach 24 million by 2030. Ironically, heart attack often affects people at the height of their professional careers with profound social, economic and vocational consequences. Although recent medical advances have improved the outcome of patients hospitalised with a heart attack, the suddenness with which heart attack develops and takes its victim by surprise poses a significant barrier for any timely intervention. Therefore, prevention of heart attack in the unsuspecting people cannot be overemphasised.
Epidemiological researchers have identified several biological and social factors that increase the risk of heart attack. Fortunately, these can be modified by adopting healthy lifestyle practices, such as regular physical exercise, smoking cessation, and healthy diet as well as through management of health conditions like hypertension, high blood cholesterol and diabetes. In addition, specific preventive therapies are now available that could significantly reduce the risk of heart attack. However, a major challenge facing the contemporary healthcare practitioners lies in identifying among apparently healthy people individuals who are at elevated risk of a heart attack and who would potentially benefit from the available preventive therapies cost-effectively.
Physicians generally estimate the risk of heart attack using mathematical algorithms called ‘risk calculators’. Several such risk calculators are currently available that can provide10-year estimates of the risk of heart attack in the form of a per cent figure; some of these can even be used to assess the 30-year or lifetime risk. Most of these are simple and use online tools wherein a physician just needs to plug in few values to get the risk estimate for an individual patient. Lately, applets for risk prediction have become freely available on hand-held electronic devices for more efficient use in physicians’ offices.
Estimation of the risk of heart attack helps both physicians and their patients in decision-making. A patient is considered to be at high risk (and advised appropriate further clinical testing) if his/her 10-year risk estimate is ≥ 7.5 per cent and low risk (and encouraged to continue and optimise healthy living habits) if it is <2.5 per cent. The American Heart Association currently recommend to estimate 10year risk every four to six years in adults over 40 years of age who are free from heart disease.
A limitation of the available ‘heart attack risk estimation tools’ is that these may sometimes overestimate or underestimate the actual risk of a heart attack. Further, a substantial number of individuals are categorised in the ‘intermediate risk’ category (between 2.5 per cent and 7.5 per cent) where management decisions are less clear. Over the past few decades, medical researchers have identified additional risk markers and imaging modalities which could improve our accuracy of predicting heart attack. While some of these ‘Novel Biomarkers’ appear promising, these are not ‘Prime Time’ yet for routine clinical application.
In summary, estimation of an individual’s risk of heart attack can potentially provide a window of opportunity to intervene and reduce or eliminate the risk of heart attack in apparently healthy people. Such risk estimation can be easily performed in terms of an objective number in physician’s office. No single risk model will be appropriate for all patients, and your physician will determine the most appropriate risk assessment tool for you and any need for additional testing.
So next time you walk in for a health check, ask your physician about your ‘number’ to help you take appropriate steps for preventing a heart attack. The writer is specialist cardiologist at Primacare Specialty Clinics, Bur Dubai