Dr. Robert G. Wilkins, an interventional cardiologist and vascular medicine specialist at Hattiesburg Clinic, provides insight on early detection in the nation's leading cause of death.

                    Heart disease is the leading cause of death in the U.S., and unfortunately, Mississippi leads the nation in deaths from heart disease. One out of every two  heart attack victims has no warning because the first sign or symptom is often the event itself.

February is National Heart Disease Awareness month and is a good time for people to assess their risks for a heart attack.  So how does one determine his or her risk? One of the most common tools is the Framingham Risk Score developed from data obtained through decades of Framingham Heart Studies, which classifies a person’s 10 year risk of a heart attack as low, intermediate or high by evaluating known risk factors including age, cholesterol level, blood pressure and tobacco use.

Treatment to reduce one’s risk is generally based on his or her Framingham score. So, a person at high-risk might be advised to take aspirin, statin or a cholesterol-lowering drug, while a low-risk individual would not receive this recommendation. 

Unfortunately, the Framingham Risk Score has been found to be more useful in assessing risks in large groups of people and not in assessing risks in individuals because it does not consider all risk factors such as family history of premature heart disease, diet, obesity and physical activity level. So a person whose score is low or intermediate may actually be at a higher risk for a heart attack. Another criticism is that this score only estimates 10 year risks instead of lifelong risks, and underestimates risks in women and minority groups.

A newer approach in risk assessment is to evaluate for the presence or absence of the actual disease instead of just evaluating for risk factors of heart disease. This has become much easier to do in the last few years with widely available imaging tools including CT scan coronary calcium scoring, carotid intima-media thickness measurement determined by carotid ultrasound, and a simple blood pressure measurement called the ankle brachial index or ABI. 

A coronary calcium score is a measurement of the amount of calcium in the walls of the coronary or heart arteries. Calcium is a component of atherosclerosis or plaque that causes blocked arteries leading to a heart attack. A high coronary calcium score means a greater amount of plaque in the heart arteries, which increases one’s risk of a heart attack. There has been a large amount of research which has validated this measurement as a valuable risk assessment tool to help determine an individual’s risk.

The carotid artery ultrasound has been available for years and can easily reveal the presence of plaque build-up in the large arteries that supply blood to the brain. A more detailed image of the carotid artery wall allows for the measurement of the carotid intima-media thickness or CIMT. An abnormal CIMT is an early assessment that atherosclerosis is present and a person’s risk is increased.

Another simple but underutilized risk tool is the ankle brachial index obtained by comparing the blood pressure in the ankle to the blood pressure in the arm. A normal value is 1.0 and the lower the ABI, the higher a person’s risk. If one’s ABI is less than 0.9, his or her risk of cardiovascular death in ten years is approximately 50 percent.

This February, people need to give extra attention to their heart health by visiting their doctor and asking the doctor to help calculate their risks of a heart attack. Risks can be reduced through lifestyle changes or other therapies. Remember, the key to preventing heart disease is early detection and early treatment.