A group of five simple medical tests provides doctors and patients a long-term, wide-range glimpse into a person’s risk of developing heart disease, whether it is heart failure, arrhythmia, or heart attack. When interpreted together, these tests are now considered to illustrate a more accurate prediction of heart disease than traditional approaches.
Tests focusing on blood pressure, cholesterol, diabetes status, and smoking history are the classic approach to attempting a prediction of heart disease, but researchers from UT Southwestern Medical Center, based on two large-scale population studies, suggest a new combination of techniques:
Three blood tests
An electrocardiogram, also known as an EKG or ECG, “listens” to the heart’s electrical activity, telling doctors how fast the heart is beating, if the beat is regular, and how strongly the heart is being pumped with electrical impulses. Ultimately, the EKG provides insight into any sign of hypertrophy, a condition where the heart muscle is thickening, which can negatively affect healthy heart functioning.
The CT Scan
In a condition called atherosclerosis, buildup of plaque in the arteries can cause blood clots when the plaques burst. A CT scan is a low-radiation way of measuring coronary artery calcium, which can contribute to plaque buildup.
The Blood Tests
A series of blood tests look for C-reactive protein (a sign of inflammation), a hormone called NT-proBNP (a sign of heart stress), and high-sensitivity troponin T (a sign of heart muscle damage). Along with the EKG and the CT scan, these blood tests in their entirety have been shown to improve accuracy of heart disease predictions as well as broaden the range of heart diseases for which scientists can predict risk.
"This set of tests is really powerful in identifying unexpected risk among individuals with few traditional risk factors,” explained UT Southwestern Professor Dr. James de Lemos. “These are people who would not be aware that they are at risk for heart disease and might not be targeted for preventive therapies.”
De Lemos and others from UT Southwestern are confident in the ability of these tests to predict heart disease thanks to two large population studies, one funded in part by NASA. This study was designed to develop strategies for predicting heart disease in astronauts; both studies followed a large group of healthy people for more than 10 years.
A simple scoring system was designed for each of the five tests to calculate their accuracy; one point was given for each abnormal result, and those study participants with five points had a 20-fold increased risk of developing some sort of heart complication over the next decade, compared to people with zero points.
"These five tests have all stood on their own already. And they each tell us something different about potential heart problems - they're additive,” explained Dr. Amit Khera, Director of UT Southwestern’s Preventative Cardiology Program.
"There has been a real need to bring modern science to the problem of heart disease risk prediction, which has relied on traditional risk factors for decades,” de Lemos concluded. "We wanted to determine whether advances in imaging and blood-based biomarkers could help us to better identify who was at risk for heart disease."
The present study was published in the journal Circulation.