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.
(Our Organization is not responsible for the content of Internet sites.)
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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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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