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How healthy is your heart? Screening for cardiovascular disease


t’s reported that a heart attack occurs every two minutes in this country, writes Dr Rohan Jagathesan. Advanced coronary

heart disease can exist with minimal or no symptoms, and then suddenly and rapidly progress to a heart attack or even sudden car- diac death. However, if an abnormality can be identified early enough, the future risk of a cardiac event can be significantly reduced. Screening for coronary heart disease is dif-

ferent from the estimation of risk that GPs of- fer. Your GP can measure your blood pressure, cholesterol and glucose levels, and record your family history and smoking habits. This data is then plugged into a risk calculator and medical advice is offered based on the results. While risk estimation identifies the likelihood of a future event, screening identifies actual existing disease.

WHAT DOES SCREENING INVOLVE? Standard screening for heart conditions will usually involve an assessment with a cardi- ologist, an ECG (an electrical heart tracing), an echocardiogram (a painless ultrasound scan of the heart) and an exercise stress test (a treadmill or bicycle test). A more sensitive

screening test for coronary heart disease is now available called a coronary artery calcium (CAC) scan. Coronary artery disease develops by a pro-

cess of atherosclerosis where plaques build up within the walls of your arteries causing them to narrow. These plaques are deposits in the artery walls that are made of fat, cho- lesterol and calcium, and it’s the calcium in these plaques that can be reliably detected by the use of a CAC scan. Therefore, if calcium’s detected, it’s likely that coronary artery dis- ease is present and the extent of calcium in your heart arteries is a measure of the severity of heart disease. Conversely, if no calcium is detected, this suggests that you’re at low risk of a future heart attack. This test can de- tect very early stage disease, potentially many years before a standard health screening, and is currently the most sensitive meth- od for determining your future risk of a cardiac event. The CAC scan is fast, painless and easy. It’s

completely non-invasive and requires no spe- cial preparation. The entire procedure takes about 10 minutes and uses a very low dose of X-ray radiation.

CORONARY ARTERY CALCIUM SCORING HELPS GUIDE APPROPRIATE STATIN TREATMENT The current NICE recommendations are that preventative treatment with statins should be offered to persons with a 10% risk of de- veloping cardiovascular disease over the next 10 years. This assessment’s based on a stand- ardised risk calculator. However, the use of the risk calculator may result in unnecessary treatment of a number of

individuals with

A CT coronary calcium scan: the heart’s the light grey mass in the middle and the arrow points to a large calcified plaque

statin drugs. The recent BioImage study from the USA identified that 28% of the study par- ticipants that were deemed eligible for statin therapy, based on the risk calculator result, actually had no coronary artery calcium. The

A CT coronary artery calcium scan offers you a more personalised and individual approach to the preventative treatment of cardiovascular disease with statin therapy

conclusion was that these patients should be reclassified as not requiring statin therapy. The study also found that 10% of patients with a low risk calculator score had an elevat- ed coronary artery calcium score and there- fore would benefit from taking statins. A CT coronary artery calcium scan therefore offers a more personalised and individual approach to preventative treatment of cardiovascular disease with statin therapy.

WHO SHOULD CONSIDER SCREENING FOR HEART DISEASE? So if you’re a male over 40 or a female over 45 and can tick one or more of the following criteria, you could benefit from a coronary calcium score: • Do you smoke or have you ever smoked? • Do you have a family history of heart disease? • Do you suffer with high blood pressure? • Do you have raised cholesterol levels? • Do you have a history of diabetes? • Are you overweight? Few of us will have ideal risk levels on all

screening tests. However, if you do have test results that are less than ideal, it doesn’t mean that you’re destined to have poor health. On the contrary, it means you’re in a position to begin changing your health in a positive way and offers an opportunity to apply the best of medical advice, modern treatments and life- style changes to make a difference and help avoid a future heart attack.

Meet the expert

Dr Rohan Jagathesan is a consultant car- diologist who works in west Essex and east Hertfordshire. He completed his undergraduate and postgraduate educa- tion in London, and is accredited in all aspects of general cardiology with a spe- cific interest in coronary artery disease and coronary intervention. He is current- ly the divisional lead cardiologist at the Essex Cardiothoracic Centre in Basildon and the Essex cardiac lead for the East of England NHS Strategic Clinical Network. His private practice is based at the Rivers Hospital in Sawbridgeworth, Hertfordshire, and The Brook Suite at the Essex Cardiothoracic Centre.

If you’re at all worried about the state of your heart, please contact Dr Jagathesan for a consultation T: 07740 942414 F: 01371 700377 E:

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