An Easier Way to Assess the Risk of Heart Disease

American Heart Month in full swing and the American Heart Association is celebrating a 25 percent reduction in deaths from coronary disease.

Although this seems like good news, but heart disease still reigns as the No. 1 killer in the U.S. — taking more lives than all cancers combined.

Primary care physicians serve on the front lines, but rarely have the time for the extended conversation that is needed to assess a patient’s overall heart disease risk.

In the past, many doctors have assessed the risk of cardiovascular events, such as stroke or heart failure, individually. Now, a new tool may allow both general physicians and patients to know their overall risk of any cardiovascular disease.

This index is intended to help patients see the big picture so they can take action early enough to prevent this silent killer from manifesting.

“Our function flags the chances not only of what takes you to the hospital, but also what damages your heart,” said Richard D’Agostino, co-principal investigator of the Framingham Heart Study, which produced the risk assessment.

The study, which appeared in Circulation: Journal of the American Heart Association, applied data from 8,491 patients collected over 12 years to find the 10-year risk factor for any cardiovascular event including stroke, heart failure, coronary heart disease and peripheral artery disease.

According to the evaluation, 1,174 participants were diagnosed with a cardiovascular disease during those years, which correlated significantly with the 10-year risk factor.

The new tool is not yet available online, but should be up shortly, D’Agostino said. The old 10-year risk assessment can be found here.

D’Agostino explained that the new system defines a person’s heart age according to risk factors, which he hopes will motivate people to make necessary changes. “You may say you’re a 45-year-old person,” he said, “but maybe you’re heart is the heart of a 55-year-old person because you’re at that much higher risk, which will hopefully give a person an incentive.”

Physicians and patients who find that a heart is old beyond its years can then use the tool to see where the risk is coming from. If a person’s risk factor is higher than 20 percent, D’Agostino said they should definitely be on medication, while someone in the 10 to 20 percent range may just need to make lifestyle changes.

“For moderate risk it’s very helpful,” said Dr. Gerald Fletcher, a spokesman for the American Heart Association and cardiologist at the Mayo Clinic in Jacksonville, Fla. He said this is much better than the previous risk tool formulated by the Framingham Heart Study, which is funded by National Institute of Health. Fletcher said this will be most efficient in a primary care setting, where people who score in the 10 to 20 percent range can discuss medication options and behavioral changes such as exercise with their doctors.

But cardiologists also acknowledge that many primary care physicians are strapped for time, so this tool will only be as successful as its simplicity.

“If it’s not terribly easy, it’s not terribly useful,” said Dr. Robert Kim, a cardiologist at New York-Presbyterian Hospital/Weill Cornell.

But D’Agostino said this excel-like program takes only seconds. As opposed to earlier versions, which only gave risk for certain events, as well as the heart age and overall risk, and it’s an easy way for doctors to discuss options with their patients.

Dr. A. Mark Fendrick is an internist and professor at the University of Michigan who has been using the older tool for years and wishes more of his colleagues would use it in their offices.

He noted that any general doctor should already have all of the data points, such as diabetes and smoking status, from every patient. “I think if [physicians] had the computer in the exam room and got over the hump and tried it once or twice, they’d be using it all the time,” he said.

Even if every doctor in the country used this risk assessment, and Fletcher estimated many already use the previous version, the effect it has on a patient’s behavior is still unknown. “Patients have to be a little responsible on their own, he said. “This is a preventable problem. These are preventable diseases.”