Asymptomatic cardiovascular changes are powerful predictor of future heart disease

11/05/04

University of Pittsburgh researcher reports on short-term outcomes at American Heart Association meeting

NEW ORLEANS, Nov. 9 – An index of early cardiovascular changes measurable even before symptoms appear is a more powerful predictor of future stroke, heart attack or other coronary heart disease than traditional risk factors such as smoking, obesity and a sedentary lifestyle. More aggressive intervention at the time these changes are first detected could have a positive impact on cardiovascular disease-related illness and death.

In a study presented today at the American Heart Association's Scientific Sessions 2004 in New Orleans, Lewis Kuller, M.D., Dr. P.H., professor and past chair of the department of epidemiology at the University of Pittsburgh Graduate School of Public Health, reported on the short-term outcome of patients in the Cardiovascular Heart Study, a population-based longitudinal study of coronary heart disease and stroke in adults over age 65 sponsored by the National Heart, Lung and Blood Institute of the National Institutes of Health.

"Now we can identify older men and women who don't have any clinical disease or other risk factors, and yet who are at very high risk," said Dr. Kuller. "Especially among women, these measures are really quite powerful."

Measures of early cardiovascular changes before symptoms appear, such as narrowing of the carotid arteries, electrocardiographic abnormalities and ankle-arm blood pressure index and carotid intima-media thickness (markers of early atherosclerosis), all were found to be strong,independent risk factors for future cardiovascular events including heart attack and stroke,Dr. Kuller said.

Data were analyzed for 2,454 patients with subclinical disease as identified by this index of measures and 1,608 people who did not have early evidence of cardiovascular disease referenced over a period of more than 10 years to gauge predictive value for later development of clinical heart disease factors such as angina, heart attack, bypass surgery or angioplasty and stroke. Those who had evidence of subclinical disease early on faced a substantially higher risk of cardiac events later on, the study found.

Black women with subclinical disease had more than a two-and-a-half-fold higher risk of a subsequent cardiac event than those who did not have early evidence of cardiovascular changes – the highest risk noted. Black and white men were found to be nearly two times as likely to have clinical disease after 10 years if evidence of disease was present earlier. White women with subclinical disease had a 60 percent higher risk of a subsequent cardiac event, the study found.

"In contrast to traditional measures that prove a snapshot picture of risk factor levels at one point in time, the index of measures reflects cumulative vascular burden that can more accurately point to later risk for coronary artery disease," Dr. Kuller continued. "Earlier interventions, perhaps with drugs to treat cholesterol and hypertension, as well as controlling diabetes and making modifications in exercise and diet could perhaps help to reverse the process."

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