Test Panel Improves Prediction of Heart Disease Risk

Researchers have found that combined results from 5 simple tests – an EKG, a limited CT scan, and three blood tests – better predicted who would develop heart disease compared with standard strategies that focus on blood pressure, cholesterol, diabetes, and smoking history.

The five tests together provide a broader and more accurate assessment than currently used methods. “This set of tests is really powerful in identifying unexpected risk among individuals with few traditional risk factors. These are people who would not be aware that they are at risk for heart disease and might not be targeted for preventive therapies,” said Prof. James de Lemos, cardiologist at University of Texas Southwestern Medical Center (Dallas, TX, USA).

The five tests are: A 12-lead EKG provides information about hypertrophy (thickening of heart muscle); A coronary calcium scan (via low-radiation imaging) identifies calcified plaque buildup in heart arteries; A blood test for C-reactive protein indicates inflammation; A blood test for the hormone NT-proBNP indicates stress on the heart; A blood test for high-sensitivity troponin T indicates damage to heart muscle.

Four are readily available and the fifth test – high-sensitivity troponin T – will be available soon. Troponin testing is regularly used to diagnose heart attacks, but high-sensitivity troponin fine-tunes that measure, pointing to small amounts of damage that can be detected in individuals without symptoms or warning signs.

“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” said Dr. de Lemos, “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 data analyzed were from two population-based studies that each followed a large multi-ethnic cohort of initially healthy individuals for more than 10 years. The new study, led by UT Southwestern cardiologists, focused on a broader spectrum of cardiovascular disease events.

“A major focus of this study is to expand the scope of risk prediction beyond just heart attack and stroke. We believe that people are interested in the whole portfolio of heart problems that can develop,” said cardiologist Prof. Amit Khera, of UT Southwestern. The test panel not only expanded risk prediction to include the likelihood of heart failure (a chronic condition in which the heart progressively weakens) and atrial fibrillation (a heart rhythm disorder), but also proved to be a better predictor of heart attack and stroke than currently recommended approaches.

The added value comes from careful selection of tests that were complementary but not redundant, said Dr. Khera, “These five tests have all stood on their own already. And they each tell us something different about potential heart problems – they’re additive. As a result, we are getting a good look at global cardiovascular disease risk.” For example, compared with those with no abnormal results, individuals with five abnormal results had over 20-fold increased risk of developing heart complications over the next 10 years.

The study was partly funded by NASA to improve strategies for predicting heart disease. If an astronaut, especially on a long-term mission, “has a cardiovascular event, that would be catastrophic,” said Dr. Khera. What is useful for predicting astronauts’ health is useful for the public. People interested in their heart risk over the next 10-20 years “can get a lot of useful information from these five tests,” said Dr. de Lemos.

These tests are not for everyone and should be done only in collaboration with a physician with expertise in heart disease prevention to help interpret the results.

The study, by de Lemos JA et al, was published March 30, 2017, in the journal Circulation.