technology
Framingham Score
May Not Lower Risk
A
commonly used tool to
assess the likelihood of
heart disease may under-
estimate risk. according
to a study conducted at St. John
Hospital and Medical Center in
Detroit. These findings were pre-
sented at the recent 2009 American
College of Cardiology's 58th Annual
Scientific Sessions in Orlando.
The study's senior investigator is
Gerald Cohen, M.D., director of non-
invasive cardiology at SJH&MC.
In a study of 136 patients, cardi-
ologists at St. John compared the
results of carotid ultrasound test-
ing, in combination \dvith high speed
CT scans of the heart's arteries, to
the Framingham Risk Score. The
Framingham is a tool that doctors
routinely use to assess the 10-year
risk of heart disease based on
seven factors: age, gender, total
blood cholesterol, HDL (good) cho-
lesterol, smoking status, blood pres-
sure and whether blood pressure
medication is being taken.
Doctors found that a majority of
patients indentified as low risk by the
Framingham score had abnormal test
results when examined using carotid
ultrasound and a CT heart scan.
"Based on this study, combining
non-invasive imaging tests such as
ultrasound and CT scans with the
Framingham Risk Score could be
a more effective way to evaluate a
person's lifetime risk for heart dis-
ease," says Cohen.
Of the 136 patients, 57 percent
were indentified as low risk based
on the Framingham Risk Score.
However, 49 percent of those
patients were found to have thick-
ening in the walls of their carotid
arteries after ultrasound.
Also, abnormal calcium and
plaque levels were discovered in up
to 37 percent of the patients after
the CT scans.
"Middle-age patients who have
heart attacks often have a low risk
score, average cholesterol, or only
one risk factor. Knowing about ath-
erosclerosis in your body may help
motivate lifestyle and preventative
care changes in people who other-
wise incorrectly assume that they are
at low risk," according to Dr. Cohen,
a resident of Franklin and a member
of Congregation Shaarey Zedek in
Oakland County.
Dr. Cohen, in back, and staffers watch as
a patient is tested.
This study comes on the heels of
another important study led by Dr.
Cohen that also points to carotid
ultrasound as an important and
cost-effective tool in indentifying
heart disease.
The study found that using the
non-invasive test may be the safest,
fastest and most cost-effective way
to predict if someone has a com-
mon form of heart disease.
Previous research has shown a
strong link between carotid artery
disease and atherosclerosis, known
as hardening of the arteries. when
confirmed by an invasive coronary
angiogram.
For the St. John Hospital study,
heart doctors examined the relation-
ship between the presence of carotid
artery disease and early atheroscle-
rosis by performing ultrasound of the
carotid arteries along with a high-
speed CT scan on 150 patients.
Doctors found carotid artery
plaque in 71 percent of the study
participants and some degree of
atherosclerosis in 66 percent of
those in the study.
That study was further evidence
that carotid ultrasound may be the
desired initial imaging tool in diag-
nosing hardening of the arteries,"
says Dr. Cohen.
"The results also indicate that
coronary ultrasound may predict the
presence of coronary artery disease
as well as the angiogram."
Dr. Cohen says carotid ultrasound
has a number of advantages over
angiograms in the detection of ath-
erosclerosis. Ultrasound is faster,
non-invasive and radiation free. In
addition, the procedure is relatively
inexpensive and can be repeated to
follow the progression and regres-
sion of disease.
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