Combination Test Better Predicts Cardiovascular Risks than Standard Methods

A combination of tests may be able to better assess cardiovascular risks than current methods, a new study published by Circulation found.

When the results from the tests — an EKG, a limited CT scan, and 3 blood tests – were combined, the study authors were able to better predict which patients would develop heart disease, compared with traditional methods that account for blood pressure, cholesterol, diabetes, and smoking status.

“This set of tests is really powerful in identifying unexpected risk among individuals with few traditional risk factors,” said researcher James de Lemos, MD. “These are people who would not be aware that they are at risk for heart disease and might not be targeted for preventive therapies.”

A 12-lead EKG is able to provide data about the thickening of the heart muscle, while a coronary calcium scan can identify plaque build-up. Additionally, testing the blood for C-reactive protein can indicate inflammation, NT-proBNP hormone indicates stress on the heart, and high-sensitivity troponin T indicates cardiovascular damage, according to the study.

In hospitals, troponin is tested to diagnose heart attacks. High-sensitivity troponin is able to point out small damage that is not accompanied by symptoms or warning signs.

Four of these tests are currently available, and the high-sensitivity troponin T test will be available soon, making the novel method highly possible in a care setting.

Included in the new analysis were data from 2 large population studies that followed patients for more than 10 years. The authors focused on a larger spectrum of cardiovascular events, rather than just those associated with cholesterol build-up, like traditional assessments, according to the study.

"A major focus of this study is to expand the scope of risk prediction beyond just heart attack and stroke,” said researcher Amit Khera, MD. “We believe that people are interested in the whole portfolio of heart problems that can develop including heart failure and atrial fibrillation.”

The set of 5 tests includes the prediction of events, such as heart failure, while also better predicting heart attack and stroke than current tests, according to the study.

“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,” Dr de Lemos said. “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 authors wrote that the results from the tests were complementary, but not redundant.

"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," Dr Khera said.

To gain the final results, the tests were combined using a scoring system where 1 point was given for each abnormal result. The authors discovered that patients with 5 abnormal results had a more than 20-fold increased risk of heart complications over 10 years compared with those who did not have abnormal results, according to the study.

The study received funding from the National Space Biomedical Research Institute, a NASA consortium aimed at understanding the effects of space travel on the body.

"NASA is considering long-term missions, for example to Mars. Astronauts are highly trained people and there's a heightened investment in long-term missions,” Dr Khera said. “If someone has a cardiovascular event, that would be catastrophic.”

Predicting the cardiovascular health of the general population, including astronauts, is important for prevention.

"We're interested in taking the principles used by NASA and applying them to healthy people,” Dr de Lemos concluded. “An individual who is interested in obtaining a lot of information about his heart risk over the next 10 to 20 years can get a lot of useful information from these 5 tests.”

While the overall results of the tests proved to be a good predictor of cardiovascular events, the authors emphasize that that the tests should be done in collaboration with a physician who specializes in heart disease prevention, the study concluded.