Women's Heart Risk Linked to Coronary Calcium
About 5 percent of women considered at low risk for heart disease still face potential cardiovascular problems because of calcium buildup in their arteries, finds a study in the of Archives of Internal Medicine.
"Previous studies have demonstrated that calcium is predictive of coronary artery disease in other populations," says study lead author Dr. Susan G. Lakoski, at the Wake Forest University School of Medicine in Winston-Salem, North Carolina. "We traditionally have the question of looking at low-risk people."
The standard method of measuring heart risk is the Framingham risk score, which is based on findings of a major decades-long study of residents of a Massachusetts town.
The score includes such factors as age, cholesterol levels, diabetes, smoking, and obesity, but not calcium.
Too Early for Routine Testing
Dr. Lakoski and her colleagues used computerized tomography (CT) scans of the chest to measure coronary artery calcium in 3,601 women between 45 and 84 years of age. Women with diabetes and women older than 79 years of age were excluded from this group.
Ninety percent of the women were considered "low risk," because their Framingham scores indicated they had less than a 10 percent chance of a cardiac event in 10 years. High risk is a test score of 20 percent or higher.
Over an average of the next 3.75 years, 24 of the low-risk women had heart events - such as heart pain or a heart attack - and 34 of the women had a so-called cardiovascular disease event, including heart events, stroke, or death, the study found.
Women with the highest calcium scores were especially at risk, says Dr. Lakoski.
"They had an 8.6 percent risk of a coronary event," she says.
Dr. Lakoski says it is probably too early to consider routine testing of coronary artery calcium to gauge heart risk for women. The number of study participants was small, and further research is needed.
Still, Dr. Suzanne Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital in New York City, called the study findings important.
"The risk of heart disease in women is often underestimated, because they develop heart disease later than men, often at age 65," she says. "By measuring calcium, we can show that they might actually be at higher risk, and that is important because they can benefit from preventive measures."
Lifestyle Continues to be Key Factor
Heart-risk estimates for women based on traditional risk factors might be misleading because of societal changes, says Dr. Steinbaum.
"Younger women are developing heart disease earlier than we originally thought," she says. "This is where calcium might be an important modality in classifying risk."
A test for coronary artery calcium is easily done, notes Dr. Steinbaum, but health insurance companies currently do not pay for it.
While there are no known measures to reduce coronary artery calcium, a woman who knows of its presence can still take preventive measures, explains Dr. Lakoski.
"She needs to offset it with lifestyle measures that affect risk factors that are modifiable, such as cholesterol," she says.
Always consult your physician for more information.
Online Resources
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American Heart Association - Cholesterol
National Heart, Lung, and Blood Institute - Guide to Physical Activity