New research suggests that ultrasound may be “ultra good” at diagnosing heart disease in people not technically categorized as being at high risk — this is important because most doctors currently rely on a tool called the Framingham Risk Assessment Tool that, when it is the only measure used, misses many such patients. In a recent study, ultrasound revealed that three out of four women the Framingham tool would call “low risk,” but who had metabolic syndrome, in fact had serious signs of heart disease.
Ultrasound is a relatively inexpensive technology that doesn’t involve radiation, unlike CT scans. While it is not currently widely used for this purpose, some doctors believe that it may be a good way to identify cases of early-stage heart disease that might otherwise slip through the cracks.
At Massachusetts General Hospital in Boston, cardiologist Danya L. Dinwoodey, MD, and her colleagues conducted heart and circulation ultrasounds on women classified as low risk for cardiovascular disease according to the traditional Framingham risk scoring system. This tool considers factors such as age, gender, cholesterol, blood pressure and smoking status — but does not take into account obesity or whether a patient has metabolic syndrome (defined as having three or more of the following: insulin resistance, abdominal obesity, high blood pressure, high triglycerides and low levels of HDL “good” cholesterol), which also is a significant risk factor for heart disease and stroke.
Of the 43 women (average age of 51), 32 (74%) had metabolic syndrome and 29 (67%) were obese. When ultrasounds were conducted on these women, Dr. Dinwoodey found that…
These abnormal ultrasound findings signal far higher cardiac risk than their Framingham scores alone, Dr. Dinwoodey warns. She presented these results in June 2010 at the annual Scientific Sessions of the American Society of Echocardiography. Since the study was small in scope, larger-scale research is necessary to confirm the results.
This research demonstrates that conventional risk-assessment tools may fail to pick up at-risk individuals, missing an opportunity to get them into preventive treatment and counseling, says Dr. Dinwoodey. She believes that ultrasound testing may be a practical solution. It can provide additional data to help determine how aggressively to intervene with treatment — perhaps ultimately saving lives, she added. While this research was done on women, Dr. Dinwoody said that it’s likely that it can also be a helpful screening tool to identify heart disease in men with similar risk factors.
If you are overweight or suffer from metabolic syndrome, ask your doctor about appropriate testing to determine your risk for heart attack and stroke, and get advice about what you can do to reduce that risk. At present, health insurance does not cover screening ultrasound, although Dr. Dinwoodey hopes that this will change as soon as evidence continues to accumulate that existing assessment tools fall short. In the meantime, take active steps to protect your heart — follow a healthy diet, get regular exercise, control your weight, don’t smoke and consult your physician about whether it is a good idea for you to take a daily low-dose aspirin.
