You have no symptoms that indicate anything is wrong with your heart—yet you still might have silent coronary artery disease (CAD).
Recent finding: Among 9,533 people age 40 and older with no known heart disease who participated in the Copenhagen General Population Study, 61% of the men and 36% of the women had asymptomatic subclinical coronary atherosclerosis—aka, silent CAD. Participants were diagnosed using a CT coronary angiogram (CTCA), which detects four patterns of plaque build-up—non-obstructive and non-extensive (the mildest form of silent CAD)…non-obstructive but extensive…obstructive and non-extensive…and the most severe form, obstructive and extensive, which accounted for 10% of those with silent CAD. Obstructive and extensive CAD increases risk for heart attack eightfold compared with that for an average person.
These findings prompted questions—should everyone age 40 and over be screened as a prevention strategy…what is the best test for this…and are there any characteristics that would suggest some people with silent CAD have a higher risk profile than others?
The DANE-HEART study, conducted by researchers at University of Copenhagen, has set out to answer some of these questions. For the study, 6,000 asymptomatic persons at risk for CAD were randomly assigned to get preventive treatment based on CTCA findings or traditional cardiovascular risk-assessment scores. The results of this study, expected to be completed in five to seven years, will help identify who needs aggressive treatment.
What you can do now: If you don’t have any CAD symptoms or known risks factors—you don’t smoke and you get quality sleep, have good exercise capacity and eat a healthy diet—the chance of having silent CAD is low. But if you’re overweight, don’t exercise and have high blood pressure or cholesterol, it’s time to make healthy lifestyle changes to manage these risk factors.
Diagnosis: An imaging test will help make a diagnosis. In addition to CTCA, the coronary artery calcium (CAC) CT scan highlights areas of calcified plaque in arteries and generates a score. The higher your calcium score, the higher your heart attack risk. The CAC CT scan uses less radiation than CTCA and no dye, but it doesn’t provide as much information as the CTCA.
Treatment: Along with lifestyle changes, treatment often starts with statins. It can take several months to find the right combination of medications, especially if you’re taking antihypertensive medications. Your physician will help you reach your goals and manage side effects.
