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Heart Services: Are You Stuck in the Middle?

When your heart health numbers put you in between low and high risk for heart disease, three tests can help your doctor determine the best course of action.

When it comes to heart disease, doctors know how to treat people whose heart health numbers — specifically, their blood pressure and cholesterol levels, as well as their age and weight — identify them as high risk. They also know what to do for those who are at low risk for heart disease. But what about people whose numbers fall somewhere in the middle, between low and high risk? A person is considered to have an intermediate risk for heart disease with the following:

  • Blood pressure between 129/89 and 139/89
  • LDL level of 100-130 and HDL of less than 40
  • Two or more of these five risk factors — family history of heart disease, high blood pressure, high cholesterol, diabetes and smoking. Being moderately overweight also adds to your overall risk.

“The majority of the population falls here in the middle,” says Michael Notarianni, MD, Chief of Cardiology at Virginia Hospital Center. “For example, let’s say your LDL is 120 and you have two of the five risk factors. The question is, are you more like the population that is at high risk for cardiovascular disease or are you more like those at the low end of the spectrum?”
To find out whether a patient is more like the high or the low end and determine the most appropriate treatment recommendations, Dr. Notarianni advises having three screening tests: a fasting lipid profile, a high-sensitivity C-reactive protein (CRP) test, and a CT scan for calcium score.
The fasting lipid profile tests for cholesterol. Anyone over 40 who hasn’t had their cholesterol checked in the last two years should get one done, says Dr. Notarianni. It’s easy to add the CRP test to a fasting lipid profile. They’re both blood tests and can be done at the same time.
“CRP is a marker for inflammation, which is the underlying cause of heart disease,” Dr. Notarianni says. “If the CRP result comes back high, we would treat you as high risk, which would typically include weight loss and exercise, plus a daily aspirin and statin medication. If it’s low, we would consider you to be low risk and might recommend trying diet and exercise to bring your numbers down before trying more aggressive treatment.” The CT scan for calcium score can be another valuable diagnostic tool for those at intermediate risk for heart disease. This non-invasive test takes less than a minute and has low radiation exposure.
The CT scan images the heart to detect and quantify calcium deposits in the coronary arteries, explains Russell McWey, MD, Department Chief of Radiology & Diagnostic Imaging. Calcium deposits are an early sign of arteriosclerosis, or hardening of the arteries.
“From the CT scan, we calculate a score of how much calcium is present,” Dr. McWey notes. “We correlate that score with the patient’s age to assess the probability of significant coronary artery disease.”
There’s no way to change some of the risk factors, including age, family history and diabetes (unless it is weight-induced). But other risk factors, including high blood pressure, high cholesterol and smoking, can be controlled, advises Dr. Notarianni. People who are at intermediate risk for heart disease have the best reason in the world to be screened. That’s when there’s still time to take steps to prevent heart disease.
“Coronary disease comes on over time,” Dr. Notarianni says. “If you wait until the disease is already there, you’ve waited too long. You want to treat it before that happens. Coronary disease is silent — until it’s not. By the time you have blockages, it’s too late to do prevention.”

What's Your Number?

The best way to prevent heart disease is to find out whether you’re at low, intermediate or high risk. To calculate your 10-year risk of having a heart attack, visit the National Cholesterol Education Program.

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