By Dr. Ainat Beniaminovitz, MD, FACC
In our daily practice we are often confronted with the task of “cracking the black box”. Patients present without symptoms of heart disease but are troubled with the thought that a close and seemingly healthy relative had a heart attack at a young age. It is smart to be concerned. People with a first degree relative (father, mother, brother or sister) who had a heart attack, stent or bypass by 55 years of age for a man or 60 years for a woman have a genetic risk for heart disease.
Most diagnostic tests for heart disease do not measure total or genetic risk. Instead, they detect disease that already is present in the form of significant blockages in arteries. Coronary calcium scoring is a more suitable test for people with a genetic risk because it enables detection of the earliest signs of plaque deposition in the arteries. The body deposits calcium in areas of disease, and a diseased artery that has plaque buildup will also accumulate calcium. Coronary calcium scoring utilizes a CAT scan, which is very good at detecting calcium. A CAT scan of the chest (without any injections of contrast) is a very simple and noninvasive way to diagnose the presence of early or even advanced disease. The coronary calcium score is based on the size and density of any detected calcium deposits. The higher the score, the more plaque is in the arteries and the more likely it is to obstruct blood flow. A person with a low score can be treated with aspirin and cholesterol reduction to prevent or slow the deposit of additional plaque. A high score might warrant a stress test to determine whether plaque buildup is obstructing blood flow.
Although you cannot change your genes, you can change your risk factors – smoking, high blood pressure, high cholesterol levels, diabetes – to delay their genetic expression. If you have a first degree relative with early coronary disease, visit a cardiologist to learn whether you are at risk and potentially can change the future of your health!