These are exciting times for the diagnosis and treatment of heart disease. It has been noted over the last decade that the number of people going through surgery for heart disease has fallen dramatically. This is due to the number of advancements that have made great gains in the treatment of heart disease.
A major gain is the testing of cholesterol and other blood fats through advanced lipid analysis. These tests, which can be done in any doctors office with a simple blood test, allow us to pick up other factors in someones bloodstream that could have otherwise gone undiagnosed, and could be the cause of their heart problems. This is especially important in families as these factors are often hereditary.
The second major advance has been coronary calcium scoring. While this has been around for decades, it has finally come into its own. A high coronary calcium score in a man over 40 years of age or a woman of 50 is highly predictive of whether or not they have atherosclerosis (fatty buildup in their arteries). This is such a powerful test that if your calcium score is zero when you are a certain age, then it means you do not have the disease process in the arteries to your heart regardless of your cholesterol level.
This is very important because we have known for years that it is not just what your cholesterol is, but what your body does with it. In other words, there are individuals who have cholesterol levels that are astronomical yet do not have fatty buildup in their arteries. Likewise, there are people who have normal or even low cholesterol, but have already had heart attacks, angioplasty or bypass surgery.
The combination of coronary calcium scoring and advanced lipid testing is the future of Cardiovascular Health Screening.
One of the most exciting and innovative diagnostic tools is the CTA or CAT Scan Angiography. There is a new generation of ultrafast CAT scanners that will be available in this area in the very near future (meaning the next several months). This scanner will be able to do angiograms (dye pictures of the arteries) utilizing a simple injection through the forearm. The procedure will be able to be performed as an outpatient and will save at least 20% to 30% of people who have, otherwise, no known blockages from an invasive procedure called the coronary angiogram.
The CTA can also detect which patients have mild-to-moderate or severe blockages, so that they can be treated more aggressively with cholesterol lowering medicines.
The mainstay of treatment for atherosclerosis is still the lowering of cholesterol; and the primary groups of medicines used for this purpose are the statins (Zocor, Mevacor, Lipitor, Crestor, Pravachol, Etc.). While most people have heard many things about these drugs, they are in fact proven to be safe for the great majority of patients. These drugs are responsible for a 30% to 35% reduction of heart attacks, and an even greater reduction in stroke rates in these individuals.
There are helpful new drugs on the forefront that will affect cholesterol in different ways from the statins. We hope that the combination of the statins and these new medicines, along with early diagnosis of the disease process, will eventually lead to fewer and fewer procedures to relieve blockages and a significant decrease in death from heart attack and stroke.
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