Recent findings presented at the 2024 European Society of Cardiology Congress indicate that nearly 40% of patients with acute coronary syndrome were classified as low risk based on the Atherosclerotic Cardiovascular Disease (ASCVD) risk score. This study involved 166 patients, of whom 64 scored below 5 on the risk assessment.
Additionally, 12% of the patients were considered borderline risk, scoring between 5 and 7.5%.
Lead author Dr. Amir Ahmadi, a cardiologist at Mount Sinai Foster Heart Hospital, and presenting author Dr. Anna Mueller, an internal medicine resident, emphasized the need for new methods that go beyond traditional symptom assessments and risk scores to directly identify underlying coronary disease.
Key Findings
Dr. Mueller highlighted the humbling experience of reassuring patients who are typically considered low or no risk, only to discover that many still have heart disease. She noted that existing risk scores were developed at a time when the understanding of heart attack pathology was limited, and imaging tools for assessing subclinical coronary disease were not available.
Dr. Mueller compared the situation to cancer screening, where individuals are screened regardless of symptoms or risk factors. She suggested that a similar approach may be necessary for heart disease screening.
Dr. Ahmadi added that if individuals who experience a heart attack had seen a cardiologist just days before, many would have been missed due to their low-risk status. He pointed out that nearly half of these patients would not have been offered statins because they fell into this category. This indicates that the long-standing efforts to identify risk factors may need to shift towards directly identifying the disease itself.
The Importance of Identifying Disease
Dr. Ahmadi explained that current practices focus on estimating the risk of heart disease rather than detecting it. He emphasized that advancements in technology, such as CT scans, allow for a direct examination of the disease, specifically the plaque in coronary arteries.
This shift in focus could lead to more effective treatment strategies.
While the study presents compelling evidence for changing screening practices, the authors acknowledge the need for further research. They stress that randomized trials are necessary to evaluate the cost-effectiveness of population-level screening for coronary disease.
Conclusion
The findings from this study underscore the importance of reevaluating how heart disease is screened and treated. By focusing on identifying plaque and the disease itself rather than solely relying on risk assessments, healthcare providers may be able to better prevent and manage heart disease. As the understanding of cardiovascular health evolves, so too should the strategies for screening and intervention.