Imagine if a simple diagnostic test could accurately assess your risk of experiencing a heart attack in the near future.
That technology doesn’t currently exist on a widespread basis, but that could soon change.
Every year, hundreds of thousands of people in the United States experience heart attacks. These cardiovascular events, usually brought on by coronary artery disease, are so widespread that statistically, a heart attack will strike someone in this country every 40 seconds.
Physicians are currently limited in the ways they can assess their patients’ relative heart attack risk.
However, a team of researchers from the University of Oxford in England and the Cleveland Clinic in Ohio has developed a noninvasive predictive test that uses equipment already in place at many healthcare facilities.
Their research, published late last month in The Lancet, has moved doctors a step closer to achieving what one researcher interviewed by Healthline called the “Holy Grail” of heart attack detection.
New application for CT scans
“Can we predict that a person is going to have a heart attack tomorrow afternoon as they’re shoveling snow?” asks study author Dr. Milind Desai from the Cleveland Clinic’s Department of Cardiovascular Medicine. “That has always been the ‘Holy Grail’ and researchers have worked toward identifying some markers, noninvasively, to look at coronaries.”
Desai and his colleagues found that dangerous plaques that build up and become inflamed, eventually causing heart attacks, give off a chemical signal that can alert physicians to an impending heart attack, giving them time to take proactive, preventative steps to mitigate the risk.
This detection system, known as the Fat Attenuation Index (FAI), uses standard computed tomography (CT) scanning technology to measure plaque and detect risk.
In all, the researchers studied nearly 4,000 patients in Germany and the United States for up to 10 years after they received their CT test.
“This new marker is strongly associated with downstream death related to heart attacks or fatal heart attacks,” Desai told Healthline. “What I was surprised by was the derived values from the German cohort were almost identical to the American cohort. This is using different scanners, different time frames, different protocols, and different countries, yet the numbers were consistent. So it was, in our opinion, fairly robust.”
The test gives an easy-to-understand score on a patient’s risk of having a heart attack.
Those with an abnormal FAI number were up to nine times more likely to have a fatal heart attack in the next five years.
‘Ticking time bombs’
Predictive technology that identifies, with a degree of certainty, a patient’s likelihood of experiencing a heart attack can yield dividends whether they eventually experience a heart attack or not.
A problematic FAI score can alert doctors and patients to the need for intervention, whether it comes in the form of prescribing statin medications or encouraging lifestyle changes.
What’s more, an FAI score can communicate urgency and encourage changes that might not have taken place otherwise.
Even for patients who do eventually experience a heart attack, the early warning of an abnormal FAI score would give both doctor and patient an idea of the risk, along with ways to deal with the aftermath.
“Hopefully, those who do experience a heart attack can survive it, because for those who don’t drop dead, cardiologists are good at fixing the problem,” said Desai.
Desai says that the FAI system could also help future drug trials.
“There are already drugs on the market that people have studied which help reduce inflammation over and above statin therapy to help prevent future heart attacks,” he said. “Can these [FAI] markers serve as an endpoint in drug trials? As this process of detection of plaque and quantification of the attenuation evidence becomes more automatic, we could develop new therapies using this as an end point, as a marker that can be modulated.”
While the FAI technology is an exciting new frontier for cardiologists, it’s important to recognize that predictive technology is not preventative technology, even if it does help spur preventative steps.
These changes consist of the same best-practice advice many of us have heard already: eat healthy, get plenty of exercise, and visit your doctor.
Before more invasive methods of lowering inflammation, such as statin medications are considered, most doctors encourage their patients to make lifestyle changes to lower their risk.
That said, an abnormal FAI score might just be the kick in the pants that some patients need to start making these all-important changes.
Desai says that since FAI utilizes already-existing CT scanners and has been proven effective on a wide range of different scanners testing different populations, integrating the technology into physicians’ offices could take place sooner rather than later.
To that end, researchers at Oxford and the Cleveland Clinic are working on making analysis simpler.
“People don’t want to spend more time than they have to analyzing a scan, so they may want to upload to a cloud scanner where a company or group of analyzers will analyze the data and give a number that will be incorporated on the doctor’s report,” said Desai.
The biggest lesson from the study, says Desai, is the importance of collaboration and teamwork when it comes to making meaningful medical breakthroughs.
“I’m very proud of the collaboration and interpersonal relationships here,” he said. “The mission was to get the best product out there, and the collaboration is what allowed us to see this through.”