26 October 2013

Have you ever wondered what the risk for developing a heart attack is in women? Finding out risk levels will make it easier to assign necessary therapies to eventually cure a person. To do this, several methods can be used.

The most famous method to calculate heart attack risk is by using the Framingham Risk Calculator. Combining your value of good cholesterol (HDL), total cholesterol, age, blood pressure, smoking status (smoker or not), and gender, doctors are able to provide a value for risk within a 10-year period for developing or dying from a heart attack.

For example, a 55-year-old lady with hypertension, who is well treated, with a blood pressure of 130/78 mm Hg, a total cholesterol level of 240 mg/dl, a good cholesterol 40 mg/dl and who smokes, has a 11 % chance of developing or dying from a heart attack within the next 10 years.

The value of 11% means 11 out of 100 people with this level of risk will have a heart attack within the next 10 years. Doctors consider this example as someone with high risk, who needs to be on a prescription to lower her level of bad cholesterol.

Unfortunately, the method used to calculate the 55-year-old’s risk is based on data gathered from a town called Framingham in Massachusetts, USA. The risk of someone living in the USA is very different from someone else living in Lebanon, or anywhere else. The method used also does not include family history of coronary artery disease, and does not measure risk very well in women, as determined through several studies.

All in all, the Framingham Risk Calculator is not the ideal method for calculating risk in women in Lebanon. Local doctors have found alternatives by measuring the amount of calcium present in the coronary vessels. Calcium being found in the walls of coronary vessels is abnormal. Many studies have shown that this is proof of atherosclerosis.

Women can now perform safe tests that will calculate the amount of calcium present in the coronaries, further estimating the amount of atherosclerosis. Coronary calcium tests perform very well in both men and women, with the risk of having a heart attack varying according to the value of the calcium score.

·       Calcium score of 0 = very low risk

·       Calcium score of 1-99 = low risk

·       Calcium score of 100-399 = intermediate risk

·       Calcium score above 400 = high risk

Various methods are being used in Lebanon to calculate the risk of heart attack in women in Lebanon, some of which are more accurate than others. Coronary calcium scoring in particular is safe, reliable and provides better results in women.

Dr.Hussain Isma’eel ,MD,FESC,FSCCT

Co-director,vascular Medecine Program

Division of Cardiology AUB