New Screening For Cardiovascular Disease

Checking out the patient’s heart disease risk factors used to be very basic. Lifestyle questions were one aspect: was the patient smoking? Did he have a lack of exercise? Did he have a risk of heart disease in the family? The patient’s diet was analyzed and the body weight was assessed. Cholesterol and triglyceride levels were the basic labs that provided more information. The risk factor assessment, as exemplified by criteria from the Framingham study, made a lot of sense.

In the meantime cardiologists are concerned that all these points are no longer sufficient in identifying individuals at risk for heart disease. Dr. Morteza Naghavi, president for the Association for the Eradication of Heart Attacks, is concerned that it is not only obesity and hypertension that bear the risk for heart attacks, but atherosclerosis. A lot of heart attacks occur in the low- and moderate risk groups. As far as he is concerned, every man aged 45-75 and every woman from 55-75 needs to be screened. We are better equipped to do something for people who have a high plaque burden (deposits in the blood vessels.) Statins are the medication of choice to help these patients.

Screening techniques have become less invasive, as imaging technology has made large progress in recent years. The condition of the carotid artery can be assessed by ultrasound (carotid intima-media thickness or CIMT). Coronary calcification score (CACS) can be measured by CT scanner. The tests are done in a few minutes, and the cost at the most is a few hundred dollars. A patient would only be screened every five years. Screening procedures work and save lives, as demonstrated in the screening for breast cancer. The SHAPE team (The Screening for Heart Attack Prevention and Education) has calculated that the screening cost is even better than breast cancer screening. There are other tests that improve the sensitivity of traditional criteria, like the blood test for C-reactive protein, but in assessing the patient’s risk, it does make sense to go to the source of disease. The striking color image that demonstrates the atherosclerotic burden will allow the patients to see the problem with their own eyes.

New Screening For Cardiovascular Disease

New Screening For Cardiovascular Disease

It may be a healing shock that has a beneficial effect on the compliance of patients. Test results of laboratory work are words, but here a picture is worth a thousand words when it comes to encourage the patient to actively work on prevention.

More information on heart attacks:

Reference: National Review Of Medicine, July 30, 2006, page 7

Last edited November 1, 2014


Better Recovery From Strokes Through Early CT Scans


You can have a better recovery from strokes through early CT scans. This was published in the September 2001 issue of the American Journal of Neuroradiology (Am J Neuroradiol – 01-SEP-2001; 22(8): 1534-42). A group of clinicians from the Foothills Hospital in Calgary/Alberta published an article with a scoring system for CT scans. These scans were done on every patient with a stroke. By utilizing early CT scans and this scoring system an ischemic stroke (due to a blood vessel that closed off in the brain) could be rapidly assessed.

Early CT scan helps to decide whether clot-busting drugs help the patient

Within 3 hours of the beginning of the stroke the treating physician would know whether the patient would benefit from clot-busting drugs (TPA or tissue plasminogen activator) or not. Dr. Pexman and co-workers had noted that patients with an Alberta Stroke Program Early CT Score (ASPECTS) of less than 7 had a poor survival rate or an outcome with high dependency on caregivers. Patients with a score of 7 to 10 had a much better survival chance and were ideal candidates for the clot-busting therapy. The radiologist who reads the CT scan of the brain of the stroke patient divides th CT scan into 10 regions. Researchers evaluate the findings systematically and obtain an ASPECTS score.

Ischemic strokes treated early

Dr. Michael Hill, an assistant professor at the University of Calgary, and one of the co-workers of this initial study has now completed a further follow-up study together with Dr. A.Buchan, director of the Calgary Stroke Program. The authors published the results of the study in the August 2003 issue of the medical journal “Stroke”. They found that ischemic strokes (from clots in the middle cerebral artery) have the best outcome when detected by CT scan early (within 3 hours of the beginning of the stroke) and if thrombolysis therapy with TPA, the clot-busting drug, is done before 6 hours after the beginning of the stroke.

Better Recovery From Strokes Through Early CAT Scans

CT Scan of Ischemic Stroke

Stroke in the middle cerebral artery diagnosed early

The lack of blood circulation from a stroke, which closed the middle cerebral artery, is shown in this link. What does that mean in practical terms? Let us assume a patient is suddenly losing all of the strength and movement in one arm and losing speech as well. In this case the physician orders an emergency CT scan right away. This helps to determine that the patient had a stroke in the middle cerebral artery region. Let us say that the ASPECTS score was between 7 and 10. This patient’s physicians would likely treat the stroke with the clot-busting medicine mentioned being confident that there likely will be a good outcome.

Less permanent palsies with early intervention 

Before this therapy was available, many of these patients ended up with a permanent arm palsy without much function. They likely also sustained a permanent speech deficit as well. After the clot-busting therapy many of these patients have a much better outlook. Now they have a considerably better return of function in their arm and regain their speech as well. Unfortunately, the opposite is true as well.

Those with an ASPECTS score below 7 do poorly with their stroke

Those with a poor ASPECTS score below 7 will not be candidates for the clot-busting therapy. They tend to do poorly. Several countries use this scoring system of early CT scans already to investigate the severity of strokes (ASPECTS). Among those are Canada, the US, Australia and Europe.  Dr. A.Buchan said: “Early detection and intervention in stroke is critical to achieve a positive outcome”. He is the director of the Calgary Stroke Program. In addition, he is also a professor in the department of clinical neurosciences of the University of Calgary/Alberta. Here is a link for more background on strokes.