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Oct. 4, 2024 – A silent threat, often overlooked in routine checkups, is coming to light with new research that could reshape how doctors assess the risk of heart attacks and strokes. A study published in the Journal of the American College of Cardiology highlights the dangers of hidden plaque buildup in arteries—a condition known as atherosclerosis. This finding has the potential to transform the way heart health is evaluated, placing greater emphasis on early detection through imaging.
The 12-year study tracked 5,700 people, revealing that individuals with undetected plaque buildup were significantly more likely to die than those with clear arteries, regardless of their cholesterol levels, blood pressure, or other health conditions. The research underscores the importance of scanning blood vessels to detect atherosclerosis early, offering a more complete picture of heart disease risk.
Lead author Dr. Valentin Fuster, MD, PhD, director of Mount Sinai Fuster Heart Hospital in New York, commented on the power of imaging in assessing heart health: “Imaging has more power than risk factors alone, but combining both provides the most powerful tool.” He suggested that 3D ultrasound could become the future standard in screening for atherosclerosis.
A New Approach to Heart Health
Atherosclerosis, often undiagnosed until severe symptoms like heart attacks or chest pain (angina) emerge, is a leading cause of death worldwide. Dr. Quynh Truong, MD, MPH, a cardiologist at Weill Cornell Medicine, stressed the urgency of earlier detection: “We are too slow and too late in the game. That’s why we are seeing so many heart failures.”
The new study emphasizes that even people with no symptoms or obvious risk factors could have significant plaque buildup. Currently, doctors assess heart disease risk by measuring cholesterol, blood pressure, and lifestyle factors like smoking. But imaging offers a more direct view of arterial health and could be pivotal in preventing heart disease before symptoms arise.
Imaging for the Future
Dr. David Maron, MD, who co-wrote a commentary accompanying the study, explained that showing patients images of their own atherosclerosis can be a powerful motivator. “It’s incredibly effective in helping people change their behavior and agree to take medication for controlling cholesterol or blood pressure.”
While coronary calcium scans and ultrasounds can detect plaque, these tests are not routinely used for people with low risk scores. However, this may soon change. Portable 3D ultrasound devices, which could send results directly to smartphones, are on the horizon. Until then, Dr. Fuster recommends more frequent use of CT scans, particularly for people at moderate risk.
Who Should Get Scanned?
Though imaging can be expensive and is not always covered by insurance, Dr. Maron suggests that most men over 40 and women over 50 consider calcium scans, especially if they have a family history of heart disease or uncontrolled risk factors like high cholesterol or blood pressure.
However, for patients with well-controlled LDL cholesterol (ideally below 70 mg/dL), imaging may not be necessary. But for those hesitant to take medications like statins, imaging could reveal the hidden dangers of undiagnosed atherosclerosis.
The Fight Against Atherosclerosis
Atherosclerosis often starts early in life, accelerating during middle age. Public health efforts have struggled to promote widespread prevention among younger people. However, with this new research, monitoring plaque buildup over time could become a key tool in predicting heart attack risk, even for those who appear healthy.
Dr. Maron urges patients to focus on what are known as “Life’s Essential 8” to manage heart health: maintaining a healthy diet, staying physically active, avoiding smoking, managing sleep and weight, and keeping cholesterol, blood pressure, and blood sugar levels in check.
“This is a hidden killer,” Dr. Maron warned. “There are millions of people walking around right now with coronary disease or carotid disease, and they don’t know it. If they did, they would take action.”
As doctors and researchers push for earlier and more frequent imaging, this hidden threat may soon become a key focus in preventing heart attacks and strokes, potentially saving countless lives.
