If you've lost a family member prematurely to heart disease, greater reassurance about your risk of suffering the same fate is critical.
That's why a high-powered randomised controlled study led by the Baker Heart and Diabetes Institute that followed patients over three years has confirmed the best approach to treating people who sit in the precarious intermediate risk zone, where they can often be overlooked.
The study was conducted in partnership with the Menzies Institute for Medical Research and the Victorian Heart Institute and sites in Perth, Adelaide and Brisbane. It involves seven hospitals and screened nearly 1100 people aged 40–70 years with a first-degree relative who developed coronary artery disease before 60 years, or a second-degree relative with onset before 50 years. Of these, 450 were at intermediate risk, and more than 360 patients had CT scans at baseline and three years to check their response to treatment.
Patients at intermediate risk were randomly allocated to either usual care or a combination of practitioner-led, Coronary Artery Calcium Score (CACS)-informed education and lifestyle intervention, including moderate-intensity statin therapy.
The study found that CACS images — a CT scan of a person's heart to flag calcium, which identifies the fatty plaques that can narrow and block arteries — were a valuable adjunct to education.
Lead researcher and cardiologist, Professor Tom Marwick says optimising patient engagement in prevention strategies is essential. In standard practice, adherence to 'primary prevention' statin therapy at one year is about 50%, he says. In contrast, he says high adherence to statins after CACS-guided education and management was associated with a reduction in dangerous lipids like low-density lipoprotein cholesterol and a slower build-up of plaque, compared with usual care.
Professor Marwick says: "The study showed that use of the Coronary Calcium Score was very helpful in the management of intermediate-risk people with inherited coronary artery disease."
"This approach helps both GPs and patients to visualise the early signs of heart disease via a CT scan and take action in the form of statin treatment before they experience more severe heart blockages and suffer a serious event like a heart attack."
"The resulting control of plaque progression with statin-therapy would be expected to save heart attacks and death over subsequent decades."
