Age and Calcium in Arteries Determine Heart Attack Risk, Research Says

“You are as old as your arteries.” That bit of common wisdom just received a new dose of support from the latest medical research.

A new study led by a Baptist Health South Florida researcher shows that absence of coronary artery calcium (CAC) in elderly individuals directly relates to a very low risk of having a heart attack in the next decade. On the other hand, the early presence of CAC in younger individuals age 45-55 was associated with a much higher risk of heart attack in the same time period.

“The findings are in line with previous reports where we clearly show that coronary artery calcium is best at predicting a lower risk of heart attacks, even in individuals who are considered to be at higher risk by traditional measures, such as high cholesterol, multiple risk factors, diabetes and, as in our study, being elderly,” said Khurram Nasir, M.D., the study’s senior author and director of research for the Center for Wellness and Prevention at Baptist Health Medical Group in Miami.

In the study based on data from nearly 7,000 adult participants, researchers assessed whether a simple computed tomography (CT) heart scan that measures the degree of plaque deposits in the coronary arteries, known as CAC testing, could better predict heart disease across the entire spectrum of aging. Current national American Heart Association guidelines use formulas heavily dependent on age to determine an individual’s potential for having a heart attack or stroke in the next 10 years.

“We believe that irrespective of age, CAC testing provides a personalized assessment of risk to help a clinician accurately weigh treatments as well as allow patients to make a more informed decision regarding the need for a lifelong commitment to preventive medications, such as statins,” said Dr. Nasir, who also is an adjunct faculty member at the Johns Hopkins University School of Medicine.

Results from traditional risk factor calculations could make an individual a candidate for heart disease management with statins, which are known to reduce risk for heart attack in appropriate individuals. For example, almost all men and the majority of women age 65 and older are considered for statin treatment even if they do not have other risk factors, such as high cholesterol, smoking, diabetes or hypertension, whereas many young individuals are not considered at risk.

In the study, which was recently published in Mayo Clinic Proceedings, a third of elderly participants had no detectable calcium deposits on the heart scan. That factor translated into a very low risk of having a heart attack; yet because of their age, those elderly participants were likely candidates for preventive medications, based on traditional screening methods using age alone. Conversely, almost 20 percent of much younger individuals age 45-54, had mild amounts of calcium deposits and a higher risk of a heart attack in the time duration, yet their age range did not automatically put them in the risk category for treatment with medications.

“The results clearly establish that the belief — You are as old as your arteries — holds true. We strongly believe this data along with our other reports will strongly influence future guidelines, giving CAC testing a major role in accurately assessing the risk of having a heart attack irrespective of one’s age group. Considering the heart scan is the most accurate predictor of heart attacks, costs only $100, takes two to three minutes to perform, is widely available and associated with minimal radiation, the debate has shifted from ‘Why heart scan?’ to ‘Why not?’ ” Dr. Nasir said.