Middle Aged People Need Imaging to See Inside Their Arteries

Dave Warner

Let’s say you’re cruising along in your 40s, maybe your early 50s, and you’re feeling fine.

In your prime, so to speak, with no thought of your arteries clogging, or worse yet, any kind of cardiac issue. You have no symptoms, and so it just doesn’t enter your mind.

Especially if you’re male, that could be a false assumption, according to a new study in Spain that an American cardiologist, Dr. Ann Bolger, calls a very important and useful weapon in the battle against coronary artery disease.

The study, which involved 4,184 men and women between the ages of 40 and 54 with no symptoms, found that 63 percent of that group did, in fact have evidence of plaque forming in their arteries, a condition called atherosclerosis.

And the men in the study outpaced the women – 71 percent of men had plaque, compared to 48 percent of the women.

The study, published in Circulation, the journal of the American Heart Association, noted that atherosclerosis is often only discovered after what it calls a cardiovascular event – that could be a heart attack, or a stroke, in lay terms.

“This is of particular importance because (cardiovascular) events are often fatal, and many deaths attributable to coronary artery disease are sudden,” the study said.

Dr. Bolger, of the University of California at San Francisco, puts it another way, speaking of the age group in the study:

“We know that this is a golden moment to intervene in terms of prevention.”

“These are people,” she said, “who if you can get their attention now and change their adverse health behaviors and potentially treat treatable risk factors – diabetes, high cholesterol, high blood pressure and certainly smoking cessation, activity levels and dietary changes – all of those things become extraordinarily impactful, if you do them early and in a sustained fashion.”

“So, this is a really important study, and it has been done very carefully,” she said.

In other words, early detection may help arrest the development of the disease, said the study.

Noninvasive procedures – such as ultrasound, imaging via a CAT scan, and an MRI (Magnetic Resonance Imaging) has, according to the Spanish study “unlocked the potential to evaluate atherosclerosis in asymptomatic populations.”

The study involved images of the carotid, aortic and cardiac arteries as well the ilio-femoral area, a wish-bone shaped region from the pelvis down to each leg.

The study said that the ilio-femoral has not been examined as much as other areas of the body.

What this all means, suggested Dr. Bolger, is that people who were considered to be without symptoms and were thought to be at low risk by traditional means still could be high risk.

She called that finding “profoundly impactful.”

“The thing to realize is that even though you feel fine, even though you do not have any kind of symptoms that anybody would think would be related to vascular disease, it doesn’t mean that you don’t have the beginnings or even the established disease,” she said.

Having said that, Dr. Bolger added that the Spanish study does not show that the type of atherosclerosis they are finding can predict your future – meaning it does not show you may have a heart attack or a stroke.

Still, she said, it’s important for us to make the right choices in our lives.

“What I tell my patients is that you live in the United State, you’re eating the food we have, you’re breathing the air that we have, you’re exposed to all kinds of things,” she said.

And then, she suggested, “Just go ahead and assume that you’ve got it,” meaning atherosclerosis.

“And change the things you can.”

“People don’t have to smoke,” she said.

And they can manage their weight, avoid processed food, be more active and keep track of their blood pressure.

“People walk around in denial,” she said, “I think the biggest value of this study is hey, probably not a good idea to bet that you’re one of the less than 50 percent who don’t have this disease. Just assume you’ve got it and do that things that are not hard to do compared to bypass surgery.”

“This is the number one American disease,” she said, “There is nothing more prevalent. Get over it. Do what you’re supposed to do.”

Some people, she said, are more vulnerable than others – those who smoked for 20 years, or those who have family history.

It is for those people, she suggested, that having a non-invasive, low-risk imaging scan may end up being the most reasonable thing to do.

Here’s a list of risk factors you can do something about, according to the American Heart Association:

  • Smoking. The association says smokers have a much higher risk of heart disease than nonsmokers.
  • High LDL cholesterol and/or triglyceride levels.
  • High blood pressure.
  • An inactive lifestyle, meaning little or no physical activity.
  • Being overweight. The association said overweight people are more likely to develop heart disease even without any other risk factors.
  • Diabetes, which the association said seriously increases the risk of developing cardiovascular disease.
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