Risk Scoring Overlooks Women's Heart Disease

(Ivanhoe Newswire) -- Ruling out heart problems based on traditional risk factors, like age, cholesterol levels, and smoking status, may be hurting more than helping women. A pair of recent studies found traditional risk-factor scoring leaves out nearly one-third of women likely to develop coronary artery disease.

The Framingham Risk Estimate is the current standard for assessing a patient's risk of coronary heart disease. It is a total estimate of how likely a person is to suffer a fatal or non-fatal heart attack within 10 years. It's based on a summary of major risk factors, including age, blood pressure, blood cholesterol levels and smoking.

The studies, from cardiologists at Johns Hopkins University School of Medicine and its Heart Institute in Baltimore, found many women with cardiovascular health problems slip through the cracks. The Framingham Risk Estimate tends to be more accurate when predicting the risk of a heart attack in men and less accurate when predicting the risk of heart attack in women.

Risk assessments may have played a part in catching more potentially fatal heart problems in men. Death from cardiovascular disease in men has declined steadily over the last 20 years. The rate of death, however, has stayed the same in women.

For the most recent study, Johns Hopkins researchers calculated the Framingham score of a group of women. They found 98 percent of the women had a very low risk of having coronary heart disease in the future.

When these results were compared to results from a CT scan, which measured the calcium built up in the women's arteries, however, there was a big discrepancy. One third of the women classified previously as having a very low risk were found to have atheroclerosis, a hardening and narrowing of the arteries that could lead to a heart attack. In fact, 12 percent of the women in the study were found to have advanced stages of atherosclerosis. Another 6 percent had severe calcium buildup.

Researchers say the Framingham score leaves out several risk factors that would make the tool a better judge of women's heart health, like family history and metabolic disorders. They say this results in missed opportunities to reverse risk factors and reduce the chance a woman would die of a heart attack.

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SOURCE: Published online in American Heart Journal, Dec. 16, 2005