NEWS The conventional cardiovascular risk factors (dyslipidaemia, hypertension, diabetes, smoking, obesity and family history of coronary artery disease) are largely redundant when assessing significant coronary narrowing in symptomatic patients. According to a doctoral dissertation published at Umeå University, coronary artery calcium score and male gender are the most reliable predictors of significant coronary narrowing, the most common cause of angina (chest) pain when walking or exercising.
“If you want to predict significant narrowing in a patient with chest pain, just do a brief CT scan to get the calcium score,” says Rachel Nicoll, doctoral student in the Department of Public Health and Clinical Medicine and author of the dissertation.
“Our findings show that there is no need to bother with measuring cholesterol or taking blood pressure. If the patient is male and has a high calcium score, then chest pain is very likely due to significant narrowing in one or more branches of the coronary artery”.
In an international multi-centre study, Rachel Nicoll carried out studies on 5,515 symptomatic patients from five European countries and the USA. She found that the coronary artery calcium score, followed by male gender, were far more reliable predictors of coronary narrowing than the conventional risk factors. These results were consistent, irrespective of geographical region.
“It makes sense that coronary calcification is a more reliable indicator of arterial narrowing as a cause of chest pain,” says Rachel Nicoll. “It is directly imaging the extent of coronary disease whereas the presence of conventional risk factors may only reflect a systemic or metabolic disorder.”
Atherosclerosis and narrowing of the coronary artery have traditionally been associated with high cholesterol. Rachel Nicoll therefore paid particular attention to any sign that dyslipidaemia, i.e. high levels of blood lipids/fats, might predict significant narrowing. However, according to the research, dyslipidaemia proved not to be a predictor at all, neither in the population as a whole nor when broken down into patients from northern and southern Europe and the USA.
Rachel Nicoll is a doctoral student at the Department of Health and Clinical Medicine at Umeå University. She comes from London, England, where she is a lecturer and writer in Environmental Medicine, and has an MSc in Nutritional Medicine.
On Thursday September 22, Rachel Nicoll, Department of Public Health and Clinical Medicine, will publicly defend her dissertation with the title: Insights into the relationship between atherosclerosis risk factors and coronary calcification. Faculty opponent: Professor Jan Engvall, Department of Medical Health Sciences /Division of Cardiovascular Medicine, Linköping University. Principal supervisor: Professor Michael Henein.
The dissertation defense takes place at 9:00 am in Lecture Hall D, NUS 1D (Tandläkarskolan), 9th floor, University Hospital of Umeå.
Rachel Nicoll, Department of Public Health and Clinical Medicine
+46 90785 2652; rachel.nicoll@umu.se
Photo: CT scan image shows coronary artery calcification in white (Photo: Rachel Nicoll)
Editor: Daniel Harju