THE PRESENT AND FUTURE OF HEART ATTACK PREDICTION

Dr. Pranab Jyoti Bhattarchyya

Medical science is relentlessly striding ahead and modern technologies are substantially aiding this accelerated march towards the future of heart attack prediction.

Doctors, researchers and scientists are presently working intensively to find ways to predict heart attacks years before any symptoms arise.

This is important because early prediction means early intervention, and early intervention can save valuable lives especially amongst young individuals in their most productive years of life.

Traditionally physicians have relied on standard assessments of cholesterol, blood pressure, lifestyle factors and health conditions such as diabetes to predict whether a patient is likely to suffer a heart attack.

Age, lipid levels, obesity, lack of activity and stress can all contribute to blocked arteries, preventing blood flow to the heart muscle leading to a heart attack. By gathering data, test results and patient information, cardiologists can generate various risk assessment tools and scores that indicates a patient’s heart attack risk.

Predicting the risk of a heart attack involves assessing a combination of non-modifiable and modifiable risk factors, often through tools like cardiovascular risk calculators. The physician uses this information to estimate ones risk of suffering from a heart attack and help suggest a prevention plan.

Non-modifiable risk factors are those that cannot be changed and include age, gender, family history, race and ethnicity. The risk of heart attack increases with age and men generally have a greater risk of a heart attack than women and tend to have them earlier in life.

A family history of early heart attack either in the father, mother or siblings significantly increases ones risk. Indians as an ethnic group are prone to develop heart attacks a decade earlier compared to the Western population. Certain rare inherited genetic disorders can directly increase heart attack or sudden cardiac death risks which are also categorized under non-modifiable risk factors.

Modifiable risk factors are those that can be altered by adopting a healthy lifestyle and strictly following medical advice. Smoking, tobacco use, vaping, exposure to second hand smoke can damage blood vessels and promote plaque build-up leading to heart attacks. Uncontrolled high blood pressure (hypertension), diabetes, obesity and being overweight, physical inactivity and unhealthy diet high in saturated fats, trans fats, sodium and sugar and low in fresh fruits and vegetables can lead to heart disease. Emotional stress has negative effect on heart health and can also lead to overeating and smoking.

Cardiovascular risk calculators are key tools used by doctors to estimate the risk of a heart attack or stroke over a 10-year period or lifetime period using simple parameters like age, gender, blood pressure, cholesterol levels, diabetes status, and smoking history. They provide a percentage based score that categorizes risk as low, borderline, intermediate, or high.

The original risk calculator was the Framingham Heart Risk Calculator which is now largely considered out-dated and has been replaced by current more advancedand precise risk calculators like the ASCVD (Atherosclerotic Cardiovascular Disease) Risk Calculator Plus, the AHA (American Heart Association) PREVENT Calculator and the Reynolds risk score.

Beyond risk calculators, additional tests may be required for a more personalized approach to refine risk prediction in those with moderate to high risk. These may include blood tests like high sensitivity-CRP, NT-proBNP, high sensitivity troponins, a full lipid profile, an ECG and exercise stress test (TMT). Sophisticated non-invasive tests like coronary artery calcium CT scans (calcium score) can provide additional information.

Development of new technologies can better predict cardiovascular disease risk. Wearable devices and watches help to monitor the heart. A certain Japanese car manufacturer is working with researchers to study how their cars can detect when drivers are having a heart attack. Algorithms are being developed using AI (Artificial Intelligence) to predict heart attack. Retinal scans are being studied and thought to provide useful information. Cardiologists are studying how certain gut bacteria can provide clues about a patient’s likelihood of a heart event. Measuring blood levels of a molecule called TMAO, which is produced by gut bacteria, have shown possibility to predict the risk of death up to seven years later.

The risk for a heart attack is dynamic and not fixed. Aggressively adopting a healthy lifestyle is important and can help those who fall in moderate to high risk to lower their risk levels significantly. Keeping blood pressure, blood sugar, and lipids within recommended limits, maintaining a healthy body weight with regular physical activity, avoiding smoking, tobacco and excessive alcohol consumption and adopting a diet low in salt, sugar, saturated fats, trans-fats and high in fruits and vegetables are important measures recommended. Additionally, engaging in stress reducing activities like yoga, meditation, pursuing hobbies, and timely consumption of daily meals are equally important.

Despite tremendous advancements in heart attack prediction, a holistic approach to prevent heart attack is the need of the hour to save productive life years and prevent long term disability. The importance of lifestyle modification, physical activity, proper diet and regular intake of medicines as advised cannot be overstated.

Dr. Pranab Jyoti Bhattarchyya, Professor of Cardiology, GMCH (Gauhati Medical College & Hospital), Email: drpranabguwahati@gmail.com  

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