Preventing Heart Attack and Stroke Through Early Intervention

Atherosclerotic Cardiovascular Diseases (ASCVDs) that result from the buildup of cholesterol deposits (plaques) in the blood vessels are on the rise and striking younger age groups. Apparently healthy people with no preexisting cardiovascular disease seem to suffer from a major heart attack, stroke or sudden death. It is possible to prevent a heart attack or stroke through early identification says Dr. Vijayakumar S., Senior Consultant Interventional Cardiologist and Clinical Lead in Cardiac Imaging, Apollo Hospitals, Greams Road, Chennai. 

“Prevention gains great significance in a world where heart attack is the leading cause of mortality, of which one-fourth of the heart attacks occur in persons less than 40 years of age, one-half of heart attack related deaths below 50 years, and 50% in patients without any pre-existing symptoms,” he says.

Heart Attack and Stroke are Preventable 

According to American Heart Association, 90% of the strokes and heart attacks are preventable by early identification and treatment. Since cholesterol deposits start as early as 20 years of age, progress slowly and result in heart attack or stroke between 40 and 80 years, if identified early, it is possible to reverse with cholesterol lowering medications. Even in later stages you can reduce chances of a major heart attack or stroke.

Current Approach to ASCVD screening 

Risk factors like diabetes mellitus, high blood pressure, high cholesterol levels, smoking, overweight and family history of heart attacks increase the chance of cholesterol deposits. The present Risk-factor scoring approach based on various combinations of these conditions can estimate the risk of heart attack or stroke and is used currently in allocating preventive therapy. Risk scores are available free online and are automatically generated, classifying risks as low, intermediate and high.

“Identification of plaque on CT or US imaging helps the physician decide on preventive treatment with statin and aspirin and more aggressive modifiable risk factor targets (lower levels of LDL cholesterol and blood pressure). It also improves medication adherence and lifestyle modification on the part of the patients”

Dr. Vijayakumar S.,Senior Consultant Interventional Cardiologist and Clinical Lead in Cardiac Imaging, Apollo Hospitals, Greams Road, Chennai.

Prevention

The ASCVD prevention focuses on lifestyle modification, and medical treatment (pharmacotherapy). 

Pharmacotherapy involves treatment of risk factors, such as diabetes mellitus and systemic hypertension. Preventive pharmacotherapy includes cholesterol lowering medication (statin) and aspirin. Lifestyle modification and treatment of risk factors are recommended across all the risk groups

Modern Approaches for Early Identification of Risk 

Risk factor-based approach is not foolproof since cholesterol deposits can also occur due to unknown risk factors. Inherent factors like resilience and susceptibility of individuals can also influence build-up of cholesterol deposits. 

Modern approaches for early estimation of ASCVD risk have introduced atherosclerotic plaque imaging techniques (like mammography) that can help charter preventive therapies. 

Coronary artery calcium (CAC) scan is a non-invasive CT scan that detects and measures calcium deposits in the coronary arteries (heart), which are signs of plaque buildup and a risk for heart attack. 

US (ultrasound) plaque imaging is a noninvasive diagnostic method to visualize atherosclerotic plaque in arteries, primarily the carotid (neck) and femoral (groin) arteries, to assess its size, and composition. 

These three tests, combined with the risk scores, provide precise estimation of 10-year ASCVD risk. Based on whether low, intermediate, or high risk / diabetics, the optimum time interval for the scan would be 5-7 years, 3-5 years, and 3 years, respectively.

Featuring insights from Dr. Vijayakumar S., Senior Consultant Interventional Cardiologist and Clinical Lead in Cardiac Imaging, Apollo Hospitals, Greams Road, Chennai.

📞 For appointments, call Apollo Hospitals Chennai at 044 4040 1066