Dr. Jacqueline Gerhart: Heart Attack Predictors
Madison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears weekly on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.
Dear Dr. Gerhart: My dad died at age 50 of a heart attack. His sister had heart surgery for blocked arteries at age 58 - and she just died last month at age 64. Is there a way to predict my likelihood of dying young of a heart attack based on when my family died?
Dear Reader: I am very sorry to hear about the loss of your father and the recent loss of your aunt. You are correct; genetics does have a strong influence on whether you will get heart disease or a stroke. And there are ways you can calculate your risk for heart attack, stroke or cardiac death based on your personal risk factors.
One method we use at the University of Wisconsin is called "Health Decision." It was created by Dr. John Keevil and colleagues at the UW Preventive Cardiology Department. It is specifically meant for physicians and health care providers to use in the office as a tool for discussing cardiac prevention.
When I see my patients at the clinic, I often use this "calculator" to help show them their percent likelihood of having a heart attack or dying from heart disease in the next 10 years. Then I can help them set goals for what they can change to decrease their chances of heart attack or cardiac death.
The calculator takes into account both changeable and non-changeable risk factors.
- Risk factors you can't change: Age, gender, family history and personal history.
- Risk factors you can change: Weight, blood pressure, cholesterol, blood sugar and if you are a smoker.
In Health Decision, you can increase or decrease different values, like blood sugar or cholesterol, and see how this affects your risk. When I have difficult discussions with patients about losing weight, quitting smoking or taking medications to help blood pressure or cholesterol, I often pull up this tool as an objective measurement. For example, I can show a patient their heart attack risk if they smoke, and how it changes if they quit smoking. It's quite eye opening and useful.
There are other calculators available that can be used in different situations. If you are contemplating having surgery, for instance, your doctor can calculate your likelihood of having a cardiac complication from the surgery.
One common calculator used in this situation is called the Goldman Cardiac Risk Index, or the Revised Cardiac Risk Index. The Goldman calculator looks at your history and your pre-operative lab values. The Revised Cardiac Risk calculator looks at mainly your personal risk factors - such as if you are diabetic or if you have heart disease, kidney disease or have had a stroke.
Your physician will also calculate your risk from the surgery alone. For example, having surgery for cataracts is much less risky than having a lung resection for lung cancer. You can then add up your total risk by adding the surgical risk and your personal risk together.
So, yes, your health care provider should be able to calculate your approximate risk of "dying early" - or at least within the next 10 years from a heart attack. And there are many other calculators out there, some of which you can even get on your smartphone.
The two discussed above (Heart Decision and the Goldman/RCRI) can be found online. However, I caution you that they are intended for professional use. Please discuss how to interpret results with your physician.
This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.
Date Published: 08/21/2013