Heart disease: Half of adults over 40 may have 'hidden' condition

  • About 17.9 million around the world died in 2019 from cardiovascular disease, with 85% of those deaths attributed to stroke and heart attack.
  • While non-modifiable factors such as family history can affect a person’s risk of developing heart conditions. There are also modifiable risk factors, including smoking, hypertension, high cholesterol, and obesity.
  • Researchers from the University of Copenhagen in Denmark have found people without known cardiovascular disease that have undetected obstructive coronary atherosclerosis increase their risk for a heart attack eightfold.
  • Their findings suggest that nearly half of all adults over 40 may have “hidden” heart conditions that go undetected.

In 2019, about 17.9 million people globally died from cardiovascular diseases, with 85% of those deaths attributed to stroke and myocardial infarction, also known as a heart attack.

Every 40 seconds, someone in the United States has a heart attack.

There are several modifiable risk factors for heart attack, including smoking, high blood pressure, high cholesterol, and obesity. And there are also some non-modifiable risk factors, including family history and different diseases such as diabetes.

Now researchers from the University of Copenhagen in Denmark have found in people without known cardiovascular disease that having an undetected obstructive coronary atherosclerosis increases their risk for a heart attack eightfold.

Their findings also suggest nearly half of the adults over 40 may have such “hidden” heart conditions.

The study appears in the Annals of Internal Medicine, a journal of the American College of Physicians.

Coronary atherosclerosis and heart attack

Coronary atherosclerosis — also known as coronary artery disease — occurs when plaque from cholesterol deposits builds up inside the arteries that bring blood to the heart.

This plaque buildup narrows the arteries, making it harder for blood to get to the heart.

Symptoms of coronary atherosclerosis may include:

  • pressure, squeezing, or pain in the chest
  • shortness of breath
  • light-headedness
  • nausea
  • heartburn and/or indigestion

Although there is no cure for coronary artery disease, the condition can be managed through lifestyle changes and medications. And sometimes, surgery may be required to open or replace fully-blocked arteries.

Coronary atherosclerosis is the most common cause of heart attack. A person experiences a heart attack when blood is no longer able to get to their heart.

Symptoms of a heart attack include:

  • the feeling of pressure, squeezing, heaviness, or aching in the chest
  • pain that spreads from the chest to other parts of the body, such as the arms, back, or neck
  • shortness of breath
  • dizziness
  • nausea and/or vomiting
  • coughing and/or wheezing from fluid build-up in the lungs

Heart attack symptoms may come on very quickly or last for a few days. The quicker a person receives treatment for a heart attack, the better their survival rate.

Examining heart attack risk

According to Dr. Klaus Fuglsang Kofoed, clinical associate professor in the Department of Clinical Medicine at the University of Copenhagen in Denmark and corresponding author of this study, the research team decided to study how coronary atherosclerosis impacts a person’s risk for a heart attack because it is the disease process responsible for heart attack and cardiac death.

“It may develop many years before an individual has any symptoms,” Dr. Kofoed told Medical News Today. “To prevent heart attack, it is therefore very important to understand what characteristics define an asymptomatic individual at elevated risk of clinically manifested diseases.”

In this study, Dr. Kofoed and his team examined over 9,500 people aged 40 or over who had no known symptoms of cardiovascular disease. Study participants were assessed using computed tomography angiography (CTA) to look for any previously undiagnosed obstructive coronary atherosclerosis.

Upon analysis, researchers found 54% of the study participants had no detectable coronary atherosclerosis.

Of the remaining 46% that were found to have previously undetected coronary atherosclerosis, 36% of participants had nonobstructive disease, and 10% had obstructive disease.

Additionally, scientists found among participants diagnosed with previously undetected coronary atherosclerosis, 61% were males, and 36% were females.

“The greatest surprise was that as high as 10% had obstructive diseases yet without having symptoms.

[This is] a very important observation which we will explore further in additional analysis.”

– Dr. Kofoed

Improving heart attack preventive measures

MNT also spoke with Dr. Rigved Tadwalkar, a board certified cardiologist at Providence Saint John’s Health Center in Santa Monica, CA, about this study.

Dr. Tadwalkar said this is an exciting study because it addresses a fundamental question in cardiology — what is the significance of coronary artery disease in the asymptomatic person?

“Thus far, our understanding about the significance of coronary artery disease comes mostly from those who have clinical symptoms of the disease and have undergone invasive coronary angiography,” Dr. Tadwalkar explained. “Those with obstructive coronary stenoses by invasive coronary angiography have traditionally been viewed as high-risk, but with the advent of CT coronary angiography and improvements in the technology, it has been increasingly recognized that specific plaque characteristics may confer additional risk.”

“It was eye-opening to see that among people with no symptoms, subclinical atherosclerosis may be found in more than 50% of men and nearly one-third of women,” he added. “Similarly striking was the discovery that 10% of this study population had obstructive coronary disease.”

Dr. Tadwalkar also commented that the results of this study are of high value in determining an asymptomatic person’s risk for a cardiovascular event.

“The use of CT coronary angiography in the preventative setting would allow us to establish whether coronary artery disease truly exists, which is a question that we are often not able to definitively answer for patients under current guideline-based practice,” he continued. “Based on the results of the CT coronary angiogram, we should now be able to better determine whether an asymptomatic person is at a higher risk of having a heart attack or dying.”

“This is informative in helping us craft appropriate preventative strategies so that people deemed to be at higher risk have a much better chance of not succumbing to a cardiovascular event,” Dr. Tadwalkar added.

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