Calcium Test Predicts Stroke Risk

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Calcium Test Predicts Stroke Risk

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In the trial, CAC predicted stroke in both men and women and was more predictive in persons younger than 65 years than in
older individuals. It was also independent of the presence of arterial fibrillation and Framingham risk factors.
It was most effective in discriminating stroke risk specifically in persons in low (<10%) and intermediate (10% to 20%)
Framingham risk categories, investigators report. Lead investigator, Dirk M. Hermann, MD (University Hospital Essen,
Germany), stated that, "When a patient stands in front of us we can find out about their risk factors such as diabetes, blood
pressure et cetera, but we don't know much about their extent of vascular disease. We know that CAC is a good predictor of
MI [myocardial infarction], but we wanted to know if it is a good predictor of stroke as well, and we found that it was. This study
shows that the risks go together. If a patient is at risk of MI, they are also at risk for stroke. We now have a test that can tell us
if a patient is at risk of 2 very common conditions."
"CAC, as we now have shown, is able to predict stroke events independent of established risk factors, making this marker
promising for risk stratification not only in the hands of cardiologists but also in the hands of neurologists," the authors
conclude.
"This study suggests that broad CAC screening of the population may be the way forward," Dr. Hermann said. Still, he added,
"We have to think carefully about whether this is feasible. We don't recommend this at the moment because of the radiation
risk." However, he points out that imaging techniques are rapidly evolving and the ability to see disease processes in the body
is improving "dramatically."
"New multi-slice CT [computed tomography] is associated with much lower radiation, so perhaps in the future broad screening
programs will be possible. Then it will be public health question as to whether it is cost-effective," he said. "Even cardiologists
are not routinely doing CAC screening at the moment, but it is starting to happen in certain centers practicing preventative
medicine. This is modern medicine."
For the current study, 4180 persons aged 45 to 75 years from the population-based Heinz Nixdorf Recall study without
previous stroke, coronary heart disease, or myocardial infarction, were evaluated for stroke events over an average 94
months.
Cox proportional hazards regressions were used to examine CAC as a stroke predictor in addition to established vascular risk
factors (age, sex, systolic blood pressure, low-density lipoprotein, high-density lipoprotein, diabetes mellitus, smoking, and
arterial fibrillation). During the follow-up period, 92 incident strokes occurred (82 ischemic and 10 hemorrhagic). Patients who
sustained a stroke had significantly higher CAC values at baseline (median, 104.8) than those without stroke (11.2). In a
multivariable Cox regression, log10(CAC+1) was an independent stroke predictor, with a hazard ratio of 1.52. CAC was most
predictive in patients at relatively low cardiovascular risk and in younger rather than older patients.
"That's probably because higher-risk and older patients have many more risk factors so the CAC result will become less
relevant," Dr. Hermann speculated. "Whereas in younger and lower risk patients, there's nothing else to tell you that this
person is at risk so it is more useful."
In the paper, the authors write, "These observations indicate that among cohorts without apparent risk, subjects exist that
nonetheless exhibit a high stroke incidence. On the basis of our data, CAC is suitable to identify those subjects."
Stroke. Published online February 28, 2013. Abstract
Excerpted from Calcium Test Predicts Stroke Risk
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09/03/2013 15:08:34