University of Virginia Health System

Women's Heart Risk Linked to Coronary Calcium

About 5 percent of women considered at low risk for heart disease still face potential cardiovascular problems because of calcium buildup in their arteries, according to a study in the Archives of Internal Medicine.

The score includes such factors as age, cholesterol levels, diabetes, smoking and obesity - but not calcium.

Amy Tucker, M.D., Associate Professor of Medicine at the University of Virginia Health System, says the study's results highlight the need for all women to live a heart-healthy lifestyle.

"The study emphasizes the need for women to commit to risk factor modification and to heart-healthy lifestyle even if their calculated Framingham risk for a heart attack or stroke is low," Tucker says. "The Framingham risk score is designed to predict cardiovascular events over a 10-year period from the time it is calculated; however, a 'low' 10-year risk does not translate into a low lifetime risk, as the investigators point out. Women tend to have cardiovascular events later in life than do men, but when they occur, these events are more often fatal or debilitating."

Too Early for Routine Testing

Lakoski and her colleagues used computerized tomography (CT) scans of the chest to measure coronary artery calcium in 3,601 women between ages 45 and 84. Women with diabetes and women older than 79 were excluded from this group.

Ninety percent of the women were considered low risk because their Framingham scores indicated they had less than a 10 percent chance of a cardiac event in 10 years. High risk is a test score of 20 percent or higher.

Over an average of the next 3.75 years, 24 of the low-risk women had heart events - such as heart pain or a heart attack - and 34 of the women had a so-called cardiovascular disease event, including heart events, stroke or death, the study found.

Women with the highest calcium scores were especially at risk, says Lakoski.

"They had an 8.6 percent risk of a coronary event," she says.

Lakoski and Tucker say it is probably too early to consider routine testing of coronary artery calcium to gauge heart risk for women. The number of study participants was small, and further research is needed.

"More research is needed to understand how coronary calcium testing compares with other methods for predicting risk, whether it is useful for following response to treatment, and what value it adds in treating women who already follow the recommended prevention guidelines for low-risk patients," Tucker says. "It may turn out to be useful for identifying women who stand to benefit from more aggressive preventive treatments."

But Dr. Suzanne Steinbaum, Director of Women and Heart Disease at Lenox Hill Hospital, calls the study findings important.

"The risk of heart disease in women is often underestimated, because they develop heart disease later than men, often at age 65,” she says. "By measuring calcium, we can show that they might actually be at higher risk, and that is important because they can benefit from preventive measures."

Lifestyle Continues to be Key Factor

Heart-risk estimates for women based on traditional risk factors might be misleading because of societal changes, says Steinbaum.

"Younger women are developing heart disease earlier than we originally thought," she says. "This is where calcium might be an important modality in classifying risk."

A test for coronary artery calcium is easily done, notes Steinbaum, but health insurance companies do not pay for it.

While there are no known measures to reduce coronary artery calcium, Tucker says, women can take several steps to reduce their risk for heart disease. Women should quit smoking, take steps to lower high blood pressure and high cholesterol levels and control their blood sugar if they have diabetes. 

"Every woman - regardless of calculated risk -should eat a healthy diet, exercise at least 30 minutes daily and maintain an ideal body weight," Tucker adds.

To learn more about heart disease prevention or other women's health topics, visit www.uvahealth.com.

Women can learn more about their unique risks for heart disease - and how to better manage those risks - through Live Red, UVA's new heart-health initiative. You'll learn how heart-attack symptoms can be different for women than for men, and you can take an online risk assessment to learn your personal heart disease risk factors.

There, you can sign up for Club Red, our free heart-healthy club for women. Benefits include tips from UVA healthcare providers and a gift package to help you live red in style.

Always consult your physician for more information.