Five simple health indicators can evaluate a healthy person's risk of heart damage from clogged arteries without drawing blood for medical tests, a new study finds. The new method may be an effective way to predict risk and possibly help patients make lifestyle changes that lower their chances of heart disease and strokes.
- Blood pressure
- Body mass index
- Eating fruits and vegetables
- Smoking status
Looking at these five factors is nearly as accurate as adding on established bloodtests to measure cholesterol and blood sugar levels, says Valentin Fuster, MD, PhD, physician-in-chief at The Mount Sinai Hospital and one of the study’s researchers.
"These five risk factors carry some crossover with what we measure in blood," he says. "I wouldn't say it's 100% accurate but it's very, very close."
Comparing Two Methods
Fuster's team studied nearly 4,000 office workers in Madrid who were ages 40 to 54 and free of heart disease. They compared the five-factor score, known as the Fuster-BEWAT score, with the Ideal Cardiovascular Health Index or ICHS, a score recommended by the American Heart Association. The association set a goal of improving the cardiovascular health of Americans by 20% by 2020.
BEWAT stands for blood pressure, exercise, weight, alimentation (or diet), and tobacco. ICHS includes those five plus a blood test of blood sugar and cholesterol.
The researchers tested the men and women with ultrasound and CT scans to look for early signs of heart disease, such as plaque buildup in the arteries. They looked at the heart's arteries, the arteries to the leg, the aorta, and the two carotid arteries supplying blood to the head and neck. They examined these images to see how they compared to a person’s scores on the Fuster-BEWAT, reflecting their lifestyle and blood pressure, and the ICHS, reflecting lifestyle plus blood pressure, blood sugar and blood cholesterol results.
They found that the better the score on the ICHS or the Fuster-BEWAT, the less likely the person was to show early evidence of clogged arteries. The correlation between the two scores was good in predicting how much early heart disease was present.
Deciphering the New Test's Score
Each of the five health indicators was classified as poor, intermediate, or ideal. To achieve ideal status on all five, you needed to:
- Have a blood pressure below 120/80
- Have a body mass index (BMI) below 25
- Eat more than 4 servings of fruits and vegetables daily
- Exercise moderately for 150 minutes or more a week, or vigorously for 75 minutes or more
- Not smoke, or not smoke within the past year
Only 6.5% of the men and women met all five ideal indicators, the researchers found.
Fuster's team looked at the images of each patient’s arteries and then looked to see if the scores on the two tests predicted the extent of disease. They found that the Fuster methodology compared closely to the ICHS program.
For instance, a smoker or a recent smoker with blood pressure higher than 140/90, doing very little physical activity, and with a BMI more than 30 and a poor diet would have five risk factors, he says. "With five risk factors, 31% of your arterial system is already covered with disease," Fuster says.
Fuster says using the five indicators will help doctors, especially those in locations with limited services, evaluate their patients quickly and easily.
Edward Fisher, MD, PhD, the director of the Center for the Prevention of Cardiovascular Disease at New York University School of Medicine, reviewed the findings but was not involved in the study. He called the correlation between the two methods in predicting the amount of early cardiovascular disease ''impressive."
"Except for blood pressure, all of the other BEWAT factors are lifestyle in nature," Fisher says. The new finding, he says, should encourage doctors to ask patients about all four habits. While it is difficult to predict if the BEWAT approach will become widespread, it seems to have value as an addition to existing risk evaluation methods, he says.
Bottom line? "Lifestyle factors are important," Fisher says. "The things we can do for ourselves really count."