Model Might Better Determine Women's Risk For Heart Disease, Study Says

A model developed by researchers at Brigham and Women's Hospital might help physicians better determine a woman's risk for heart disease, according to a study published in the Feb. 14 issue of the Journal of the American Medical Association, the Boston Globe reports. According to the Globe, physicians for 40 years have used five risk factors -- age; smoking habits; blood pressure; total cholesterol levels; and levels of HDL, or "good," cholesterol -- to determine heart disease risk. For the study, Paul Ridker, a specialist at Brigham and Women's Hospital, and colleagues gathered data on more than 24,000 U.S. women ages 45 and older who had never experienced heart disease or cancer to determine which 35 potential risk factors accurately determined a woman's risk of cardiovascular events. The researchers followed the women for 10 years and tracked whether they experienced a heart attack or stroke and whether they required bypass surgery or another procedure to clear blocked arteries. Researchers found the five traditional factors, as well as family history and a woman's levels of the C-reactive protein, a measurement of inflammation, were relevant factors in assessing heart disease risk. The model tested in the study, called the Reynolds Risk Score, takes into account the five traditional factors, whether a woman's parents experienced a heart attack before age 60, and a woman's C-reactive protein levels (Smith, Boston Globe, 2/14). The study found that the traditional model failed to identify women who did not display traditional risk factors but develop heart disease, which could be up to 20% of cases. Many women under the traditional model who were found to have less than a 20% risk of developing heart disease over a 10-year period were reclassified under the Reynolds Risk Score, according to the study (BBC News, 2/14). The traditional model and the Reynolds Risk Score had similar risk assessments for more than 90% of women. According to the Globe, Brigham and Women's Hospital holds a patent on the C-reactive protein test, which costs about $8 to $12 per patient, and the hospital and Ridker receive royalties each time the test is administered (Boston Globe, 2/14).

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Ridker said the new model is "important because we now have a simple and inexpensive way to correctly classify women's risk and, therefore, get the right drugs to the right women" (Boston Globe, 2/14). Roger Blumenthal of the Johns Hopkins University School of Medicine said, "Physicians should incorporate these factors into their testing and decision-making about which women are most likely to develop cardiovascular disease," adding that physicians "should intervene with lifestyle changes and drug treatment before symptoms start to appear" (BBC News, 2/14). C. Noel Bairey Merz, a heart specialist at Cedars-Sinai Medical Center, said, "While [the Reynolds Risk Score] is a very encouraging, user friendly tool, I would like to see other people vet it," adding that it "remains to be seen" whether the model is "really going to make a big difference" in determining women's risk for heart disease (Boston Globe, 2/14).

The study abstract is available online.

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