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Tests to evaluate risk of heart attack

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Although diabetes increases the risk of heart attack in general, a variety of imaging tests may be used to further establish risk in an individual.

A stress test can identify impaired blood flow to the heart (also known as ischemia) during exercise or stress. The greater the ischemia, the greater an individual’s future risk of heart attack or death. “These people may be more likely to benefit from bypass surgery or stenting. Given the results of the FREEDOM trial, bypass surgery should be more strongly recommended for appropriate candidates with diabetes,” says Dr. Ron Blankstein, a cardiologist specializing in preventive cardiology and cardiac imaging at Harvard-affiliated Brigham and Women’s Hospital.

One type of stress test uses positron emission tomography (PET) to evaluate blood flow in the arteries and also calculates the ability of the arteries to meet increased demand for blood during times of stress. This is called coronary flow reserve, or CFR. When CFR is abnormal—even when there is no known history of coronary artery disease—a person is at higher risk for a heart attack. In addition to identifying a significant narrowing in a major artery, an abnormal CFR also can show disease in very small arteries (known as microvascular disease).

“In some people, microvascular disease may precede the development of more serious blockages in major arteries,” says Dr. Blankstein.

Sometimes, a coronary calcium score or cardiac computed tomography (CT) test can reveal whether the person has calcium deposits that suggest the presence of plaque in the arteries. The absence of any calcium deposits can signify very low risk. But when calcium deposits are present in multiple arteries, risk increases.

“Not everyone with diabetes needs further testing, particularly if they are already on advanced medications for heart disease. Testing should only be done if the results will affect how an individual will be treated,” says Dr. Blankstein.

Preventing heart disease or slowing its progression remains an important goal for people with diabetes, Dr. Blankstein says: “If we can identify and treat those who have early stages of the disease, we can prevent plaque from growing and, thus, forestall the need for procedures such as bypass surgery or stenting.”

Posted by: Dr.Health

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