Two new studies find that many people with risk factors for heart disease, such as diabetes, high cholesterol, and high blood pressure, do not develop early signs of heart disease if their coronary artery calcium score is low.

Both studies appeared in the most recent issue of the Journal of American College of Cardiology (JACC) and one of them was also presented at the American Heart Association Scientific Sessions 2019 in Philadelphia last month.

“Traditionally we tend to rely on basic risk factors such as cholesterol level and others to decide the risk and the need for therapies such as statins or injectable PCSK9 inhibitors,” said Khurram Nasir, M.D., the division chief for preventive cardiology at Houston Methodist DeBakey Heart & Vascular Center and the senior author of both papers. “However, our prior work and now these current studies are strongly suggesting that we will be better off if we rely on whether individuals have early signs of disease.”

Nasir says the first study followed more than 67,000 patients from multiple centers for nearly 13 years. Researchers concluded that those patients without presence of a high coronary artery calcium score, even if they had multiple risk factors, did much better and had less risk of dying from heart disease than others who had a high coronary artery calcium score and no risk factors.

"Overall, our results showed that rather than relying of basic risk factors, it may be better to undergo a heart scan that costs between $75 and $150, that can allow flexible treatment goals if a person has no signs of disease," Nasir said.

In the second study, Nasir and his group found that nearly half of the patients with a genetic defect in their metabolism called heterozygous familial hypocholesterolmia (HeFH), which causes a person to be born with cholesterol levels two to three times higher than normal and carries a very high risk of having a premature heart attack, had no atherosclerosis in their coronary arteries when their coronary artery calcium score was low.

“We now are pursuing an international effort to find out and understand what specific characteristics these individuals, in both studies, have that are protecting them from developing atherosclerosis,” Nasir said. “Once we figure that out we can develop therapies that will give everyone a better chance of not developing atherosclerosis and preventing heart disease.”