While coronary heart disease and diabetes are often seen in the same patients, a diagnosis of diabetes does not necessarily mean that patients also have coronary heart disease, according to a new study from researchers at Intermountain Health in Salt Lake City.

The Intermountain study found that proactively screening patients with diabetes 1 and 2 for coronary heart disease who have not shown symptoms of heart problems does not improve long-term mortality rates, nor does it lower the chance of them having a heart attack or stroke in the future.

“Our study found that doing these kinds of screenings on patients doesn’t make any marked difference in their long-term survival rates,” said J. Brent Muhlestein, principal investigator of the study and co-director of cardiovascular research at Intermountain Health.

“Instead, results of our study reinforce that we should be focusing on other proven interventions for people with diabetes, like medication management, diet and exercise, to help these patients lead long and healthy lives,” he added.

Findings from the Intermountain Health study were presented at the American Heart Association’s Scientific Sessions 2024 in Chicago on Monday, November 18.

For the study, Intermountain Health researchers examined data from FACTOR-64 study, a randomized clinical trial of 900 people with type 1 or type 2 diabetes for at least three to five years without coronary artery disease symptoms.

Of these patients, 452 were screened with a coronary computed tomography angiography (CCTA), which uses a powerful X-ray to make a 3D image of the heart. Researchers compared

these patients with a control group of 448 people who were treated with standard optimal diabetes care guidelines.

Enrollment occurred between July 2007 and May 2013, and followed up on in May 2024.

Researchers found that using CCTA to screen for cardiovascular disease did not significantly affect the rates of all-cause mortality or of non-fatal heart incidents, like heart attack and stroke. This was true when researchers initially followed up four or five years after the CCTA screening, and again at 12 years.

“These findings should discourage the use of CCTA for screenings in diabetes patients who do not show any symptoms of heart disease,” said Dr. Muhlestein.

“While our study showed that screening for coronary heart disease with CCTA won’t make any difference, it did show that if patients carefully medically manage their diabetes, they may live almost as long as somebody who does not have diabetes, which wasn’t the case before,” said Dr. Muhlestein. “This study shows that, even over an extended period of time, a screening like this can’t replace those kinds of critical behaviors.”

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Coronary artery calcium (CAC) scores have become a non-invasive way for physicians to easily determine how much plaque has built up inside a patient’s coronary arteries, but the question has been how accurate the score is in identifying women, as well as men, who are at high risk for a heart attack or death.

Now, a major new study by researchers at Intermountain Health in Salt Lake City finds coronary artery calcium scores are not only highly effective in identifying those at risk for future heart attacks, but also for death, and risk prediction was found to be as good in women as in men.

Results from the Intermountain Health study found that in addition to predicting risk of coronary death and non-fatal heart attacks, coronary artery calcium scores also correlated to all-cause mortality. Researchers found that people with a score of zero were three times less likely to die from any cause.

“The coronary artery calcium score appears to be an excellent and accurate indicator of health and overall prognosis, even beyond heart disease,” said Jeffrey L. Anderson, principal investigator of the study and distinguished research physician at Intermountain Health.

Findings from the Intermountain Health study were presented at the American Heart Association National Scientific Sessions 2024 in Chicago on Monday, Nov. 18, 2024.

Coronary artery calcium testing is becoming more common in heart healthcare. These tests are non-invasive, use as little radiation as a mammogram, and are relatively cheap, especially compared to PET stress tests, coronary CT angiograms, or coronary angiography.

For the Intermountain Health study, researchers reviewed the electronic health records of 19,495 women and 20,523 men who had undergone PET/CT scans because their physicians

suspected they had a risk of heart disease, but who hadn’t yet had a heart event, such as a heart attack.

Of these patients, 7,967 had a CAC score of zero, meaning they had no calcified plaque in their coronary arteries. Of this group, women on average were older than men (60.5 years for women, 53.8 for men), which correlates to how women often develop heart disease later in life than men, Dr. Anderson said.

Researchers then followed up on patients about two years later. They found that a zero CAC score predicted a low risk for coronary death or nonfatal heart attacks in both men and women. CAC scores of zero were more frequently observed in women despite having an older average age.

Intermountain researchers also found that those with a zero CAC had three times lower risk of all-cause death or heart attack in both sexes.

While it’s obvious why a CAC score of zero would be a good indicator of heart health, its ability to predict all-cause mortality is novel and deserves additional study.

“We will be exploring this further to understand better why a zero-calcium score is such a good signal to overall health,” said Dr. Anderson.

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Cardiac researchers at Intermountain Health have received a $2.4 million, four-year federal grant from the National Institutes of Health to study ways to enhance care for the millions of Americans who suffer from a common, and potentially fatal, heart condition.

Intermountain Health heart researchers will use the NIH grant to study ways to enhance monitoring and treatment for patients who experience mitral valve prolapse, a condition that occurs when the heart’s mitral valve leaflets don't close properly, allowing blood to leak backward into the left atrium.

Mitral valve prolapse affects between 2% and 3% of the general population, which is roughly 7.8 million people in the United States and more than 176 million people worldwide. 

Symptoms of mitral valve prolapse may include a racing heartbeat, dizziness, shortness of breath, fatigue, and chest pain. However, for many patients, mitral valve prolapse doesn't cause any symptoms. 

Many mitral valve prolapse patients live with the heart condition their whole lives without it ever affecting their health. In other people, it can lead to additional heart disease, such as heart failure or arrhythmias, and even death.

“This study will allow us to evaluate more precisely who is going to develop moderate to severe MVP and moderate to severe-related health problems,” said Benjamin Horne, PhD, principal investigator of the study and director of cardiovascular and genetic epidemiology at Intermountain Health. “We will be more aware of someone potentially needing more intense therapy or more frequent follow up and follow them to ensure that their health is being maintained.”

When a mitral valve prolapses, the valve between the heart’s upper and lower chambers doesn’t close properly. The main complication of mitral valve prolapse is mitral regurgitation, where blood leaks backwards, and therefore doesn’t efficiently deliver oxygen throughout the body.

Mitral valve prolapse is one of the most common causes of mitral regurgitation. If the leak is severe enough, a person may need surgery to repair or replace the valve.

Heart valve regurgitation is common globally. In the United States, mitral valve regurgitation is the most common form of heart valve disease.

“As cardiologists, we are quite accustomed to diagnosing and managing mitral valve prolapse associated mitral regurgitation,” said Brian Whisenant, MD, structural heart cardiologist at Intermountain Health and co-investigator of this study. “However, by focusing on leaking values we are certainly ignoring most of the iceberg. This study looks at that whole iceberg, not just the tip.”

Through this grant, Intermountain researchers will retroactively evaluate the electronic health records of tens of thousands of Intermountain patients, going back to the 1990s.They will identify people who have been diagnosed with mitral valve prolapse, which is typically done through an echocardiogram, and follow their outcomes.

The Intermountain study will allow researchers to identify factors that could predict whether mitral valve prolapse affected a patient, and what is most common in those with poor outcomes.

Mitral valve prolapse can be caused by several heritable factors and is associated with a variety of diseases including connective tissue disorders, Graves' disease, scoliosis, von Willebrand syndrome, and muscular dystrophy. 

Intermountain researchers will work with Intermountain’s HerediGene: Population Study  to identify genetic markers for mitral valve prolapse, and Intermountain’s genealogy registry to identify families in whom mitral valve prolapse is common.

Overall, Intermountain researchers hope to create a score that will allow physicians to, upon diagnosing mitral valve prolapse, determine if “this is really going to be benign or is this something they should start considering right now when they don’t have the health problems that can arise from it,” said Dr. Horne.

For example, if someone scores high, they can be better tracked and monitored and know that surgery might be necessary in the future, Dr. Horne added.

“This study will help doctors know when mitral valve prolapse is a clue that warrants further investigation and when patients can be reassured,” said Dr. Whisenant. “In some ways, it’s like asking a dermatologist if a spot is anything to worry about. Most spots are freckles, but some are cancer. We hope this study will help us develop methods to better make that determination for patients with mitral valve prolapse.”

The grant is supported by the National Heart, Lung, And Blood Institute of the National Institutes of Health under Award Number R01HL172982. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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