Nearly a decade after launching whats known as the Spokane Heart Study, its lead investigator is preparing to publish findings that could change the way the world looks at heart-disease risk.


For instance, people who have high cholesterol but dont have symptoms of coronary-artery disease might be glad to know that cholesterol is not that important a predictor of who will develop the disease, says Dr. Harry Mielke, chief investigator for the study and director of the Health Research and Education Center at Washington State University at Spokane.


Whats more, the Spokane study has shown that many participants who were found to have coronary atherosclerosisa narrowing of the arteries that feed the heart, and the underlying cause of coronary-artery diseasedidnt have any of the risk factors commonly associated with the condition, such as high blood pressure, a history of smoking, high cholesterol, or diabetes.


Instead, the Spokane Heart Study is looking at whether another measurement, that of coronary-artery calcification, is a much better tool to gauge a persons heart health.


The stakes are high, Mielke says.


Nationally, about 50 percent of the men and 63 percent of the women who die from coronary heart disease had no symptoms of the disease before their death, he says, citing American Heart Association data. In many cases, the victims werent even aware they were at risk for the disease, he adds. Coronary heart disease is the general term encompassing coronary-artery disease and its symptoms, such as angina.


Thats the thing that was most compelling to me in agreeing to participate in the study, Mielke says. Other participants include Sylvia Oliver, a WSU researcher and assistant director of the Health Research and Education Center; Marcia Mielke, a registered nurse who is Dr. Mielkes wife; and Diane Davis, a research coordinator with the Health Research center. In addition, retired Spokane cardiologist Dr. Paul Shields helped launch the study.


Mielkes group uses electron beam computed tomography imaginga CT scanto reveal calcification in the plaque that can line the coronary arteries, a condition that can be detected even in its early stages, Mielke says. The level of calcification then is scored using a range. Someone whose score exceeds a certain level is considered to be at risk for coronary-artery disease, or CAD. Other studies have demonstrated the link between the presence of calcification and CAD, but the Spokane study is one of the longest-running looks to date at how a patients calcification score stacks up against other risk factors in terms of predicting the development of coronary artery disease in otherwise healthy people.


Mielke is writing up the studys findings regarding coronary calcification as a predictor of the disease, and plans to submit them to medical journals by the end of the year. The Health Research and Education Center already has presented those findings at medical conferences.


Responses at the conferences ranged from, gee, thats interesting to oh, thats disappointing that cholesterol, in particular, might not be as good a predictive tool as it has been believed to be, Mielke says.


Dr. Pierre Leimgruber, a cardiologist with Spokane Cardiology PS and a member of a physicians advisory group thats following the progress of the Spokane Heart Study, says the study has great potential to change the way heart disease is prevented and treated.


I think that the Spokane Heart Study has the potential of being a modern-day Framingham study, Leimgruber says, referring to a groundbreaking, long-term look at heart-disease risk on which many current assumptions are based. The Spokane study could have a significant impact even on the national scene.


Dr. Bradley Bale, a primary-care physician here who recently launched a specialty clinic aimed at heart-attack prevention (see story, page B1), says the Spokane study could actually end up being one of the premier heart studies in the world. It could end up putting Spokane on the map for heart research.


First, however, the study has to prove that coronary artery calcification is a good predictor of heart-disease risk.


Leimgruber says using coronary artery calcification as a measure of heart health was controversial when the study was launched in 1994.


There were severe critics, not just in town, but around the nation, he says.


Concerns included that the method isnt sensitive enough and that there isnt sufficient evidence to support its use.


Since then, the practice of using calcium as a measure of heart-disease risk has become more accepted, but the Spokane Heart Study could be a breakthrough in the use of the measure as a predictor of future heart disease, Leimgruber says.


Mielke says his group intends to extend the study another decade, to follow patients as they predictably begin to develop heart problems.


When it began in 1994, the study purposefully recruited relatively young subjects who had no symptoms of heart disease. In tests performed every two years, the researchers have used CT scans to document participants levels of coronary-artery calcification.


The mean age of the about 1,000 participants in the Spokane Heart Study is 52, and Mielke believes the subjects will begin to experience cardiac events, such as angina, arrhythmias, and even heart attacks and death very shortly.


The study has been funded through about $400,000 in grants, mostly from foundations, and more than $100,000 in in-kind support from the Spokane medical community, Mielke says. Its seeking National Institutes of Health funding to continue its work.


A year ago, the Atlanta-based Centers for Disease Control and Prevention asked to be part of the Spokane Heart Study. That federal agency now is performing expensive tests on blood and serum samples taken from study participants over the years to discover whether inflammation or genetics are factors in the development of coronary-artery disease.


If the Spokane Heart Study is successful in proving that coronary-artery calcification is a good predictor of disease risk, people could start receiving CT-scan screenings for calcification as they ageevery five years after age 50, for example, Mielke says. As a screening tool, the CT scan is relatively inexpensiveespecially compared with an angiogram, which is the current gold standard in diagnosing coronary atherosclerosis. CT scans also are quick and noninvasive, he adds.


If a CT scan revealed evidence of calcification, a patient could be more alert to symptoms of coronary artery disease, which some people now shrug off as acid reflux or indigestion, and that persons doctor could develop a treatment plan earlier in the disease process, Mielke says.