Heart disease is the number one killer of Australian women – claiming the lives of twenty-four women a day – and is responsible for one in eight premature deaths in women.

Pathology has an important role in helping keep women’s hearts healthy and in diagnosing and treating women with heart conditions.

Cardiology specialist Associate Professor Clara Chow told us; “A range of tests are used to assess women’s heart disease risk and tests also help in monitoring progress and treatment targets.”

One in three Australian adult women has high cholesterol and a worrying ninety percent of these women are not aware of their condition. What’s more, only one in nine women aged 30-65 know that high cholesterol is a risk factor for heart disease. This is why the Heart Foundation is so concerned about raising awareness of heart health among women and encouraging them to learn more about risk factors and to talk to their doctor about testing.

So, what tests are used in a regular heart health check?

A/Prof Chow said; “A full lipid profile is key, i.e; not just total cholesterol, but LDL-cholesterol, HDL cholesterol, triglycerides and the ratio of these. It’s important to also assess for diabetes with screening tests including glucose and HbA1C as well as looking at renal function – in terms of creatinine and eGFR.”

The new approach to lipids testing which no longer requires patients to fast for eight hours before having their blood taken for testing is good news for heart health as it makes testing easier for patients.

In terms of diagnosis and treatment, pathology is vital. A/Prof Chow said, “Pathology tests help in assessing whether there is an acute problem. Sensitive cardiac troponin tests, for example, are often used to diagnose whether chest pain is part of an acute coronary syndrome.”

High sensitivity troponin is effective in diagnosing heart attacks in women that might otherwise have been missed. This test is used extensively in Australian hospitals for people who present to emergency departments with chest pain.

The test measures the level of the protein troponin in the patient’s blood which is released by the heart muscle during a heart attack.

Fifty Australian women have a heart attack each day, and eleven of these will be fatal. Women often experience the lesser known symptoms such as pain in the jaw, shoulder, neck and back. When a woman experiences a heart attack, the level of troponin in her blood may be lower than the typical range for a man which is why a high sensitivity test is helpful in detecting it.

Diagnosing a heart attack quickly means patients can be given the best treatment.

According to the recent Economic Value of Pathology report, troponin testing can help to manage down the $167 million a year spent on people who present to emergency departments with chest pain.

A/Prof Chow said pathology allows doctors to find out more about related conditions as causes for heart problems:

“In patients with known coronary heart disease or those with heart failure there may be other tests that can help. These vary between patients but one example would be for a female patient with a new presentation of heart failure, we might do thyroid function tests and iron studies as these may help us understand what could be causing her condition.”

The Heart Foundation has succeeded in raising women’s awareness of heart disease as the leading cause of death in women, from 20% in 2008 to 35% in 2015. They are now striving to spread the message even further and reach a target of 50% by December 2017.

Learn more about the campaign here

Associate Professor Clara Chow is Associate Professor with the Faculty of Medicine University of Sydney, Director of the Cardiovascular division of The George Institute, and Program Director, Community Based Cardiac Services, Westmead Hospital.

The post Making the Invisible Visible – pathology protects women’s heart health first appeared on Know Pathology Know Healthcare.

Cholesterol is part of the lipid profile tests that are used to assess a person’s cardiovascular risk and also to monitor patients who are being treated for an existing cardiovascular condition.

The tests include measurements of total cholesterol, HDL cholesterol and triglycerides. Patients are asked to fast before having the test because food in the system can affect results.

Test results are compared to a recommended range; this is the scale pathology labs use to report whether a lipid result is within a low or high cardiovascular risk range.

Contemporary thinking is that the effect of food on a person’s test result can simply be taken into account when evaluating the results of the initial test, as evidence shows that any difference in the test results because of the patient not fasting is usually small.

Should the lipid profile reveal something of concern, or if doctors feel a comparison is needed, the test can be repeated when the patient has fasted to give doctors information to compare.

This is good news for patients as fasting for eight hours can obviously be difficult and inconvenient. It is also welcome news for pathology collection centres that may have to turn away patients who are not aware of the fasting requirement and arrive for their test after a recent meal.

Chemical pathologist Dr Lee Price said: “Many patients aren’t told by their GP or referring doctor that they should fast, or they forget to, so are turned away when they go for the test.

Also fasting is often inconvenient. Many patients will choose to have the test first thing in the morning when collection centres are busiest, which is inconvenient for patients and staff.”

When asked if a patient could even present for a test straight after lunch, Dr Price cautioned that eating right before a blood test would still not be recommended. However, patients would only need to refrain from food for about two hours before the test, rather than eight.

Dr Price says that how test results are interpreted and how cardiovascular risk is assessed is now moving on; “We now want to know what levels are the majority of the time – as most people, most of the time are in a non-fasting state.”

There is still a place for fasting tests for comparison purposes and for assessment of those being treated for existing conditions, such as those who have had a heart attack or stroke who may be taking statin drugs.

With an ageing population and concerns about growing rates of obesity and chronic health problems, cardiovascular risk assessment is fairly common and is unlikely to decrease any time soon. This means many patients will benefit from the move to non-fasting tests and doctors will be able to more easily assess risk and take appropriate action.

The post From fasting to faster; cholesterol testing changes are better for all first appeared on Know Pathology Know Healthcare.