From the headline to the text, this story is problematic–readers don’t learn the actual results of the study, which identified and measured the size and shape of inflamed and unstable fat cells in the arteries of people undergoing bypass surgery, and compared them in some fashion to people having angiograms to assess the presence of heart disease.
The story also seems to confuse two separate issues. One issue is gradual narrowing of arteries over many years, which is what this new test seems to be looking at. The second issue is a sudden heart attack that occurs in seconds, which is not the same thing.
Most confusing is that the study is designed to assess the possibility of using inflammation to predict risk in people long before they have atherosclerotic buildup that can been seen with angiograms or heart CT scans; or before there are heart disease symptoms. But the study was performed on people having bypass surgery or angiograms, presumably because they already have heart disease or symptoms. That’s a big limitation to this research that’s never discussed in the news story. The article also makes some claims about the value of statins as anti-inflammatories that need context.
Heart disease remains the number one killer of Americans, and while the use of statins, other drugs, better heart imaging and lifestyle changes (diet, exercise, smoking cessation) have seriously lowered the risk of some heart attacks and strokes, having a tool that could more accurately predict who needs statins and other interventions sooner would be most welcome.
This article attempts to describe a study designed to validate arterial tissue inflammation as a sensitive marker for heart attack risk, but stories about diagnostic advances need to make very clear what was measured, what the study’s endpoints were, i.e. what question was asked and answered; and why the investigators think their advance is worth pursuing.
The article doesn’t discuss what the study authors new “way” of assessment might add in the way of costs.
The story didn’t provide any data to give a sense of the potential benefit of the new approach. No numbers were given to explain how well it worked.
Because there is so little information about the imaging technique and what it requires, it’s hard to say what the harms or benefits might be, but certainly the story might have mentioned the potential risk of drug intervention (or non-intervention) if the inflammatory cell “marker” is valid as a predictor of heart attack risk.
Also, it would have been worth discussing if the new imaging technique exposes patients to radiation, which has been shown to increase the risk of cancer if used repeatedly.
The story does not adequately establish the quality of the evidence, except to indicate that more research is needed, implying that this is preliminary work.
From the journal article itself: “The main limitation of this study is the lack of data demonstrating a predictive value of these imaging markers for clinical outcomes, which falls beyond the scope of this current work.” There was no such caveat in the news story. Rather, the headline trumpets that it “May Predict Heart Attacks.”
No disease mongering here. The story stated that “about 750,000 Americans have a heart attack every year.”
The article appears to quote only those who conducted the study.
The article does describe current means of assessing heart attack risk, as well as some interventions (surgical and medical) to address those risks.
However, the article doesn’t mention how this new technique would stack up against standard tests like stress tests or nuclear perfusion scans. There also is the option of simply treating people with risk factors and not utilizing imaging tests.
The story explains that more research is needed before the technology might be available to everyone.
The story focuses on the use of inflammatory heart tissue as having potentially better predictive value than current risk assessment tools for heart attack. But it’s a reluctant satisfactory, because the narrative is confusing and no numbers were given to estimate the scope of the potential benefit–how well the new approach worked.
We could not locate a release from the University of Oxford or Science Translational Medicine.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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