University of Minnesota
The University's Rasmussen Center offers a 10-point test of heart health.
Toward predicting heart disease
The U's Rasmussen Center is developing a simple screen for early heart disease
By Deane Morrison
Currently, most screening for heart disease involves blood pressure and cholesterol tests, among others.
Trouble is, those tests don't necessarily reflect the presence of cardiovascular disease.
So University of Minnesota cardiologist Jay Cohn, a professor of medicine, set out to find a simple, noninvasive way to screen people for heart disease in an early enough stage to treat and prevent or delay events like heart attack or heart failure.
Today, Cohn is founding director of the U's Rasmussen Center, which offers a rapid 10-point screening. It tests for "nontraditional" factors like arterial elasticity and thickness and protein leaked from an ailing kidney. (Full disclosure: Cohn has a financial interest in the company that manufactures the test for small artery elasticity.)
"We ended up with these 10 tests because they all appeared to be important as identifiers of early disease in large arteries, small arteries, or the heart," says Cohn. "We felt that if all these organs were normal, it would be highly unlikely the person would suffer a morbid event."
Besides director and cardiologist Jay Cohn, M.D., the Rasmussen Center team includes cardiologist Daniel Duprez, M.D., Ph.D., holder of the Donald and Patricia Garofalo Chair in Preventive Cardiology.
The result was the Rasmussen score, in which each test is scored either zero (normal) one (borderline abnormal) or two (abnormal). Overall scores of 0-2 are regarded as normal, 3-5 as "early disease" and 6 or greater as "advanced disease."
By the numbers
After 10 years of screening people and following their progress through questionnaires, Cohn and several University colleagues published a preliminary report in the Journal of the American Society of Hypertension on the Rasmussen score's ability to predict heart disease in the early stages.
In the six years following screening, there were no morbid events like heart attacks, angina, stroke, and heart disease in the 0-2 group (28 percent of those screened), significantly more in the 3-5 group and significantly even more in the 6 or greater group. Specifically, in the 3-5 group (35 percent of those screened), 5 percent had an event, and in the 6 or higher group (37 percent of those screened) 15 percent did.
The Rasmussen score was more sensitive than a widely used battery of tests known as the Framingham risk score.
"To those who score between zero and 2, we say 'Live prudently, but you don't have to change anything," says Cohn. "For people who score 3 to 5, we make lifestyle recommendations to alter their behavior and identify things they should be able to do. In general, we believe that people with scores of 6 or above are in need of drug therapy."
An evolving heart health landscape
The center continues to screen—which is covered by most insurance plans—and collect data. One question that remains is whether a change in the Rasmussen score, from either lifestyle adjustments or medical therapy, tracks with improved outcomes. This will require a large-scale study, the researchers say. The center is also working on a 4-point test to identify people unlikely to have a high enough score to warrant being put through all 10 tests.
Centers based on the Rasmussen model are in Sarasota, Fla., Lafayette, La., and Atlanta. But Cohn says that with many more people dying of cardiovascular disease than of cancer, it's high time the scale of screening for heart disease caught up with cancer screening.
"I think we're failing people by not identifying early disease," he says. "I think this is a revolution in the making as to how we carry out our preventive work."