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Ahead of the curve

Lynn Hoke, F.N.P., reviews test results with Rasmussen Center patient Mike Nordberg, while Natalia Florea, M.D., examines an eye scan. (Photo: Richard Anderson)

In its 10th year, the U’s Rasmussen Center continues to show how a unique set of noninvasive tests can detect early heart and vascular disease

When seemingly healthy, symptom-free patients come to the Rasmussen Center for Cardiovascular Disease Prevention, they have one question: Am I at risk for a heart attack or stroke?

Since opening its doors in 2001, the Rasmussen Center has served more than 2,300 people who are concerned about their heart health.

“Many have a parent who has died at an early age, and they come in when they reach that same age—just to see if everything is OK,” says clinic manager Lynn Hoke, F.N.P. “Or a couple may come in together to undergo the tests because they are both worried about each other’s health.”

And they come to the Rasmussen Center at the University of Minnesota because no other center in the world approaches early heart disease detection in quite the same way.

Historically, doctors have used risk factors—high cholesterol, family history of heart disease, and high blood pressure—to predict who will have a heart attack. But that approach has limitations, says Rasmussen Center founder and director Jay N. Cohn, M.D.

“Risk factors are designed to identify statistical rather than individual risk for heart disease,” Cohn says. “Our tests actually identify the presence of early disease, which is much more sensitive in determining who is actually going to experience a cardiac or vascular event and who need not worry. We’re finding abnormalities in the arteries long before the patient even develops hypertension or high cholesterol.”

With a Rasmussen Center evaluation, an individual will undergo 10 different noninvasive tests and then get a “disease score” ranging from 0 (all tests normal, no indication of disease) to 20 (all tests abnormal, indicating advanced disease). A score of 6 or greater usually requires some form of intervention—ranging from blood-pressure or cholesterol medication to additional testing.

Ten years of patient visits have yielded countless surprises.

“You simply cannot know who has heart disease until you test for the presence of these disease markers,” Hoke says.

According to Cohn, more than 60 percent of patients tested at the Rasmussen Center have had signs of early heart or blood vessel disease, even though they had no symptoms.

A different approach

With a decade of data in hand, the Rasmussen Center is demonstrating the effectiveness of its approach.

Cohn and Rasmussen Center research director Daniel Duprez, M.D., Ph.D., are publishing results from a survey they conducted among patients who visited the center. Compared with traditional risk factor assessments, the Rasmussen disease score was far more sensitive in determining who went on to have a “cardiovascular event” such as a heart attack, stroke, angina, coronary artery bypass surgery, percutaneous coronary intervention, heart failure, or peripheral vascular disease.

Of the 35 events that occurred in the 613 patients surveyed, only one occurred in the lowrisk group (Rasmussen disease score of 0-2), eight occurred in the early disease group (score of 3-5), and 26 occurred in the advanced disease group (score of 6 or more).

The future of medicine

While it may take time, both Cohn and Duprez hope that more medical centers throughout the country will eventually use the Rasmussen approach as a way to identify those patients who need the greatest attention.

“I think this data conclusively demonstrates that the Rasmussen approach is much more personalized [and] much more sensitive in detecting heart disease than the traditional biostatistical model of risk assessment,” says Duprez, who holds the Donald and Patricia Garofalo Chair in Preventive Cardiology. “I have hope that in the upcoming years, this approach will be widely adopted—not just by clinics affiliated with the Rasmussen Center, but by the medical community as a whole.”

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