Dr. Agim Beshiri
Senior Medical Director, Abbott Diagnostics
Dr. Agim Beshiri
“Many things can be done to reduce our chance to get heart disease”
During our interview with Dr. Agim Beshiri, MD Senior Medical Director at Abbott Diagnostics, “Hospitals” magazine had the chance to shed light on the life-changing revolutionary test that allows physicians to accurately study the risks of a person having a cardiac event long before it happens.
What can you tell us about your career in healthcare?
My medical background includes internal medicine and laboratory medicine. I completed my studies and training at the University of Wisconsin, UNIBE School of Medicine and the Academy of Health Sciences.
Joining the healthcare industry gives me the opportunity to have an impact on millions of patients instead of few patients that I can see every day. This is very gratifying to know that you are a part of the global aspect of healthcare.
Heart disease is the leading cause of death in the world for both men and women, what are the latest tests that can help us predict the chance of having heart problems?
Heart disease, especially heart attacks can often happen suddenly, if we are talking about a patient that arrives at the Emergency Department (ED) with chest pain, the Electrocardiogram (ECG), is done immediately to determine if they need to be sent for immediate intervention, because they are having a heart attack.
But patients that don’t have indications on the ECG, a blood test that measures a protein called troponin, which is released from the heart when the heart muscle is damaged, can help the ED doctors to determine if the patient is having a heart attack.
This can avoid sending the patient home and risking death, or coming back with a worse condition.
What about patients who are at risk of having heart disease?
We spoke about patients within acute setting and chest pain, but if we are investigating patients for long-term impacts of heart disease and general heart disease, we look at their general risk factors, family history, hypertension, diabetes and lifestyle, as well as blood test like the lipid profile. Most recently, we introduced high sensitivity troponin-l test.
This test is so sensitive that we can detect very low levels of troponin in most of the general healthy population.
Seven years of research have brought us to this point where high-sensitivity troponin-I can be utilized for risk stratifying the general population for risk of heart disease.
Who should take the high-sensitivity troponin test and when? Should it be part of our routine health checkup?
This blood test should be done by every adult that has a health check and a clinician wants to assess their long-term risk for cardiovascular disease. Because this test is cardiac specific and is released by cardiac muscle when there is injury to that muscle, it will give patients and clinicians a better indication of their true risk for cardiac events over the next 10 years.
Unlike cholesterol which is measured for determining cardiac risk but is not released by the heart, it is what may cause the heart to be injured.
So, if the physician and the patient are aware of what may cause injury and how much injury there is, they will have a much more accurate path to determine and prevent cardiovascular disease.
Is it possible that a person can have an elevated troponin without having heart attack? And what measurements should be taken in this case?
Yes, they may not be having a heart attack, but that doesn’t mean they are not at risk of having a cardiac event in the future. When we talk about risk factors, we are talking about a 10-year risk profile. Elevated levels of troponin could be due to a chronic cause, like heart failure, chronic renal failure, hypertension or atrial fibrillation. These all cause cardiac muscle injury but are not a heart attack per se. So, a patient may not be having a heart attack, but they are having something damaging the muscle enough to elevate troponin. In these cases, we have to see the underlying causes of troponin elevation and try to modify them by lifestyle changes and possibly treating them with medication when possible.
Are there ways to help prevent heart disease and keep our hearts healthy?
Fortunately, we can do many things to reduce our chances to get heart disease; the best thing to do is to adopt a healthy lifestyle. What I mean by healthy lifestyle is:
Get regular exercise, eat a healthy diet, stay at a healthy weight, and manage stress. All these steps can help us reduce our cardiovascular risk factors tremendously.
Also talking to your doctor and knowing your family medical history are important in determining your future risk.
Can you tell us more about the high-sensitivity troponin test?
Since it was launched, the troponin test has been utilized as the gold standard in the emergency department in helping diagnose heart attacks. With all the research that we did after developing the test, we realized that we can utilize it in the prevention of cardiovascular disease and not just diagnosis. Now physicians have a blood test that can predict the chance of getting a heart attack or any cardiac event 10 years in advance. As we know cardiovascular diseases are the number one cause of death in the world, the mortality rate will exceed in 2030 all other diseases combined. Therefore, prevention is going to be key to curve that mortality rate in the world. Having said that, the high-sensitivity Troponin test will help in preventing heart disease by identifying the risk factor at an early stage, and allowing people to take control of their heart health.
What are the guidelines today on when to start screening people for heart disease?
As per the current guidelines, we start screening people for prevention at 45 years and older, but if you screen at 45 and the patient is at high risk, that means that the damage is already done and you should have screened 10 or 15 years earlier, in order to be able to reduce the risk.
The goal of screening is to detect disease at its earliest and most treatable stage.
Patients with no signs and symptoms should be aware of this test and should have the choice to know the risks they have and how to avoid having untreatable damages in the future. We need to change the way we have been practicing prevention by broadening the screening to younger age groups, including cardiac specific variables, such as high-sensitivity troponin I (which is indicated for this use), and finally drive awareness for patients as well as physicians.
