What is the cardiac testing that is needed before starting someone on hormone therapy?

Highlights

• The first step is a clinical risk assessment using the Pooled Cohort or PREVENT equations to estimate cardiovascular risk.
• Risk calculators require basic clinical variables like age and blood pressure, plus lab values including cholesterol and HbA1c.
• A coronary artery calcium score can be considered as an additional tool to help further refine a patient’s risk assessment.

Expert Insights

Foundational Cardiovascular Risk Assessment

When considering the initiation of hormone therapy, a thorough cardiovascular disease (CVD) risk assessment is the essential first step, rather than a specific battery of cardiac tests. Dr. Emily Lau, a cardiologist, emphasizes a strategy centered on clinical risk evaluation. This initial assessment forms the basis for counseling and shared decision-making regarding the potential cardiovascular implications of treatment.

Utilizing Standardized Risk Calculators

The cornerstone of this evaluation involves the use of established risk calculators. Dr. Lau recommends employing tools such as the Pooled Cohort Equation (PCE) or the newer PREVENT equations. These instruments provide a quantitative estimate of a patient's 10-year and, in some cases, 30-year risk of atherosclerotic cardiovascular disease. The strength of this approach lies in its reliance on readily available clinical and laboratory data.

Key Variables for Risk Estimation

To effectively use these risk calculators, a specific set of patient data is required. Dr. Lau notes that the necessary inputs include basic clinical variables such as age, blood pressure, and BMI. This is complemented by key laboratory values, including total cholesterol, HDL-cholesterol, and HbA1c, among others. Gathering this information provides a comprehensive and standardized snapshot of a patient's baseline cardiovascular risk profile before any therapeutic intervention is started.

"Variables required for these risk calculators include basic clinical variables (age, BP, BMI), lab variables (total cholesterol, HDl-cholesterol, HbA1c, etc)." Dr. Emily Lau

Refining Risk with Advanced Imaging

In select cases where the initial risk assessment yields ambiguous results or when a more precise understanding is needed to guide therapy decisions, further testing may be considered. Dr. Emily Lau suggests that a coronary artery calcium (CAC) score can be a valuable tool. This non-invasive test helps to further refine risk stratification by directly visualizing the atherosclerotic burden in the coronary arteries, potentially reclassifying patients into higher or lower risk categories and thereby clarifying the risk-benefit analysis of hormone therapy.

"Occasionally can consider use of coronary artery calcium score testing to help further refine risk assessment." Dr. Emily Lau