Early Cardiovascular Disease Detection

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Early Cardiovascular Disease Detection

• Paul Sommers, PhD, Co-Founder
• Rasmussen Center for Cardiovascular Disease
  Prevention
• University of Minnesota Physicians -
  Cardiovascular Division

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Agenda

• Early Detection to Prevent/Delay Morbid Events
• Rasmussen Center Overview
• Results-to-Date
• Community-Wide Benefits
• Replication and Geographic Expansion

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Early Detection to Prevent / Delay
Morbid Events

• Myocardial infarction Large arteries
• Stroke Large and small arteries
• Heart failure Left ventricle
• Arrhythmias Left ventricle
• Renal failure Small arteries
• Claudication Large and small arteries
• Dementia Small arteries

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Current Efforts
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Rasmussen Center Efforts

• Focus 40-60 year old population with no clinical
  signs or symptoms of CVD
• Prevention of CVD requires detection at a much
  earlier stage before plaque forms
• Empower physicians with new and proven
  preventative diagnostic techniques and establish
  early stage treatment plans
• All tests are reimbursed by insurance using FDA
  approved standard CPT, ICD-9 and HCPCS codes.
  Laboratory tests are certified by CLIA
• Role of Nurse Practitioner
• Health Improvement Plan for each Patient Screened

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10 Tests Focus on 3
Primary Cardiovascular Disease Systems

• Large arteries
• Large artery elasticity
• Carotid intimal-medial thickness/ abdominal
  aortic wall thickness
• Small arteries
• Small artery elasticity
• Retinal artery changes
• Microalbumin in urine
• Resting blood pressure
• Blood pressure response to three (3) minute
  normal walking exercise
• Left Ventricle
• Heart structure and function
• Left ventricle size
• Brain Natriuretic Peptide level

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Rasmussen/ Cohn Disease Score

• A global model for assessing vascular and cardiac
  health to detect early disease
• 10-test assessment effectively identifies
  approximately 30 of the asymptomatic population
  in need of treatment
• Individual cardiovascular tests were selected on
  the basis that they are predictive of
  cardiovascular morbidity and mortality
• Use of patent-pending, proprietary scoring
  method to calculate a composite score from each
  individual, the Rasmussen Disease Score (RDS)
• RDS provides significantly greater sensitivity
  and specificity for predicting future
  cardiovascular morbid events than the classical
  Framingham risk score

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Rasmussen Disease Score

• Normal Borderline Abnormal
• Resting Blood Pressure 0 1 2
• Exercise Blood Pressure 0 1 2
• Large Artery Elasticity (C1) 0 1 2
• Small Artery Elasticity (C2) 0 1 2
• Carotid IMT 0 1 2
• Retinal digital photograph 0 1 2
• Microalbuminuria 0 1 2
• Electrocardiogram 0 1 2
• LV Ultrasound (LVID, LVWT, mass) 0 1 2
• Plasma BNP or NT-ProBNP 0 1 2
• 
  
• Total 0-20

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Scoring System
Patent Pending Algorithm

• Patent-pending scoring system designed to assess
  the strength of evidence for early cardiovascular
  disease.
• For each of the ten tests performed a score of 0
  indicates a normal test result, a score of 1
  indicates a borderline result and a score of 2
  indicates an abnormal test result.
• A total score of 0 means no evidence for disease
  a total score of 20 would represent the greatest
  evidence for disease in need of treatment. Most
  scores are between these two extremes.
• Score of 0-2 Life style counseling and recheck
  in 5 years
• Score of 3-5 Life style counseling and recheck
  in 1-3 years
• Score of 6 and above Treatment of early
  cardiovascular disease

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Results

• 610 patients (44 women 56 men) out of 1,200
  screened for determination of a Rasmussen Disease
  Score from 2001-2006 returned their follow-up CVD
  event tracking surveysA comparison was made
  between the Rasmussen Disease Score (RDS) vs.
  Framingham risk estimate (RE) in the prediction
  of risk for cardiovascular morbid events
  (ME)Using a scoring system from 0 (no disease)
  to 20 (advanced disease), 33 of the
  population-exhibited scores between 0-2 (low
  disease score) 36 exhibited scores between 3-6
  and, 31 exhibited scores of 6 and above (high
  disease score) The data indicate that the
  Rasmussen/Cohn Disease Score (RDScore) is
  superior to the Framingham Risk Estimate (RE)
  10-year risk scores in identifying individuals
  destined for morbid events (ME)

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Results
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Results
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Stratification Into 3
Groups Strategy for
Prevention

• LOW RISK (33) Individuals with no early disease
  (RD Score 0-2)
• - No near-term risk
• - Public health message
• - Prudent Lifestyle no need for intervention
• - Re-screen at 5-10 year intervals
• MODERATE RISK (36) Those with early disease (RD
  Score 3-5)
• - Risk of progression events predictable within
  4 years
• - Targeted lifestyle alteration required
• - Re-screen at 3-year intervals
• HIGH RISK (31) Those with advancing disease (RD
  Score gt 5)
• - High immediate risk
• -Targeted aggressive lifestyle alteration
• -Targeted pharmacology monitored by patients
  physician
• - Re-screen at 1-2 year intervals

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Conclusion

• Identification of early disease is more sensitive
  and specific than risk factors in predicting
  future morbid events
• Effective early disease detection can be carried
  out non-invasively, inexpensively, and without
  radiation
• Such screening can appropriately stratify
  management strategies
• Effective preventive therapy could drastically
  reduce the morbidity and cost of advanced disease
  and events

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Stakeholder - Wide Benefits

• Patients Each patient (and their primary care
  physician) will receive a report outlining their
  cardiovascular health needs and risk indicators
  and, a customized cardiovascular health
  improvement plan
• Physicians Refer their existing patients to the
  program to identify the earliest evidence of CVD
  and use established treatment plans to follow the
  patient in their practice
• Payers/Employers Consistent message regarding
  the value of prevention and systematic reduction
  of health care costs

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Replication and Geographic Expansion

• Minnesota
• University of Minnesota Physicians/ Fairview
  locations
• Cohn Prevention Centers, LLC Florida and
  Louisiana
• In 2004, Cohn Prevention Centers, L.C.C. (CPC)
  was organized under Minnesota Statutes, Chapter
  322B
• New CPCs have been operating at Sarasota
  Memorial Hospital, Sarasota FLA (established in
  April 2008) and at Coeur Health, LLC in Lafayette
  LA (established in January 2009 in association
  with the Lafayette Heart Clinic)
• Discussions continue with new potential CPCs
  sites throughout USA, Canada and abroad. Mobile
  services and a 4-test pre-screening model for
  rapidly evaluating large numbers of individuals
  is in the development process

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Cardiovascular Division Research
at the University of Minnesota

• Molecular and cellular cardiovascular biology
• Cardiovascular applications of magnetic resonance
  imaging and spectroscopy
• Stem cell biology in cardiovascular repair
• Clinical and epidemiological research

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