Quarterly update-July/Aug 2004-Chapter 8 Heart Disease



Chapter 8

In the News: Risk Factors for Heart Disease

A 2003 article in the Journal of the American Medical Association (JAMA) reinforced the belief that cholesterol, blood pressure, smoking, and diabetes are the four major risk factors contributing to heart disease. A paper published in August 2003 concluded that between 87 and 100% of the victims of fatal heart attacks had at least one of these four big risks. However, when the statistics are reviewed some interesting facts emerge. These include:

• Death without risk. Ten percent of people who died of heart disease had none of the big four risk factors.

• Risk without death. A table in the JAMA article states that a large percentage of people who lived had the same risk factors as the people who died. The question emerges as to how can something be called a risk factor, if so many people have it but don’t develop heart disease?

• Define “risk.” Risk levels according to cholesterol levels are not always the answer because genetic predisposition or other factors may make some people more susceptible to heart disease than others. Heart experts believe that risk-setting numbers are important since they get people’s attention and cause them to change their way of life. Changes such as losing weight, getting more exercise, and changing dietary habits can reduce the known risks.

Another area of interest to scientists is in searching for markers in the blood for warning signs of heart disease. These tests include:

• C-reactive protein (CRP), a substance produced by the liver in response to inflammation, which most scientists now believe is how coronary artery disease generally begins. There is a strong relationship between high levels of CRP (above three milligrams per liter) and cardiovascular risk. High CRP levels has also been tied to stroke risk. Some researchers say the CRP is a better predictor of the risk of heart disease than cholesterol levels. Guidelines issued by the American Heart Association and the CDC issued in January 2003 suggest the test is recommended only if you have an intermediate risk of developing coronary artery disease in the next 10 years. However, any infection can cause high readings therefore the test must only be used in conjunction with assessments of known risk factors.

• Lipoprotein-associated phospholipase A2(Lp-PLA2). In April 2003 results from a six-year study showed high levels of Lp-PLA2 in individuals before they had coronary events-even in people who seemed not to be at risk. In July 2003 the Food and Drug Administration (FDA) approved the blood test. A problem with using this test is that it is pricey and not reimbursed by health insurance at the present time since the test is new and unproven.

References:

Blood tests: Seeking clues about your heart’s health. Mayo Clinic Health Letter

Medical Essays.

Comarow, A. (2003, September 29). When heart breaks. U.S. News and World Report.

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