Know You Heart Risks

Heart attacks continue to be the number one killer in the US. Heart attacks are also one of the major strains on the national and personal health budgets. It is essential that you know your risks for the development of heart disease so that you can take the necessary steps to decrease the chance of a premature heart attack.

Heart attacks, the major manifestation of coronary heart disease (or atherosclerosis, plaque), continues to be the leading cause of mortality in the US, and will continue to be so as longevity increases, and as the number of senior citizens increases. And, yes, many of us feel that we know what puts us at risk for a heart attack, and what we have to do in order to decrease that risk. But do we really know enough?

Many of us know, or at least heard of, the role of smoking, diabetes, obesity, lack of exercise, and hypertension. We also know of the role of cholesterol, including the “good cholesterol” (HDL) and the “bad cholesterol” (LDL), or even triglycerides. We even know that it’s better to be born with “good genes,” or to parents who never develop heart disease.

But what about the more recently recognized risks factors and tests to better detect a potential heart problem early?

Look at one cholesterol related example: We now can look not only at the total LDL and HDL, but also at their respective subclasses. There are at least two LDL patterns “predominantly small particles LDL,” also known as Pattern B, and “predominantly large particles LDL,” known as Pattern A. Pattern B is the dangerous one, and it’s the one that can usually be managed by lowering dietary fat intake. In contrast, Pattern A individuals may not benefit, or even become worse with dietary fat restriction. Similarly, there are other subclasses, each of which has its own significance and therapeutic implications.

And what about Homocyteine and Cardio-CRP? Both are potentially important markers of the risk of coronary heart disease.

Homocysteine is an amino acid produced by the body during protein digestion. Excess homocysteine injures arterial walls, thereby aggravating the effects of the “bad cholesterol”. It is more commonly found in smokers, the elderly, the heavy alcohol drinker, and in individuals with kidney failure or a recent heart attack

Inflammation of the coronary arteries accelerates the formation of coronary plaque. Cardio-CRP is a marker of inflammation, and helps identify those at risk of a first and subsequent heart attack, even when the cholesterol risk is low.

Newer blood tests, such as the ones done by the Berkeley HeartLab, Inc. go even further into analyzing inflammatory markers, and the benefit effect of certain drugs in the management of cardiac risk factors.

Early detection of plaque formation has become easier too. We’re all familiar with the common treadmill stress test, stress ECHO’s, nuclear Thallium or MIBI test, or even cardiac catheterization. But new tools have evolved. A modern “fast cardiac CT scan” in experienced hands can show calcium in existing plaque, and thus estimate the degree of atherosclerosis. Computerized coronary angiography, which is only minimally invasive, can even better assess the extent of plaque formation.

Many other developments are just below the horizon. However, an important problem hindering the use of many new techniques is coverage by the health insurance companies as well as Medicare, which traditionally take years to sanction their use. 

Regardless, we’ve come a long way in our ability to identify the risk of coronary heart disease, and to detect it early. At our practice, early detection and prevention is a cornerstone. For additional information, contact us.