While high-tech imaging techniques are being developed to detect heart disease before there are any symptoms, the low-tech basics still apply. Reducing risk factors is still the first step doctors recommend in fighting the disease.
Millions of Americans have at least one risk factor for heart disease. According to the American Heart Association, more than 40 million people in this country have total blood cholesterol levels of 240 or higher, one in four adults has high blood pressure, and more than 100 million adults are overweight.
“I screen patients indirectly,” says Carl Vaughan, M.D., a cardiologist at the New York Weill Cornell Medical Center. “If I look at a 50-year-old man, slightly overweight, with high blood pressure and no symptoms, I will address the risk factors.” These include LDL and HDL cholesterol, triglycerides, lifestyle and dietary history, high blood pressure, diabetes, smoking and family history of heart disease.
A Simple Blood Test
There are a number of substances in the blood that offer doctors clues about heart health, but according to Bruce Gordon, M.D., co-director of the Rogosin Institute Comprehensive Lipid Control Center, a routine lipid panel is sufficient 90 percent of the time. Known more commonly as a cholesterol test, a lipid panel checks LDL and HDL cholesterol, total cholesterol and triglycerides and should be done after fasting. For someone with a family history, Gordon recommends having lipids tested starting in childhood every couple of years. He says everyone else should have them tested by age 30 and then periodically checked.
Doctors can also look at other blood markers, however. One of these is C-reactive protein whose presence in the bloodstream indicates inflammation. Elevated C-reactive protein levels are linked to an increased incidence of heart disease. Gordon says early studies are very impressive, but that for a vast majority of people, testing for it won’t make a difference in therapy. It may be useful, however, in patients who have risk factors other than high cholesterol, since it’s possible to have high C-reactive protein levels and normal cholesterol.
Two other tests that can help doctors get a more complete picture are homocisteine, an amino acid that comes from the diet, and lipoprotein little a, or Lp(a), a particle that carries fat. “There’s quite a bit of evidence that levels of homocisteine correlate with heart disease,” says Gordon. Folic acid and other common vitamins lower homocisteine, but he says it isn’t clear whether taking these supplements will lower the risk of heart disease. Lp(a), on the other hand, is genetically determined. Together with high LDL, high Lp(a) levels can indicate an increased risk of heart disease and may explain some of the genetic factors involved.
Gordon says that these tests are good for patients with a family history of heart disease or for those who have unexplained heart disease. He says that any test other than a lipid panel, including the new scanning techniques, should only be used for selected cases, such as when someone has no risk factors, but high cholesterol or normal cholesterol and a bad family history. “I only use any test when I think it might change my therapy,” he says.
While some patients may be inclined to line up for the latest test that lets them actually see what’s going on in their hearts, doctors emphasize that the best way of detecting potential heart disease is to look for the factors that cause it.
But not everyone pays attention to things that could contribute to heart disease. “There are so many adults that don’t know their LDL and HDL,” says Nathan Wong, Ph.D., associate professor and director of the Heart Disease Prevention Program at the University of California, Irvine. “Many of the basic things aren’t being done, like blood pressure screening and treatment, and cholesterol screening and treatment.”
While it may not be exciting, Vaughan says that non-invasive screening for heart disease begins with a personal history and a family history. “We know from autopsy that this disease begins in childhood,” he says. While it’s true that a bad family history or a genetic predisposition can’t be controlled, many risk factors can, often without medication.
Smoking, for example, more than doubles the risk of having a heart attack, according to the American Heart Association. The first course of treatment for high blood pressure and high cholesterol is often a lifestyle change. Getting more exercise, changing your diet, and cutting back on alcohol can sometimes bring these levels back to normal. Both of these changes often lead to weight loss, another step that will decrease your chances of heart disease.
Medical advances will surely make it easier to detect heart disease early, but healthy living will probably always remain on the front line. “We really need to take care of the basic things before we start talking about the fancy tests people should be getting,” says Wong.
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