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Researchers Explore Tools to Identify Individuals at Risk for Heart Disease

Researchers Explore Tools to Identify Individuals at Risk for Heart Disease Researchers Explore Tools to Identify Individuals at Risk for Heart Disease Orlando, Fla—As physicians become increasingly aware of the predictive value of risk factors and the expanding options for preventing or delaying cardiovascular disease events, researchers are developing new tests to further identify high-risk individuals. Such new techniques “are so much more appropriate today now that we know we can prevent problems even before [cardiovascular disease] develops,” said Gerald Fletcher, MD, a professor of medicine at the Mayo Clinic College of Medicine in Jacksonville, Fla. Fletcher served as moderator of a press briefing at the March Scientific Session of the American College of Cardiology, where researchers from several teams described improvements in assessing heart disease risk in specific populations. Researchers are exploring ways to identify individuals at risk for heart disease, such as a test for cholesterol in skin tissue. (Photo credit: IMI International Medical Innovations Inc) But expressing a more cautious note is LTC Allen J. Taylor, MD, director, cardiovascular research at Walter Reed Army Medical Center, Washington, DC. “I think it’s right that the more preventive therapy we have, the better off we are and the more one can be hopeful about pushing the envelope for diagnostic testing,” Taylor said. “But the validation process still needs to run its course to really know where these tests’ appropriate clinical places are.” New Cholesterol Test New Cholesterol Test One new technique involves noninvasive testing for skin tissue cholesterol. “There’s great need for a simple and noninvasive marker of cardiovascular risk that can be used in an office setting,” said James Stein, MD, principal investigator and codirector of the Preventive Cardiology Program and director of the Vascular Health Screening Program at the University of Wisconsin Hospital and Clinics, in Madison. “We found that skin sterol content is a noninvasive marker that could help identify subclinical atherosclerosis in asymptomatic middle-aged adults—even after controlling for risk factors and risk predicted by the Framingham model.” New Cholesterol Test In his study, Stein tested 81 consecutive patients (36% women, average age 55 years) without known vascular disease who were referred to his facility for determination of carotid intima-media thickness—an established surrogate for subclinical atherosclerosis. Using the PREVU Point of Care Skin Sterol Test, marketed and distributed by McNeil Consumer Healthcare, Fort Washington, Pa, Stein found that the odds of having high carotid intima-media thickness increased by 59% for every 10 units of change in skin cholesterol. Stein said the company plans to sell the test for between $20 and $30. New Cholesterol Test Stein admitted that his results are preliminary; there has yet to be a formal sensitivity analysis. If the results are validated in larger and more diverse cohorts, he envisions the test being used for patients considered to be borderline candidates for more aggressive treatment. A low score might suggest watchful waiting or lifestyle changes, whereas a high score may argue for aggressive management, Stein said. More is Better More is Better High-sensitivity C-reactive protein has drawn substantial media attention as a strong predictor of adverse cardiovascular events. But for predicting events in women with suspected ischemic heart disease, this famous inflammatory biomarker may need help from its lesser-known counterparts, said researchers from the University of Florida and the University of Pittsburgh. More is Better Christopher B. Arant, MD, of the University of Florida College of Medicine, Gainesville, said his research team, using data from the Women’s Ischemia Syndrome Evaluation (WISE) study, found that multiple biomarkers for inflammation along with low hemoglobin levels predicted adverse cardiovascular events in women with suspected ischemia better than any single biomarker or traditional risk predictor. More is Better “This may be a useful tool for cardiovascular risk prediction in women presenting with chest pain,” Arant said. More is Better Arant and colleagues studied 595 women, who were followed up for an average of 3.6 years. They found that 12% of women without abnormal inflammatory markers had an adverse cardiovascular event compared with 37% of women with three abnormal inflammatory markers (high-sensitivity C-reactive protein, interleukin-6, and serum amyloid A). And when low hemoglobin levels were present, 20.7% of women without abnormal inflammatory markers and 45.5% of those with all three markers had an adverse cardiovascular event. Improved Calcium Scoring Improved Calcium Scoring Coronary artery calcification is another tool used to gauge coronary risk by measuring subclinical atherosclerosis. However, European researchers said current reference data in the United States that enable a physician to place patients in certain coronary risk percentiles are misleading and result in an underestimation of risk. Improved Calcium Scoring Axel Schmermund, MD, a cardiologist with the University Clinic in Essen, said the use of preselected patients in the US studies that formed the basis for current referral cohorts using the Agatston calcium score biased the results. As a consequence, scores considered to be at the upper end of the normal range actually represent individuals who have an elevated coronary risk. Improved Calcium Scoring “High-risk people are overrepresented in the older cohorts because they’re worried or their doctors are worried” about their cardiovascular health, Schmermund said. “And then the so-called ‘worried well’ are overrepresented in the younger cohorts.” Improved Calcium Scoring Schmermund’s team used electron-beam computed tomography to determine coronary artery calcification of 4814 participants in the Heinz Nixdorf Recall study. The study participants, 92.9% of whom had no history of coronary artery disease, were from the German Ruhr area, and ranged in age from 45 to 74 years. The team found that the median Agatston calcium score was lower in their study group, suggesting that findings from previous referral cohorts underestimate true risk. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Researchers Explore Tools to Identify Individuals at Risk for Heart Disease

JAMA , Volume 293 (21) – Jun 1, 2005

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Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.293.21.2582
Publisher site
See Article on Publisher Site

Abstract

Researchers Explore Tools to Identify Individuals at Risk for Heart Disease Orlando, Fla—As physicians become increasingly aware of the predictive value of risk factors and the expanding options for preventing or delaying cardiovascular disease events, researchers are developing new tests to further identify high-risk individuals. Such new techniques “are so much more appropriate today now that we know we can prevent problems even before [cardiovascular disease] develops,” said Gerald Fletcher, MD, a professor of medicine at the Mayo Clinic College of Medicine in Jacksonville, Fla. Fletcher served as moderator of a press briefing at the March Scientific Session of the American College of Cardiology, where researchers from several teams described improvements in assessing heart disease risk in specific populations. Researchers are exploring ways to identify individuals at risk for heart disease, such as a test for cholesterol in skin tissue. (Photo credit: IMI International Medical Innovations Inc) But expressing a more cautious note is LTC Allen J. Taylor, MD, director, cardiovascular research at Walter Reed Army Medical Center, Washington, DC. “I think it’s right that the more preventive therapy we have, the better off we are and the more one can be hopeful about pushing the envelope for diagnostic testing,” Taylor said. “But the validation process still needs to run its course to really know where these tests’ appropriate clinical places are.” New Cholesterol Test New Cholesterol Test One new technique involves noninvasive testing for skin tissue cholesterol. “There’s great need for a simple and noninvasive marker of cardiovascular risk that can be used in an office setting,” said James Stein, MD, principal investigator and codirector of the Preventive Cardiology Program and director of the Vascular Health Screening Program at the University of Wisconsin Hospital and Clinics, in Madison. “We found that skin sterol content is a noninvasive marker that could help identify subclinical atherosclerosis in asymptomatic middle-aged adults—even after controlling for risk factors and risk predicted by the Framingham model.” New Cholesterol Test In his study, Stein tested 81 consecutive patients (36% women, average age 55 years) without known vascular disease who were referred to his facility for determination of carotid intima-media thickness—an established surrogate for subclinical atherosclerosis. Using the PREVU Point of Care Skin Sterol Test, marketed and distributed by McNeil Consumer Healthcare, Fort Washington, Pa, Stein found that the odds of having high carotid intima-media thickness increased by 59% for every 10 units of change in skin cholesterol. Stein said the company plans to sell the test for between $20 and $30. New Cholesterol Test Stein admitted that his results are preliminary; there has yet to be a formal sensitivity analysis. If the results are validated in larger and more diverse cohorts, he envisions the test being used for patients considered to be borderline candidates for more aggressive treatment. A low score might suggest watchful waiting or lifestyle changes, whereas a high score may argue for aggressive management, Stein said. More is Better More is Better High-sensitivity C-reactive protein has drawn substantial media attention as a strong predictor of adverse cardiovascular events. But for predicting events in women with suspected ischemic heart disease, this famous inflammatory biomarker may need help from its lesser-known counterparts, said researchers from the University of Florida and the University of Pittsburgh. More is Better Christopher B. Arant, MD, of the University of Florida College of Medicine, Gainesville, said his research team, using data from the Women’s Ischemia Syndrome Evaluation (WISE) study, found that multiple biomarkers for inflammation along with low hemoglobin levels predicted adverse cardiovascular events in women with suspected ischemia better than any single biomarker or traditional risk predictor. More is Better “This may be a useful tool for cardiovascular risk prediction in women presenting with chest pain,” Arant said. More is Better Arant and colleagues studied 595 women, who were followed up for an average of 3.6 years. They found that 12% of women without abnormal inflammatory markers had an adverse cardiovascular event compared with 37% of women with three abnormal inflammatory markers (high-sensitivity C-reactive protein, interleukin-6, and serum amyloid A). And when low hemoglobin levels were present, 20.7% of women without abnormal inflammatory markers and 45.5% of those with all three markers had an adverse cardiovascular event. Improved Calcium Scoring Improved Calcium Scoring Coronary artery calcification is another tool used to gauge coronary risk by measuring subclinical atherosclerosis. However, European researchers said current reference data in the United States that enable a physician to place patients in certain coronary risk percentiles are misleading and result in an underestimation of risk. Improved Calcium Scoring Axel Schmermund, MD, a cardiologist with the University Clinic in Essen, said the use of preselected patients in the US studies that formed the basis for current referral cohorts using the Agatston calcium score biased the results. As a consequence, scores considered to be at the upper end of the normal range actually represent individuals who have an elevated coronary risk. Improved Calcium Scoring “High-risk people are overrepresented in the older cohorts because they’re worried or their doctors are worried” about their cardiovascular health, Schmermund said. “And then the so-called ‘worried well’ are overrepresented in the younger cohorts.” Improved Calcium Scoring Schmermund’s team used electron-beam computed tomography to determine coronary artery calcification of 4814 participants in the Heinz Nixdorf Recall study. The study participants, 92.9% of whom had no history of coronary artery disease, were from the German Ruhr area, and ranged in age from 45 to 74 years. The team found that the median Agatston calcium score was lower in their study group, suggesting that findings from previous referral cohorts underestimate true risk.

Journal

JAMAAmerican Medical Association

Published: Jun 1, 2005

Keywords: heart diseases

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