Cardiac
Risk Assessment
Evaluating and Reducing Your Risk
for Heart Disease
The first sign of heart
disease is often death. Cardiovascular disease kills nearly
one million Americans each year, half of them with the
first heart attack. Interventions include bypass surgery,
balloon angioplasty, heart transplant, and catheterization.
All have their risks; even catheterization kills about
one in 500 people undergoing the procedure. Up to four
percent suffer serious complications, which include arterial
trauma, profound hypotension, bacterial endocarditis, emboli,
and hemorrhage. The economic cost of these procedures is
phenomenal; a half a million bypass surgeries at over $50,000
each help make cardiovascular treatment a 260 billion dollar
a year growth industry.
The cardiovascular system
pumps about 2,000 gallons of blood each day, as the heart
beats about 100,000 times. That's a lot of work to do when
things go wrong. The primary direct cause of problems is
atherosclerosis-fat deposits in the arteries throughout
the body. While it may seem tempting to accept the conventional
thinking that fats in the diet are the main culprit, the
real causes of cardiovascular problems are just not that
simple. More on that later; first, let's focus on how to
assess risk.
Laboratory markers of particular value include several
that are usually little discussed:
Triglycerides: Levels reflect the severity of CHD. Increases
are associated with abnormal clotting; this is not true
of cholesterol, and increased triglyceride levels are much
more significant than increased cholesterol.
Lipoprotein (a) (known
as "lipoprotein little a"): This is the molecule that bind cholesterol to the walls
of the arteries; high levels are the most significant
laboratory indicator of risk for coronary disease and
stroke. Levels
of lipoprotein (a) respond to supplements and dietary
measures (although they are said to be largely hereditary).
Homocysteine: This amino acid metabolite scrapes the inner
layer of the blood vessels and makes the lesion that initiates
atherosclerosis. Levels of homocysteine are predictive
of cardiac risk. Elevations are caused by less than optimal
levels of certain key nutrients.
Fibrinogen: This protein strongly affects blood coagulation
and platelet aggregation; excesses act as a trigger for
the atherosclerosis-promoting effect of high triglycerides.
C-Reactive Protein: This is a marker for the systemic
inflammation that occurs in developing atherosclerosis.
It is a strong predictor of heart attack and stroke.
These clinical laboratory
markers give clues about risk. Medical history (including
family history), dietary history, and physical exam provide
the experienced physician with further evidence. What you
might call a clinical sixth sense, or intuition, takes
on a certain import for a physician with enough time in
practice.
Medical studies have proven
that lifestyle changes and supplements can not only prevent
or halt coronary heart disease-they can reverse it, even
in severe cases, within a year (The Lancet 1990; 336: 129-133).
Such studies are consistent with my experience with patients
with heart disease for over twenty years. Laboratory markers
and associated symptoms are nature's warnings. If heeded,
they can mark the beginning not of a rapid decline into
illness and death, but rather of a journey toward a long,
active, and healthy life. My job is to interpret those
warnings and guide you in setting your new course. |
