Unmasking hearts at risk: Indicators can be hidden

Most patients with heart disease have one or more risk factors. The trick is to identify them, especially when the signals, and the patients, don't fit a traditional pattern.

By Susan J. Landers, AMNews staff. Feb. 20, 2006.

Who is a candidate for a heart attack in the next year, or two or three? Wouldn't we all like to know. The best predictors identified thus far can determine with a fair amount of certainty only who will have a heart attack within the next decade.

Can't modern medicine do better?

Yes it can, many say. And a search has been on for the past several years for new signals that go beyond the traditional markers of cholesterol levels, hypertension, diabetes, smoking and family history.

A handful of novel risk factors has emerged, and some of them could have a place in a physician's toolbox.

But physicians are divided concerning their use. Some support the value of testing for such risk factors as C-reactive protein, fibrinogen, homocysteine or lipoprotein(a) and LDL particle size and number. Coronary calcium scans also are considered by some to be useful tests to flag a heart in imminent danger.

Other physicians hesitate to use these measures, while a middle camp uses them only selectively.

"Our research suggests that if you have a patient with a family history of heart disease and they are age 40 and over if a man, or age 45 and over if a woman, a physician might want to think about getting a coronary calcium scan," says Roger Blumenthal, MD, director of the Ciccarone Preventive Cardiology Center at the Johns Hopkins School of Medicine in Baltimore.

"They may also want to think about getting a C-reactive protein blood test in addition to the standard cholesterol profile and checking their patient's blood pressure and blood sugar," he says.