Thursday, February 23, 2012

Time for new tools to screen for heart disease?

A new study from Nottingham in the UK has suggested that further 5% of people can be picked up for the risk of developing heart disease if the family history is taken by the treating family physician. This is because a patient is more likely to develop Coronary Heart Disease (CHD) if they have a father or brother younger than 55 years who had CHD or a mother or sister younger than 65 with the disease. This has got me thinking about risk factors and heart disease and how "scientific" the whole issue really is. But first up I must stress that I fully endorse current methods of risk factor analysis because it's the best, and only tool that we currently have: but as tools go, they're still fairly primitive!

Blood pressure. A well known "risk" for both heart and vascular disease - think strokes and circulation. The way Docs measure BP hasn't changed since the middle of the 19th century - the equipment has, because for over 100 years the pressure was measured in mms of mercury and its only in the last 20 years that the mercury has been replaced solely because it is an environmental hazard!  Blood pressure is measured "indirectly" by inflating a cuff at the midpoint of the biceps muscle until the artery -deep below the muscle - is occluded (blocked off): then one listens (or a microphone does) for the sounds of returning blood flow whilst the pressure in the cuff is reduced. This is not 21st century rocket science! The measurement is supposed to be done with the patient lying down for 5 to 10 minutes and then  repeated a few minutes later to confirm: many of the Docs I know have the BP cuff on their patients arm just as the patients are in the act of sitting down  - hardly an accurate reflection of what is happening to the heart and blood vessels, if one is going to then prescribe medications for life in order to control "raised" blood pressure.

High Cholesterol: the advent of Statin medications has had a dramatic impact on the management of people with known CHD - it's good stuff. But we still don't know whether the outcomes have been due to lowering LDL (so called bad cholesterol) or to other lifestyle changes. Also, what about the "Good" cholesterol HDL - which in most cases is not affected by taking Statins - how high is protective, and is all Good HDL in fact good HDL?  There are still a lot of unanswered questions.

Physical activity: nearly all long term studies rely on patients filling out questionnaires which is noble, but is it accurate?

Smoking: in my book stopping smoking is the best thing anyone can do for their own health -period!

Diet: again, nearly all the information gathered is from patient questionnaires: and what is the impact of having a "night off" from healthy eating to celebrate a wedding or anniversary?

Family History: Why is 55 such a magical number? In my own case I would be deemed low risk as my father had no signs until his mid 70's and my older brother CAD didn't surface until after I was diagnosed in my early 50's.

Then there's flossing teeth, eating walnuts, meditation .. quite an endless list of very "interesting" yet indirect ways of assessing risk.

My point is not to rubbish or reduce the impact of assessing risk for CHD, but a call to arms to find better ways of determining risk. This is a big killer and a big "harmer" and we need to get our best and brightest focused on alternatives to the "dodgy" tools that we currently use. Governments and Heart Foundations should be looking to encourage young researchers to take up the challenge with creative "think-tanks" etc, and perhaps also review their own focus on how they currently spend their "hard earned dollars".
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1 comment:

Mariodacatsmom said...

Another great post on an interesting subject. My husband has had open heart surgery - about 10 years ago. He's been fine ever since, but we really do try to watch the diet, and he does work out at a health club. He has a strong family history of heart disease and was fortunate in that he didn't have his first problem until age 62.