Fri 26 Oct 2007
Update on heart attack and stroke prediction
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Predicting future risk of heart attacks and stroke (cardiovascular disease or CVD risk) is something the medical profession has tried to improve for many years. At present methods based on information gained from the very long-term Framingham study are the most widely used formulas. These use information on factors such as sex, age, family history, presence of diabetes, high blood pressure, obesity, smoking, lack of exercise and fasting low-density lipoprotein (LDL) and high density lipoprotein (HDL) cholesterol and fasting triglycerides. However even when all are taken into account, these factors do not fully explain the risk, so the search is always on for more predictive factors
A recent article in this News section entitled “Have new lab tests improved the prediction of heart attacks” discusses the fact that despite a lot of initial publicity a number of new lab tests being touted are not very useful.
Now two new measures are being discussed. Two new studies published in the Journal of the American Medical Association provide evidence that postprandial (after eating) triglyceride levels may deserve more attention in the assessment of risk of heart disease. These studies suggest that a blood sample taken a few hours after your last meal may identify a risk for heart attack and other serious cardiovascular problems that are not identified from the traditional fasting triglyceride test after a 12-hour fast (today’s preferred test). The studies carried out in Denmark and the US showed that blood triglyceride levels measured in a the relatively short window of 2 to 4 hours after a meal give extra information and predict risk better than the standard fasting triglyceride test. This may be because the post-prandial triglyceride test is a measure of the level of damaging lipoprotein particles called remnant particles.
Don’t expect this test to be used by your doctor in the near future however. More studies will be required to prove the true values of the test and exactly how it should be used.
The second predictive measure being discussed is the waist circumference. Waist circumference as a measure of abdominal obesity has been studied for some time. However two recent articles in Circulation and a presentation at the recent Canadian Cardiovascular Congress have thrown new light on this measure. Measurement of waist circumference and fasting triglyceride levels together can be used to predict extra cardiovascular risk beyond that predicted by the usual Framingham factors. This seems to be especially true in women. It seems that intra-abdominal fat is different from subcutaneous fat (fat under the skin) distributed around the rest of the body. Intra-abdominal fat predisposes the carrier to the so-called “metabolic syndrome” with increased prevalence of diabetes, high triglycerides, low HDL (good) cholesterol, high blood pressure and increased risk of cardiovascular disease including heart attacks.
This is something you can act on yourself immediately. If you have fat around the abdomen which you can easily see and assess with a tape measure, then diet and exercise together can help to remedy the situation. Even if you don’t lose weight but do reduce your waist circumference by converting fat into muscle, this is very likely to improve your risk profile and your health overall.
From Lab Tests Online-US