Non-food Things
Prediction of heart disease risk improved
By Ben Wasserman - foodconsumer.org
Feb 14, 2007 - 10:55:28 AM

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Editor’s note:  For many people who value natural ways to prevent heart disease and stroke, this study does not mean too much.  Many of us, readers of foodconsumer.org know that the prevention needs to start at very young age with a healthy lifestyle including a healthy diet, avoidance of smoking, and moderate physical exercise.
 

Adding two new risk factors to a traditional cardiovascular risk algorithm can enhance prediction of a white woman's ten-year risk of heart disease or stroke, according to a research report published in the Feb. 14 issue of the Journal of the American medical Association.

With high-sensitive C-reactive protein and family history of heart disease considered along with other traditional risk factors, researchers built two new models which were able to better predict the cardiovascular events in women compared to the traditional methodology.

Using the new models, the researchers could also classify half of the women who were at intermediate risk of heart disease as predicted by the traditional model into higher risk or lower risk categories, which would enable doctors to prescribe accordingly to better help patients reduce their risk.

Framingham coronary prediction algorithm, which is based on   risk factors including age, blood cholesterol (or LDL cholesterol), HDL cholesterol, blood pressure, cigarette smoking, and diabetes mellitus, is often used to estimate one's risk of developing angina pectoris, myocardial infarction or coronary disease death over the course of ten years.

The method is fairly old and its prediction is limited.   A better model is needed to predict the cardiovascular risk as 50 percent of patients who got their first cardiovascular event such as heart attack or stroke do not show any prior symptoms.   And also up to 20 percent of coronary events occur in people without any traditional risk factors while many women with those risk factors do not have any coronary event.

Paul M Ridker and colleagues from Brigham and Women's Hospital, Boston, Mass wanted to develop new cardiovascular risk algorithms based on both traditional and novel risk factors to better predict the risk of cardiovascular events such as heart attack and stroke for women.

For the study, Ridker and team analyzed 35 risk factors among 24,558 initially healthy U.S. women age 45 years or older, who participated in the Women's Health Study, a nationwide cohort started in 1992. Two thirds of the cohort (derivation cohort) were used to build the new models while the remaining one third (validation cohort) was used to validate the new risk algorithms with regard to its accuracy of the risk estimation.

They followed up the women for ten years for incident cardiovascular events including myocardial infarction, ischemic stroke, coronary revascularization, and cardiovascular death.  They came up with two models, model A, the best fitting model and model B, the clinically simplified model B (the Reynolds Risk Score).

The researchers reported both models were better than the traditional method in terms of measures like fit, discrimination, and calibration. Among those women without diabetes who were viewed at the intermediate level of risk for cardiovascular events according to the ATP-III score, the best-fitting model were able to reclassify 50 percent of the women into higher or lower risk categories, making the prediction better matched with actual event rates in the validation cohort.

A similar quality was found in the clinically simplified model B (the Reynolds Risk Score), which was based on fewer risk factors including only age, blood pressure, hemoglobin A1c if diabetic, smoking, total and high-density lipoprotein cholesterol, hs-CRP, and family history of heart attack before age 60.

There were some limitations of these new cardiovascular risk algorithms. The cohort used was comprised of mostly white women.   The models were not intended for men and other ethnic populations to predict their risk of heart disease and stroke.   Also, the data collected on blood pressure, obesity and family history were self-reported, meaning that the accuracy may be comprised to certain degree. Also the prediction may be only applied to women young than 60 years of age for a ten-year span due to the validity of some risk variables.

In an accompanying editorial, Roger Blumenthal, M.D., of Johns Hopkins in Baltimore, and colleagues applauded the study by Dr. Ridker and colleagues, saying it provides a "timely contribution to the cardiovascular-risk-prediction literature."   But they also pointed out that the impact of individual risk factors on the risk assessment remains unknown.

According to news media, Ridler is a co-inventor of patents related to the use of inflammatory biomarkers in cardiovascular disease. For each test on such inflammatory biomarkers, $6 to 8 will go to the Brigham and Women's Hospital which owns the right to the patents.

Some experts caution that further validation is needed for the newly developed cardiovascular risk algorithms.   One issue is hs-CRP.   The testing of hs-CRP and use of it in the prediction model remain questionable as research has found that its level does not accurately reflect the risk of heart disease or stroke, meaning that in practice when a drug is used to lower the concentration of this marker, and accordingly cause a drop in the predicted cardiovascular risk, the real risk may not be as predicted.

Med Page Today reported that "Ridker has served as a consultant to Schering-Plough, Sanofi/Aventis, AstraZeneca, Isis Pharmaceutical, Dade-Behring, and Vascular- Biogenics" and "he has received investigator-initiated research support from multiple for-profit entities including AstraZeneca, Bayer, Bristol-Myers Squibb, Dade-Behring, Novartis, Pharmacia, Roche, Sanofi-Aventis, and Variagenics."

Cited below is the information on heart disease for women from 4women.gov.   It is the opinion of the government and it should be regarded as such.

What is Heart Disease?

Coronary heart disease is the main form of heart disease.   It is a disorder of the blood vessels of the heart that can lead to heart attack.   A heart attack happens when an artery becomes blocked, preventing oxygen and nutrients from getting to the heart.  Often referred to simply as heart disease, it is one of several cardiovascular diseases, which are diseases of the heart and blood vessel system.   Other cardiovascular diseases include stroke, high blood pressure, angina (chest pain), and rheumatic heart disease.

One reason some women aren't too concerned about heart disease is that they think it can be "cured" with surgery.   This is a myth.   Heart disease is a lifelong condition—once you get it, you'll always have it.   True, procedures such as bypass surgery and angioplasty can help blood and oxygen flow to the heart more easily.   But the arteries remain damaged, which means you are more likely to have a heart attack.   What's more, the condition of your blood vessels will steadily worsen unless you make changes in your daily habits.   Many women die of complications from heart disease, or become permanently disabled.   That's why it is so vital to take action to prevent and control this disease.
 

What Are the Risk Factors for Heart Disease?

Risk factors are conditions or habits that make a person more likely to develop a disease.   They can also increase the chances that an existing disease will get worse.   Important risk factors for heart disease that you can do something about are:

    * High blood pressure

    * High blood cholesterol

    * Diabetes

    * Smoking

    * Being overweight

    * Being physically inactive

    * Having a family history of early heart disease

    * Age (55 or older for women)

Some risk factors, such as age and family history of early heart disease, can't be changed.   For women, age becomes a risk factor at 55.   After menopause, women are more apt to get heart disease, in part because their body's production of estrogen drops.   Women who have gone through early menopause, either naturally or because they have had a hysterectomy, are twice as likely to develop heart disease as women of the same age who have not yet gone through menopause.   Another reason for the increasing risk is that middle age is a time when women tend to develop risk factors for heart disease.   Family history of early heart disease is another risk factor that can't be changed.   If your father or brother had a heart attack before age 55, or if your mother or sister had one before age 65, you are more likely to get heart disease yourself.

While certain risk factors cannot be changed, it is important to realize that you do have control over many others.   Regardless of your age, background, or health status, you can lower your risk of heart disease—and it doesn't have to be complicated.   Protecting your heart can be as simple as taking a brisk walk, whipping up a good vegetable soup, or getting the support you need to maintain a healthy weight.

Some women believe that doing just one healthy thing will take care of all of their heart disease risk.   For example, they may think that if they walk or swim regularly, they can still smoke and stay fairly healthy. Wrong!   To protect your heart, it is vital to make changes that address each risk factor you have.   You can make the changes gradually, one at a time.   But making them is very important.   Other women may wonder:   If I have just one risk factor for heart disease—say, I'm overweight or I have high blood cholesterol—aren't I more or less "safe"?   Absolutely not.    Each risk factor greatly increases a woman's chance of developing heart disease.   But having more than one risk factor is especially serious, because risk factors tend to "gang up" and worsen each other's effects.   So, the message is clear:   Every woman needs to take her heart disease risk seriously—and take action now to reduce that risk.

The first step toward heart health is becoming aware of your own personal risk for heart disease.   Some risks, such as smoking cigarettes, are obvious:   every woman knows whether or not she smokes.   But other risk factors, such as high blood pressure or high blood cholesterol, generally don't have obvious signs or symptoms.   So you'll need to gather some information to create your personal "heart profile."

You and Your Doctor:   A Heart Healthy Partnership

A crucial step in determining your risk is to see your doctor for a thorough checkup.   Your physician can be an important partner in helping you set and reach goals for heart health.   But don't wait for your physician to mention heart disease or its risk factors.   Many doctors don't routinely bring up the subject with women patients.   Here are some tips for establishing good, clear communication between you and your doctor:

Speak up.   Tell your doctor you want to keep your heart healthy and would like help in achieving that goal.   Ask questions about your chances of developing heart disease and how you can lower your risk.   (See "Questions To Ask Your Doctor" on page 15 of The Healthy Heart Handbook for Women.)   Also ask for tests that will determine your personal risk factors.   (See "Check It Out" (PDF, 46K) on page 16 of The Healthy Heart Handbook for Women.)

Keep tabs on treatment.   If you already are being treated for heart disease or heart disease risk factors, ask your doctor to review your treatment plan with you.   Ask:   Is what I'm doing in line with the latest recommendations?   Are my treatments working?   Are my risk factors under control?   If your doctor recommends a medical procedure, ask about its benefits and risks.   Find out if you will need to be hospitalized and for how long, and what to expect during the recovery period.

Be open.   When your doctor asks you questions, answer as honestly and fully as you can.   While certain topics may seem quite personal, discussing them openly can help your doctor find out your chances of developing heart disease.   It can also help your doctor work with you to reduce your risk.   If you already have heart disease, briefly describe each of your symptoms.   Include when each symptom started, how often it happens, and whether it has been getting worse.

Keep it simple.   If you don't understand something your doctor says, ask for an explanation in simple language.   Be especially sure you understand how to take any medication you are given.   If you are worried about understanding what the doctor says, or if you have trouble hearing, bring a friend or relative with you to your appointment.   You may want to ask that person to write down the doctor's instructions for you.

Menopausal Hormone Therapy and Heart Disease

Menopausal hormone therapy once seemed the answer for many of the conditions women face as they age. It was thought that hormone therapy could ward off heart disease, osteoporosis, and cancer, while improving women's quality of life.   But beginning in July 2002, findings emerged from clinical trials that showed this was not so.   In fact, long-term use of hormone therapy poses serious risks and may increase the risk of heart attack and stroke.   The findings come from the Women's Health Initiative (WHI), launched in 1991 to test ways to prevent a number of medical disorders in postmenopausal women.   It consists of a set of clinical studies on hormone therapy, diet modification, and calcium and vitamin D supplements; an observational study; and a community prevention study.

The two hormone therapy clinical studies were both stopped early because of serious risks and the failure to prevent heart disease.   Briefly, the estrogen-plus-progestin therapy increased women's risk for heart attacks, stroke, blood clots, and breast cancer.   It also doubled the risk of dementia and did not protect women against memory loss.   However, the therapy had some benefits:   It reduced the risk for colorectal cancer and bone fractures.   Estrogen-alone therapy increased the risk for stroke and venous thrombosis (blood clot, usually in one of the deep veins of the legs).   It had no effect on heart disease and colorectal cancer, and an uncertain effect on breast cancer.   Estrogen alone gave no protection against memory loss, and there were more cases of dementia in those who took the therapy than those on the placebo, although the increase was not statistically significant.   Estrogen alone reduced the risk for bone fractures.

While questions remain, the findings make possible some advice about using hormone therapy:    Estrogen alone or with progestin should not be used to prevent heart disease.   Talk with your doctor about other ways of preventing heart attack and stroke, including lifestyle changes and medicines such as cholesterol-lowering statins and blood pressure drugs.

    * If you are considering using menopausal hormone therapy to prevent osteoporosis, talk with your doctor about the possible benefits weighed against your personal risks for heart attack, stroke, blood clots, and breast cancer.   Ask your doctor about alternative treatments that are safe and effective in preventing osteoporosis and bone fractures.

    * Do not take menopausal hormone therapy to prevent dementia or memory loss.

    * If you are considering menopausal hormone therapy to provide relief from menopausal symptoms such as hot flashes, talk with your doctor about whether this treatment is right for you.   The WHI did not test the short-term risks and benefits of using hormone therapy for menopausal symptoms.   The current U.S. Food and Drug Administration recommendation for menopausal hormone therapy is that it should be used at the lowest dose for the shortest period of time to reach treatment goals.

    * And remember:   Your risk for heart disease, stroke, osteoporosis, and other conditions may change as you age.   So review your health regularly with your doctor.   New treatments that are safe and effective may become available.   Stay informed.

If You Have Heart Disease:   Menopausal hormone therapy was once thought to lower the risk of heart attack and stroke for women with heart disease.   But research now shows that women with heart disease should not take it.   Menopausal hormone therapy can involve the use of estrogen alone or estrogen plus progestin. For women with heart disease, estrogen alone will not prevent heart attacks, and estrogen plus progestin increases the risk for heart attack during the first few years of use.   Estrogen plus progestin also increases the risk for blood clots, stroke, and breast cancer.
 

Tips for Heart Health

    * Don't smoke, and if you do, quit.   Women who smoke are two to six times more likely to suffer a heart attack than non-smoking women.   Smoking also boosts the risk of stroke and cancer.

    * Aim for a healthy weight.   It's important for a long, vigorous life.   Overweight and obesity cause many preventable deaths.

    * Get moving.   Make a commitment to be more physically active.   Aim for 30 minutes of moderate-intensity activity on most, preferably all, days of the week.

    * Eat for heart health.   Choose a diet low in saturated fat, trans fat, and cholesterol, and moderate in total fat.

    * Know your numbers.  Ask your doctor to check your blood pressure, cholesterol (total, HDL, LDL, triglycerides), and blood glucose.  Work with your doctor to improve any numbers that are not normal.
 

What Are the Warning Signs of a Heart Attack?

 For many people, the first symptom of heart disease is a heart attack.   Therefore, every woman should know how to identify the symptoms of a heart attack and how to get immediate medical help.   Ideally, treatment should start within one hour of the first symptoms.   Recognizing the warning signs, and getting help quickly, can save your life.

Know the Warning Signs

Not all heart attacks begin with sudden, crushing pain, as is often shown on TV or in the movies.   Many heart attacks start slowly as mild pain or discomfort.   The most common warning signs for men and women are:

    * Chest discomfort.   Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes.   It may feel like uncomfortable pressure, squeezing, fullness, or pain.   The discomfort can be mild or severe, and it may come and go.

    * Discomfort in other areas of the upper body including one or both arms, the back, neck, jaw, or stomach.

    * Shortness of breath.   May occur along with or without chest discomfort.

    * Other signs include nausea, light-headedness, or breaking out in a cold sweat.

As with men, women's most common heart attack symptom is chest pain or discomfort.   But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Get Help Quickly

If you think you, or someone else, may be having a heart attack, you must act quickly to prevent disability or death.   Wait no more than a few minutes—five at most—before calling 9-1-1.   It is important to call 9-1-1 because emergency medical personnel can begin treatment even before you get to the hospital.   They also have the equipment and training to start your heart beating again if it stops.   Calling 9-1-1 quickly can save your life.   Even if you're not sure you're having a heart attack, call 9-1-1 if your symptoms last up to five minutes.   If your symptoms stop completely in less than five minutes, you should still call your doctor.

You also must act at once because hospitals have clot-busting medicines and other artery-opening treatments and procedures that can stop a heart attack, if given quickly.   These treatments work best when given within the first hour after a heart attack starts.   Women tend to delay longer than men in getting help for a possible heart attack.   Many women delay because they don't want to bother or worry others, especially if their symptoms turn out to be a "false alarm."   But when you're facing something as serious as a possible heart attack, it is much better to be safe than sorry.   If you have any symptoms of a possible heart attack that last up to five minutes, call 9-1-1 right away.   When you get to the hospital, don't be afraid to speak up for what you need—or bring someone who can speak up for you.   Ask for tests that can determine if you are having a heart attack.   Commonly given tests include an electrocardiogram (EKG or ECG), a cardiac enzyme blood test, a nuclear scan, and a coronary angiogram (or arteriogram).   At the hospital, don't let anyone tell you that your symptoms are "just indigestion" or that you're overreacting.   You have the right to be thoroughly examined for a possible heart attack.   If you are having a heart attack, you have the right to immediate treatment to help stop the attack.

Plan Ahead

Nobody plans on having a heart attack.   But just as many people have a plan in case of fire, it is important to develop a plan to deal with a possible heart attack.   Taking the following steps can preserve your health—and your life:

    * Learn the heart attack warning signs "by heart."

    * Talk with family and friends about the warning signs and the need to call 9-1-1 quickly.

    * Talk with your health care provider about your risk factors for heart attack and how to

      reduce them.

    * Write out a "heart attack survival plan" that has vital medical information and keep it handy.

    * Arrange in advance to have someone care for your children or other dependents in an

      emergency.

http://www.nhlbi.nih.gov/health/hearttruth/lower/index.htm