The Latest A number of studies appearing over the last year point to new ways to help maintain heart health -- or affirm familiar ones.
At the top of the list is new clarity about the apparent links between inflammation and atherosclerosis. A study published in December in the New England Journal of Medicine found that blood levels of C-reactive protein (CRP), produced as part of the inflammation process, appear to help identify people at increased risk of heart disease, even if their blood cholesterol levels are normal and other risk factors are absent. Over an eight-year period, the study found that people whose CRP levels were in the top 20 percent had nearly five times the risk of a heart attack or stroke as those whose levels were in the bottom 20 percent. By contrast, those with the highest levels of LDL ("bad") cholesterol face only twice the risk as those with lowest levels. But the CRP test is not yet in clinical use.
For high blood pressure, the year brought news that some of the oldest medications are proving better than the newer drugs. In the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) that began in 1994 and lasted 8 years, researchers concluded that diuretics were superior at controlling blood pressure than the newer and far costlier ACE inhibitors. Diuretics, marketed for over half a century, cost less than a penny per pill.
Elsewhere in heart research, a key study linked obesity and heart failure. This was not a surprise, given the widely known ties between overweight and heart disease, but this study built on other recent research showing that type 2 diabetes, closely linked to obesity, is a powerful risk factor for heart attack. The majority of Americans are now overweight and inactive, placing them at risk for diabetes.
And then there's the relationship between the heart and hormone replacement therapy (HRT), used by millions of post-menopausal women for prevention of heart disease and other reasons. Debate continues over the results of the Women's Health Initiative, a large clinical trial that was stopped early when researchers found an increased risk of breast cancer, heart disease, stroke and pulmonary embolism among those taking HRT. But many experts advised that women who took HRT primarily for its presumed heart benefits should consult their doctors about instead taking aspirin, blood-pressure-lowering medications or cholesterol-reducing drugs. In November, the Women's Angiography Vitamin and Estrogen trial found that estrogen and antioxidant vitamins not only didn't lower heart disease risk, but posed potential harm to the heart.
Recommendations Despite the striking results about C-reactive protein, the major heart organizations say the traditional advice is still the most important: Control high blood pressure with medications if necessary, maintain a healthy body weight, eat a varied diet rich in fruit and vegetables, exercise for half an hour or more daily, don't smoke and get blood cholesterol levels to a healthy level. The latest federal guidelines are available at http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm.
The Next Thing Cell therapy experiments -- which involve extracting muscle cells, growing them in a lab and injecting them into the heart during bypass surgery to help boost recovery -- are underway in the United States and elsewhere. Another new trend employs minimally invasive surgery to do cardiac bypass, mitral valve replacements and other heart surgery. Also look for emerging research into sleep apnea, which appears to greatly increase risk of heart disease and stroke, and for new blood factors similar to C-reactive protein that may help identify seemingly healthy individuals at increased risk of heart disease.
Worry Index Nearly 62 million Americans (including 32 million women) have one or more cardiovascular diseases. Half of all Americans die of heart disease.
High blood pressure afflicts about 50 million people in the United States, according to the American Heart Asssociation. The latest data suggest that up to 90 percent of middle-aged Americans will develop hypertension at some point. About 7.5 million Americans suffer heart attacks and 4.6 million have a stroke each year.
Hype-O-Scope Widely marketed CT scans (also known as full-body or calcium scans), which cost $500 and up, are not yet recognized as heart disease screens by the National Heart, Lung, and Blood Institute or by major nonprofit heart groups. The hype over vitamin E supplements -- or any other antioxidant -- is waning, but be aware that no supplement has been conclusively linked to a reduced risk of heart disease. Also used 800,000 times a year is EDTA chelation for treatment of heart disease. Still unproven and not endorsed by any major heart group, EDTA chelation is now the subject of a five-year federally funded study.
For More Information Assess your cardiac risk at http://hin.nhlbi.nih.gov/atpiii/calculator.asp?usertype=prof, find heart-healthy recipes at www.nhlbi.nih.gov/health/public/heart/other/syah/index.htm, learn how to lower blood pressure at www.nhlbi.nih.gov/hbp/index.html, review the heart-healthy DASH diet at www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm or test your knowledge of blood cholesterol at www.nhlbi.nih.gov/health/public/heart/chol/chol_iq.htm.
Additional information is available from: American College of Cardiology: www.acc.org
American Heart Association: www.americanheart.org.
-- Sally Squires