david

NEW YORK Researchers reported Thursday that an inexpensive blood test for a protein linked to artery disease may be better than a cholesterol test for predicting a person's risk of heart attack or stroke.
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The test for the substance, C-reactive protein, may help identify people who have an increased risk even though they do not have high cholesterol. About half of the people with heart disease have normal cholesterol levels, a finding that has led many researchers to suspect that other factors must play a role in cardiovascular disease.
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Recognizing risk can help determine whether patients need to do things like change their diets, lose weight, exercise more or take medication.
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Previous reports have also found the protein test to be a good measure of risk.
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The new report, being published Thursday in The New England Journal of Medicine, is considered the strongest evidence yet because the study was large, with 27,939 women, and tracked their health for eight years. The results are thought to apply equally to men.
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The researchers, led by Dr. Paul Ridker, director of the center for cardiovascular disease prevention at Brigham and Women's Hospital in Boston, concluded that women with high C-reactive protein were twice as likely to have a heart attack or stroke as women with high cholesterol.
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"This is a very powerful and I would even argue overwhelming demonstration of the fact that it's time to move beyond cholesterol if we're trying to prevent this disease," Ridker said.
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Other researchers had varying opinions about the blood test, with some ready to embrace widespread use and others calling for more research. C-reactive protein was part of the battery of tests performed during President George W. Bush's annual physical exam in August. His level was low.
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Dr. Eric Topol, chief of cardiology at the Cleveland Clinic, who was not part of Ridker's study, said: "This is the time to make the call for using this test, not in every patient, but in a large proportion as a routine evaluation."
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At his clinic, Topol said, the test costs only $8 and has been used often for several years. He said he thought it would eventually be included in the blood tests now done routinely during checkups.
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Topol also said that at cardiology conferences, where the test is commonly offered free, he had seen doctors line up to find out their levels.
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The protein is measured in milligrams per liter of blood, and the lower the level, the better, Topol said. A high level is more than 4.0.
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Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital, said the test had predictive value but added, "I don't think we're ready to make the leap to routine screening."
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Mosca, who wrote an editorial accompanying Ridker's article, said it was too soon for routine screening because studies had not been done to determine whether lowering C-reactive protein would lower a person's risk.
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The same measures already used to treat and prevent heart disease - including exercise, weight loss, aspirin, smoking cessation and the statin drugs that are widely used to lower cholesterol - also lower levels of the protein.
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Mosca said she did use the test in some patients, particularly those who had some risk factors but were borderline cases in terms of whether they needed drug treatment.
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Dr. James Cleeman, coordinator of the National Cholesterol Education Program at the National Heart Lung and Blood Institute, expressed views similar to Mosca's and said his group would not recommend routine use of the test now. But that could change, he said.
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Experts from the American Heart Association and the Centers for Disease Control and Prevention expect to issue guidelines soon for using the test, said Dr. Robert Bonow, president of the heart association. He said Ridker's report would influence the guidelines.
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Even researchers who do not think the test is ready for the public said the study was extremely important in helping to explain the development of heart disease.

PW Comm # 10

david

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coleman

by the time most people decide to get a check like this, it's already too late

"I believe in the brotherhood of man, all men, but I don’t believe in brotherhood with anybody who doesn’t want brotherhood with me. I believe in treating people right, but I’m not going to waste my time trying to treat somebody right who doesn’t know how to return the treatment."
Malcom X Speech, Dec. 12 1964, New York City.