Searching For Better Tests To Spot Heart Disease

For far too many people, the first sign of heart disease is frightening chest pain, a rip-roaring heart attack, or a
stroke. Why don't doctors have the equivalent of that old trick seen in countless Westerns - putting an ear to the train
tracks to listen for the approach of the distant train? That question was raised recently when a prominent American not
previously diagnosed with heart disease -President Clinton-had bypass surgery. The December issue of the Harvard Heart Letter
looks at the trusted standby of heart disease risk assessment- the Framingham score - and newer tests that may (or may not)
improve or supplant it.


The Framingham risk score comes from the legendary, long-running Framingham Heart Study. It uses information such as
cholesterol levels, blood pressure, smoking, age, and diabetes to gauge an individual's chance of having a heart attack in
the next 10 years. (For an online Framingham risk calculator, go to hin.nhlbi.nih/atpiii/calculator.asp.)


Researchers around the country and around the world are working to refine or replace the Framingham risk score. The December
Harvard Heart Letter explores some of these possibilities, including"


-- C-reactive protein (CRP). This marker of inflammation - the same process that triggers a fever or causes swelling - could
be involved in the artery-clogging process of atherosclerosis. A simple blood test for CRP may help spot people at high risk
for a heart attack or stroke.


-- Cholesterol "fingerprint". Once there was just total cholesterol to worry about. Then we learned about bad cholesterol
(LDL) and good cholesterol (HDL). Now it turns out that there are other types, and measuring them might offer more accurate
predictions about heart disease risk.


-- Blood sugar. The average amount of sugar in the bloodstream, measured by a simple blood test for sugar-coated hemoglobin
could help identify people at high or low risk for heart disease.


-- Heart scans, stretchy arteries, and beyond. A host of other tests that look directly at the heart and arteries could
someday offer an even clearer window into heart health.


The Harvard Heart Letter is available from Harvard Health Publications, the publishing division of Harvard Medical School.
You can subscribe for $28 per year at health.harvard.edu/heart or by calling 1-877-649-9457.


Harvard Health Publications

Cambridge, MA 02138

United States

Phone 617-432-4717

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