|
VAREN BLACK: I'm Varen Black, thank you for joining us and welcome to our webcast.
The task of preventing heart attacks is a lot easier when you know who is most at risk. Today we'll be looking at a new way to predict the risk of heart attack using what are called biochemical markers. Here to explain what they are is Dr. Robert Rosenson, director of the Preventative Cardiology Center at Northwestern University Medical School. Good morning. Thank you for being with us.
We talked about biochemical markers and how they can improve cardiac care. First of all, what are biochemical markers?
ROBERT S. ROSENSON, MD: Biochemical markers are laboratory tests that have shown to be useful to identify who may be at high risk for a recurrent heart attack or initial heart attack.
VAREN BLACK: Give me some examples.
ROBERT S. ROSENSON, MD: One example is C-reactive protein, an inflammatory marker that's been available for many years. But in a more sensitive form, we now realize that this marker can identify people at high risk for death and myocardial infarction when they have acute coronary syndromes. There's also utility for C-reactive protein in identifying people at risk for the first heart attack or the first stroke. So it expands our ability to identify high-risk individuals.
VAREN BLACK: What are the new biochemical markers?
ROBERT S. ROSENSON, MD: In addition to C-reactive protein, we can look at the different sizes of the LDL particles. We now know that a small LDL particle increases the risk of the first heart attack and also increases the risk of narrowing of the arteries in people with known disease, and these small particles are much more susceptible to chemical change that influences their inflammatory potential.
VAREN BLACK: What is the connection between these biochemical markers and heart disease?
ROBERT S. ROSENSON, MD: These vulnerable plaques, these narrowings that tend to rupture are comprised of not only cholesterol, but inflammatory cells, and these inflammatory cells release different proteins into the circulation, so we're now measuring some of these inflammatory proteins, and new biochemical markers will give us a better handle on the different components of the vulnerable plaque or the consequences of inflammation within the vessel wall. Many of these markers have been shown to be useful in prospective studies, population studies where we measure a specific marker and follow people for many years. By evaluating the risks associated with an elevation in an inflammatory protein, we now learn that we can gain important insights into identifying the risk of a particular individual.
VAREN BLACK: How can they be used to help tailor therapy, these biochemical markers?
ROBERT S. ROSENSON, MD: Well, we can measure LDL size and try to lower LDL size because it's a more important predictor than LDL cholesterol. So that's one way that our drug therapies may be tailored or altered to try and reduce risk in a more comprehensive manner. By measuring C-reactive protein, that inflammatory marker, it provides additional information in people with borderline high LDL cholesterol levels. For example, if the LDL cholesterol isn't desirable but it's not high and you fall in the gray zone, these new markers can help sway the physician to start therapy or to be more aggressive with current therapy.
VAREN BLACK: Talk about improving risk stratification. Can you define that?
ROBERT S. ROSENSON, MD: Risk stratification is a way that we try and identify high-risk individuals. For example, in the Air Force Texas study, in individuals with LDL cholesterols of about 130 mg/dl, we had to treat 91 people for five years to prevent one event. If you're a woman, we had to treat 167 women for five years to prevent one event. That means that many people are taking the drugs who are not going to get benefit. So if we can measure a biochemical marker that helps identify a high-risk individual, our therapy becomes more efficient, more cost-effective, more targeted.
VAREN BLACK: What the patients want?
ROBERT S. ROSENSON, MD: Absolutely.
VAREN BLACK: How can patients ensure their doctor is utilizing these biochemical markers to optimize their care?
ROBERT S. ROSENSON, MD: A lot of these new markers are discussed in articles that appear in magazines. Some of the new findings are highlighted in the newspapers. There's different newsletters that one can subscribe to, and I think this is appropriate information to ask their primary care physician, and if the answers are not satisfactory, seek out the care of a preventive cardiologist.
VAREN BLACK: Thank you, Dr. Rosenson. As I said, it's such an important topic, and we're glad that we were able to learn more about identifying who's at risk for a heart attack and the new approaches to preventing one.
ROBERT S. ROSENSON, MD: Thank you.
VAREN BLACK: Thank you for joining us. I'm Varen Black.
|
SUMMARY