Friday, January 30, 2009

Traditional Risk Factors Often Miss Heart Disease Warning Signs

/PRNewswire/ -- Traditional risk factors such as age, standard cholesterol levels and blood pressure do a poor job of predicting heart disease risk in younger, healthy adults with a family history of early heart disease. That's according to a recent study published in Clinical Cardiology, which revealed that "emerging risk factors," including detailed cholesterol measurements such as HDL(2) and remnant lipoprotein particles, play a much greater role in determining heart disease risk than previously thought.

The study is titled Prevalence of Emerging Cardiovascular Risk Factors in Younger Individuals with a Family History of Premature Coronary Heart Disease and Low Framingham Risk Score. It is the latest in a series of clinical studies showing that the traditional Framingham risk score doesn't always do a good job of estimating that risk, especially among people in their mid-30s to early 60s.

Measurement of emerging clinical and lipid risk factors in the study was done with the VAP(R) (Vertical Auto Profile) Cholesterol Test from Atherotech, Inc. Physicians are increasingly using such detailed cholesterol testing to more accurately identify their parents' true risk of heart disease, allowing for treatment and lifestyle changes that can decrease the risk of a heart attack or stroke.

Atherotech Chief Medical Officer James Ehrlich, M.D., said the study is consistent with a growing body of research revealing how poorly the office-based exam using Framingham analysis and traditional cholesterol testing performs in identifying true cardiac risk.

"Clearly it is time for physicians to take a much more sophisticated and individualized approach to cardiac risk assessment," said Ehrlich, "which may include imaging tests and more revealing and accurate cholesterol profiling such as the VAP Test." The evidence is growing that younger individuals and most women would have been considered at such low risk by standard tests in the months prior to their heart attacks that they would not have even qualified for preventive therapy, explained Ehrlich.

The VAP Test, which is covered by most insurance providers and Medicare, provides physicians with direct measurement of LDL (bad cholesterol), HDL (good cholesterol) and all relevant cholesterol subclasses. These important but often overlooked subclasses include non-HDL, particle number as determined by accurate apoB, and emerging risk factors such as Lp(a), low-density lipoprotein remnants and small dense LDL.

The VAP Test is also the only commercially available advanced lipid profile that routinely reports all three lipoprotein parameters -- LDL, non-HDL and apoB -- considered necessary by the 2008 expert consensus guidelines issued by the American Diabetes Association and American College of Cardiology.

In the Clinical Cardiology study, researchers evaluated 89 younger men and women (average age of 47) with a family history of premature coronary heart disease (CHD) and who had a low Framingham risk score. The risk factors included in the Framingham calculation are age, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for hypertension and cigarette smoking. Patients with existing CHD or CHD equivalents were excluded.

The most common emerging risk factor for heart disease that was missed using traditional cholesterol testing methods was low HDL(2). The second most overlooked emerging risk factor was high levels of triglyceride rich remnant lipoproteins such as IDL (intermediate density lipoproteins) and very low density lipoproteins (VLDL(3)). Low HDL(2) was present in 72 percent of the study group, and high levels of IDL + VLDL(3) were present in nearly half (49 percent) of patients. In addition, 38 percent of the participants had coronary atherosclerosis as reflected in EBCT derived coronary calcium scores, and 24 percent of the participants had "at-risk" levels of C-reactive protein (above 3 mg/dl).

All patients were screened for emerging clinical and lipid risk factors with the VAP Test. Researchers noted that only 11 percent of the participants would have been prescribed lipid-lowering therapy based on current National Cholesterol Education Program Adult Treatment Panel III guidelines.

The authors concluded that, "The Framingham risk score underestimates cardiovascular risk in individuals with a family history of premature CHD, and screening for emerging cardiovascular risk factors may better assess CV (cardiovascular) risk in these patients."

People with a family history or an existing condition of diabetes, high blood pressure or heart disease -- or who are already taking cholesterol - lowering medication -- are candidates for the comprehensive VAP Test. The VAP Test is available nationwide. For more information call 877.901.8510 or visit www.thevaptest.com.

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