Framingham
Risk score:
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
http://hin.nhlbi.nih.gov/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
http://www.health.harvard.edu/heart or by calling
1-877-649-9457.