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Healthy Heart Reports

Testing For Heart Attack Risk

An article in this month's American Heart Journal shows that statins, a class of drugs to lower cholesterol, help prevent heart attacks by two different mechanisms. They lower cholesterol and they prevent blockage of arteries caused by swelling and clotting. Doctors check your likelihood for getting a heart attack by ordering a blood test to check your good and bad cholesterols. Until recently, doctors were confused by the fact that many men who had normal cholesterols suffered heart attacks. On the basis of exciting new research, your doctor now orders another blood test called C-reactive protein that measures how much swelling you have in your arteries.

Many doctors feel that this swelling is caused by infection with a bacteria such as chlamydia. People with normal cholesterols and high levels of C-reactive protein are at high risk for heart attacks. Incidently, high levels of C-reactive protein are also found in people with reactive arthritis and there is accumulating evidence that long-term treatment with antibiotics help to control reactive arthritis, but as of now, there is no good evidence that long-term antibiotics prevent heart attacks in people with high blood levels of C-reactive protein.

A recent study called THE CHOLESTEROL AND RECURRENT EVENTS (CARE) TRIAL, showed that a cholesterol lowering drug called pravastatin prevents heart attacks in men who have high blood levels of C-reactive protein. This month, the Pravastatin Inflammation CRP Evaluation (PRINCE) study confirms these findings showing that nearly 50 percent of heart attacks in North America occur in people with normal cholesterol levels, and high C-reactive protein. A report in the New England Journal of Medicine shows that statin drugs are highly effective in preventing heart attacks in people with high levels of C-reactive protein, that I think will eventually be shown to be a marker of infection. In the future, some heart attacks may be considered an infectious disease.

1) The Pravastatin Inflammation CRP Evaluation (PRINCE): Rationale and design. American Heart Journal, 2001, Vol 141, Iss 6, pp 893-898. MA Albert, J Staggers, P Chew, PM Ridker. Albert MA, Harvard Univ, Brigham & Womens Hosp, Sch Med, Div Cardiol & Prevent Med, Ctr Cardiovasc Dis Prevent, 75 Francis St, Boston,MA 02115 USA.

2) NEJM June 28, 2001.


Copyright 2001
Dr. Mirkin's opinions and the references cited are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.

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