Detect It Early, Hit It Hard
But it's a drug class that doesn't lack for controversy. How often statins should be prescribed, what dosage to start and keep patients on, and whether statins are as safe as their advocates claim are all up for grabs. A recent study has shown that Crestor, a powerful, recently introduced statin, has caused twice the rate of side effects, such as kidney and muscle damage, as other statins. But only days after it was released, authors of another study concluded that statins are not being prescribed enough. If you're on a statin, especially a high dose, you should alert your doctor to muscle soreness or pain and go every six months or so for a check of certain liver enzymes.
Doctors are also working on medications to raise HDL levels, though they are not on the market yet (box). "Many people think that increasing HDL will be to this millennium what statins were to the 1990s," says Steven Nissen, a Cleveland Clinic cardiologist.
Diabetes, which has become an epidemic, is now considered such a risk for heart disease that diabetics are felt to face the same threat as do those with established heart disease. And diabetics, says Raymond Gibbons, a cardiologist at the Mayo Clinic and president-elect of the American Heart Association, do not respond as well to most heart treatments. People who are overweight should try to trim a few pounds. "If we can get them to lose 5 percent of their body weight, that will decrease their risk of diabetes by 50 percent," says Gibbons. For a 200-pound individual, that's just 10 pounds.
What doctors would love to be able to do is to look right into the coronary arteries to see if blockages are building up, but the current technology is expensive, invasive, or both. Many blockages are lined with calcium deposits, so some researchers are promoting calcium ct scans. MRI scans also hold promise. The images from these scans are impressive, and some doctors swear by them. The AHA does not consider them ready for widespread use, however. The ct scans don't always reveal buildup of "soft" plaques, and they carry some risk from the radiation used. MRI scans aren't quite detailed enough. The scans cost hundreds of dollars, and insurance does not usually pay for them. But the biggest question is whether those getting the scans really benefit; most scan patients either have been diagnosed with heart disease or are at high risk and are being treated aggressively anyway. "We need a lot more research before this is ready for prime time," says Nissen.
Tolerating stress. Another screening tool, the tried-and-true exercise stress test, may be ready for an upgrade. Patients walk or jog on a treadmill with increasing intensity while their heart is monitored. The tests have a tendency to identify patients--women in particular--as being at risk when they're not. Yet a just published study shows that measuring the heart's tolerance for exercise in other ways, such as how quickly it recovers its normal beat, could be a more reliable predictor.
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