Detect It Early, Hit It Hard
Some men score very low on traditional measures of risk but still develop heart disease. For them, doctors are looking beyond traditional risk factors. One increasingly used measure is the blood level of C-reactive protein--an indicator of inflammation, which is now believed to be part of the heart-disease process. CRP tests are done regularly at larger heart centers, but they are not routine in most primary-care practices. Men who could benefit most from the test are those about whom their doctor isn't quite certain. They may have only a few risk factors or cholesterol and blood-pressure numbers just on the cusp. They're the ones Mary Frank wants to treat right away. "We used to say, 'That's high normal--see you next year.'" Not anymore.
On the Horizon
Heartwise, the not-too-distant future is likely to see more medications and less surgery.
Good cholesterol, or HDL, can't be raised as readily as bad cholesterol can be lowered. Individuals blessed with naturally low blood levels of a protein called CETP have remarkably high levels of HDL. CETP inhibitors, a new class of drugs, would confer the same benefits to those less genetically fortunate. Current trials are promising, but the drugs probably won't be on the market for several years.
Combo therapy, consisting of two or more heart drugs in one pill, is being tested. Typically one drug is a statin, for LDL-lowering, and others raise HDL or complement the statin in some other way.
Replacing heart valves without surgery is being tried out by interventional cardiologists. Instead of open-heart surgery, a dysfunctional valve is replaced or fixed through small tubes inserted into a blood vessel and pushed into the heart.
Accompli is the first diet drug to inhibit the brain's cannabinoid receptors, the same that are stimulated when smoking marijuana. It could help obese individuals, whose weight increases their heart risk, to drop enough pounds to make a difference. -B.Q
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