When former President Bill Clinton was diagnosed with heart disease and underwent a quadruple bypass operation to clear his blocked heartarteries in 2004, some Americans panicked and opted to undergo all sorts of tests to find out if they, too, had heart disease.
This hysteria -- and call to arms -- has been dubbed the "Bill Clinton Effect." More than two years after he underwent surgery, cardiologists now have even better high-tech tests enabling them to diagnose heart disease earlier -- with pinpoint precision. And more tests are being investigated.
Atherosclerosis takes place over a lifetime. Complications from atherosclerosis tend to happen later in life. But the process of narrowing and hardening of the arteries starts early, progressing over decades.
Developing some atherosclerosis is often unavoidable. It's the result of aging and our own genetic tendencies. A much larger part, though, is determined by our behavior and lifestyle choices as we move through life.
How old are your arteries? Are they the ones you had in college? Or are...
"Ten to 15 years ago, industry and academia alike identified cardiovascular disease [CVD] as a disease to be tackled," says Stanley l. Hazen, MD, PhD. Hazen is section head of preventive cardiology and cardiac rehabilitation at The Cleveland Clinic in Ohio. "The boon of this research has yet to be materialized, but there are an extensive number of compounds and screening methods in the pike that look promising and attractive."
From blood tests to advances in imaging, here are a few highlights in heart disease detection.
When you ask your doctor if you have heart disease, he assesses the likelihood based on risk factors. Some key risk factors are age, smoking, diabetes, being male, high blood pressure, and cholesterol. But studies have shown that almost half of the people who suffer coronary events have only two risk factors: being male and over 65. So it is very exciting when new tests come along that can help identify people before they have an event such as a heart attack.
In terms of blood markers, Hazen says that "the mainstay for assessing heart disease risk is low density lipoprotein ['bad'] cholesterol testing". But while we know that LDL plays a major role in determining heart disease, the relationship between severity and the timing of the disease is "incredibly poor. There is much room for improvement," says Hazen.
Checking for C-Reactive Protein
In terms of blood-based screening tests, doctors are increasingly looking at levels of C-reactive protein (CRP), which is an inflammatory marker found in the blood. Several studies have shown that increased concentrations of CRP appear to be associated with increased risk for coronary heart disease, sudden death, and peripheral arterial disease. Inflammation is increasingly being viewed as a major risk factor for heart disease.
"This test is recommended by the American Heart Association and the federal Centers for Disease Control and Prevention," Hazen says. "If it's used as a routine screen in intermediate-risk subjects, it's an even stronger predictor of cardiovascular disease risk than LDL," he tells WebMD. While CRP levels are not specific to the heart, "in terms of risk prediction, it's equal to or better than cholesterol," he says. "More and more we will be seeing an increase in the use of CRP as an adjunct to risk stratification."