Predicting coronary artery disease, and treatment response, is a moving target

Coronary heart disease, or coronary artery disease, the build up of atherosclerotic plaque that can cause myocardial infarction and death, remains the target of huge worldwide markets for treatment, yet the disease state represents a moving target for both predicting who will develop the disease, who has "vulnerable plaque", who is likely to suffer events like MI, who is likely to benefit from angioplasty w/ or w/o drug-eluting stents (of which type), who is likely to benefit from coronary artery bypass versus stenting, etc.

Needless to say, given the size of the market for treatments and diagnostics, ensuing of course from the prevalence and incidence of coronary artery disease, a systematic assessment is needed to better elucidate the nature of disease development and treatment for proactive purposes.  Indeed, there is definite incentive for the status quo to remain, since uncertainty in these areas supports market growth among competing technologies, yet patient outcomes and spiraling healthcare costs demand more responsible solutions.  In the least, this represents a significant market opportunity in the diagnostic arena to formulate prognosis, care plans and other measures.

Below is a brief sampling of peer-reviewed and other citations relating to prediction of coronary artery disease.


Traditional Risk Assessment Tools Do Not Accurately Predict Coronary Heart Disease

 http://www.sciencedaily.com/releases/2009/01/090106181731.htm

The study included 1,653 patients who had no history of coronary heart disease; although 738 patients were taking statins (cholesterol lowering drugs like Lipitor) because of increased risk of developing coronary heart disease. All 1,653 patients underwent a coronary CT angiogram and doctors compared their risk of coronary heart disease, determined by the Framingham and NCEP risk assessment tools, to the amount of plaque actually found in their arteries as a result of the scan.

Results showed that 21% of the patients who were thought to need statin drugs before the scan (because of the Framingham and NCEP assessment tools) did not require them; “26% of the patients who were already taking statins (because of the risk factor assessment tools) had no detectable plaque at all,” said Kevin M. Johnson, MD, lead author of the study.

“Risk assessment tools are used by physicians implicitly. Physicians use them as a way to separate and treat patients accordingly. Ultimately, the Framingham influences what every physician does, but I feel it is not good enough to show what is happening with each individual patient,” said Dr. Johnson.

“The average person tends to put a lot of weight on family history, but the association between that and coronary heart disease is only modest,” said Dr. Johnson. “We are living in an era where genetic research is in the headlines, but reality is a lot more complicated than that,” he said.

“There are still 400,000 people a year who die from heart attacks and have no warning signs at all; doctors want to be able to find those people before that happens and I hope this study gets people interested in finding out better predictors for coronary heart disease,” said Dr. Johnson.

This study appears in the January issue of the American Journal of Roentgenology.

Poor Response To Bypass Surgery Predicted By Genetic Variant http://www.medicalnewstoday.com/articles/137103.php

A variant of the gene for the inflammatory modulator interleukin (IL)-18 has been found to be associated with a prolonged ICU stay after cardiopulmonary bypass (CPB) surgery. Research published in BioMed Central’s open access journal Critical Care links the TT genotype of the IL-18 9545 T/G polymorphism with a larger pro-inflammatory response.

New risk assessment tools need to predict Coronary Heart Disease http://medicineworld.org/cancer/lead/1-2009/predict-coronary-heart-disease.html

 

"Risk assessment tools are used by physicians implicitly. Physicians use them as a way to separate and treat patients accordingly. Ultimately, the Framingham influences what every doctor does, but I feel it is not good enough to show what is happening with each individual patient," said Dr. Johnson.

"The average person tends to put a lot of weight on family history, but the association between that and coronary heart disease is only modest," said Dr. Johnson. "We are living in an era where genetic research is in the headlines, but reality is a lot more complicated than that," he said.

"There are still 400,000 people a year who die from heart attacks and have no warning signs at all; doctors want to be able to find those people before that happens and I hope this study gets people interested in finding out better predictors for coronary heart disease," said Dr. Johnson.

This study appears in the recent issue of the American Journal of Roentgenology. For a copy of the full study, please contact Heather Curry via email at hcurry@arrs.org. 

 

Calcium Scans Help Predict Coronary Risk http://www.medicinenet.com/script/main/art.asp?articlekey=88193

Scanning the heart arteries for calcium deposits can help predict future cardiac problems, a new study shows, but experts aren’t sure that adding such scans to routine checkups would be worth the cost.

"It has been shown to be predictive" of potential heart trouble, said Dr. Diane Bild, deputy director of the division of prevention and population sciences at the U.S. National Heart, Lung, and Blood Institute, which funded the study. "Whether it is actually beneficial to the people who are screened has not been shown."

A calcium scan using computed tomography (CT) costs $300 to $600. These scans look for calcification — hardening of the arteries caused by high blood fats and calcium deposits that can eventually cause blood vessel blockage. The scan is a potential competitor for much less expensive tests for coronary risk, such as blood cholesterol and blood pressure readings.

Dyslipidemia and hyperglycemia predict coronary heart disease events in middle-aged patients with NIDDM http://diabetes.diabetesjournals.org/cgi/content/abstract/46/8/1354

S Lehto, T Ronnemaa, SM Haffner, K Pyorala, V Kallio and M Laakso; Department of Medicine, Kuopio University Hospital, Finland.

Patients with NIDDM are at increased risk for coronary heart disease (CHD). However, information on the predictive value of cardiovascular risk factors and the degree of hyperglycemia with respect to the risk for CHD in diabetic patients is still limited. Therefore, we carried out a prospective study on risk factors for CHD, including a large number of NIDDM patients. At baseline, risk factor levels of CHD were determined in 1,059 NIDDM patients (581 men and 478 women), aged from 45 to 64 years. These patients were followed up to 7 years with respect to CHD events. Altogether, 158 NIDDM patients (97 men 1 and 61 women 2) died of CHD and 256 NIDDM patients (156 men 3 and 100 women 4) had a serious CHD event (death from CHD or nonfatal myocardial infarction). A previous history of myocardial infarction, low HDL cholesterol level (<1.0 mmol/l), high non-HDL cholesterol (> or =5.2 mmol/l), high total triglyceride level (>2.3 mmol/l), and high fasting plasma glucose (>13.4 mmol/l) were associated with a twofold increase in the risk of CHD mortality or morbidity, independently of other cardiovascular risk factors. High calculated LDL cholesterol level (> or =4.1 mmol/l) was significantly associated with all CHD events. The simultaneous presence of high fasting glucose (>13.4 mmol/l) with low HDL cholesterol, low HDL-to-total cholesterol ratio, or high total triglycerides further increased the risk for CHD events up to threefold. Our 7-year follow-up study provides evidence that dyslipidemia and poor glycemic control predict CHD mortality and morbidity in patients with NIDDM.

Heart Disease Risk and C-reactive Protein (CRP) http://www.medicinenet.com/script/main/art.asp?articlekey=46339

C-reactive protein (CRP) is elevated in the blood when there is widespread inflammation somewhere in the body. The evidence now available indicates that inflammation and molecules such as C-reactive protein associated with inflammation may be as important as cholesterol in determining the development of atherosclerosis ("hardening of the arteries") and heart disease.

Although C-reactive protein is clearly an important marker of inflammation, it is not at all clear why inflammation should elevate C-reactive protein levels. Some researchers have suggested that a chronic infection with certain bacteria or viruses may raise the C-reactive protein.

 

 

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2 thoughts on “Predicting coronary artery disease, and treatment response, is a moving target”

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