February is Heart Month--a time to take stock of the health of your heart.
Cardiovascular disease remains American's No.1 killer, claiming more lives than the rest of major causes of death, according to the American Heart Association.
Cardiovascular diseases include high blood pressure, coronary heart disease (heart attack and angina), congestive heart failure, stroke, and congenital heart defects.
Coronary heart disease alone is the single largest killer of Americans. The disease continues to devastate women as it accounts for one in five women's deaths.
More than 70 million Americans have one or more forms of cardiovascular disease. (2002)
- High blood pressure — 65 million
- Coronary heart disease — 13 million
- Myocardial infarction (acute heart attack) — 7.1 million
- Angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle) — 6.4 million
- Stroke — 5.4 million
There is a new test, cardio c-reactive protein test, or Cardio CRP, that more accurately determines the risk of heart attack, independent of other risk factors you might have, like cholesterol levels.
Neal Weintraub, M.D., is an associate professor and director of UI Heart Care at University of Iowa Hospitals and Clinics.
"The cardio-CRP test is a simple, inexpensive blood test that measures the level of C-reactive protein in the blood," says Weintraub. "The test does not require special preparation, such as fasting, nor does it require technologically advanced equipment or specially trained personnel," he says.
The levels of CRP tend to remain constant in individual patients and principally reflect the body's production of the protein. It possesses many features desirable of a screening test for organic disease.
"C-reactive protein is a protein present in all of our bodies. It is produced in the liver in response to many types of inflammatory states. In this regard, elevated CRP can be a non-specific finding due to indolent infections, arthritis, cancer, or many other conditions.
"However, in healthy patients, elevated CRP indicates an increased risk for cardiovascular disease. Whether the C-reactive protein itself actually contributes to atherosclerosis, or whether elevated levels serve as a marker for other factors that contribute to the disease, remains to be determined," Weintraub says.
This test is different than cholesterol testing because cholesterol testing measures the body's lipid or fat metabolism, which is closely linked to the development of heart disease, while the CRP tests the body's inflammatory state, which is closely linked to the risk of heart disease.
"Interestingly, although both cholesterol and CRP are independent predictors of coronary risk," Weintraub says, "recent studies suggest that the two factors are only weakly correlated with each other. This suggests that measuring CRP can add independent predictive value to measuring cholesterol in terms of defining one's coronary risk and in assessing the response to therapy."
Who should have a cardio-CRP test is still pretty controversial, Weintraub says. Some experts feel that it should be adopted as a general screening tool, much like cholesterol determinations, while others feel that the data are not yet strong enough to warrant such a widespread application of the test.
"My personal view is that the test is best applied to individuals who are at intermediate-high risk for heart disease," he says. "In these patients, the results of the test could have a significant impact on their care in terms of lifestyle changes or other therapies."
The test may prove to be useful in patients with established heart disease. The current goal with these patients is to lower the cholesterol level, but it is also reasonable to set a goal for CRP and to adjust therapy to achieve this goal. While both cholesterol and CRP levels independently predict the risk of heart disease, they are not closely correlated with each other and may not respond in a perfectly parallel fashion to a particular therapy.
Treatment to lower their cardio-CRP level depends on how high the level is, Weintraub says. Patients with levels in the high risk range (>2 mg/l) should probably have the test repeated to verify the result and ensure that the baseline is stable.
"In general, the types of therapies that are effective in lowering cholesterol also tend to lower the CRP level, he adds. "These therapies include diet, exercise, moderate alcohol consumption, and certain cholesterol-lowering medications.
"It is extremely important that the CRP level be interpreted in the context of the other coronary risk factors and potential symptoms that the patient may have. For example, I have seen patients with high CRP levels who have no demonstrable cardiovascular disease. It is also important to point out that patients who have very high levels of CRP (>10mg/l) need to be evaluated for underlying inflammatory or infectious disorders."
Contact UI Heart Care for information about scheduling this test. "It is important that the highly sensitive test be performed, however, since the conventional test does not accurately measure CRP levels at the low end of the range," Weintraub says.
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