Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: TUESDAY, June 13, 1995 TAG: 9506130083
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: The New York Times
DATELINE: LENGTH: Medium
The new method includes a simple measurement of the difference in blood pressure between arms and ankles, and a noninvasive acoustic test that measures narrowing of the carotid arteries that carry blood to the brain.
Many patients with high cholesterol levels do not in fact develop heart disease. Conversely, there are also many patients who develop silent heart disease without having any of the known risk factors such as high cholesterol, smoking and diabetes. The scientists who developed the new test hope it will focus attention on patients in both categories who are most at risk.
``You don't necessarily have to apply aggressive treatment to everyone with bad risk factors,'' said Dr. Lewis Kuller, an epidemiologist at the University of Pittsburgh. Kuller helped develop the new method as part of an ongoing study of the emergence of cardiovascular disease in people 65 and older.
He predicted that the technique would prove most useful for people over 60, especially those with high cholesterol, and for people of any age whose doctors think they may need drugs to help lower blood cholesterol or triglycerides, another fatty component of the blood. He also said the screening technique could be useful for people with moderately elevated systolic blood pressure (measured by the larger of the two blood pressure numbers) and for children and young adults with a strong family history of cardiovascular disease.
Without so much as a needle prick, the method indirectly measures the extent of hidden atherosclerosis, or clogging of the arteries, in people who have no outward symptoms of cardiovascular disease, such as chest pains. In a soon-to-be-published study of 5,200 older adults from four communities across the country, the researchers showed that people with significant clogging of their arteries, as determined by the new method, were two to three times as likely to die within a few years as were those without evidence of hidden, or so-called subclinical, arterial disease.
The risk of developing fatal and nonfatal coronary heart disease within the next three years was doubled for men and 21/2 times greater for women who had evidence of subclinical disease. Consideration of traditional risk factors did little to change these results.
Dr. Michael Criqui, a specialist in preventive cardiology at the University of California at San Diego, described the work as ``an area of major importance.'' He said the tests ``provide a measure of an individual's propensity for developing atherosclerosis, and that outweighs all other risk factors'' in predicting who will suffer a heart attack or stroke.
Criqui added, however: ``In a medical care system with finite resources, before recommending that something be done, we have to know what benefit would be achieved and at what cost. So far, there is limited data to show that intervention in people with subclinical disease is helpful, though logically it should be. Then, if it is beneficial, we have to find out how much it costs and what benefit is achieved for that cost.''
The tests involve no dyes or injections and no pain or risk of injury. They can be performed by trained technicians with instruments that cost a few hundred dollars and a computer to calculate the results. Two of the tests involve the use of high-frequency sound waves to assess potential blockages in the arteries that feed the brain. One of the most revealing tests, which measures the difference in blood pressure in the arms and the legs, could be put into widespread use almost immediately, Kuller said.
by CNB