AEHA Urges Caution When Considering Impact of Latest C-Reactive Protein Study; Says Predicting Heart Attacks Requires Comprehensive Approach in Which Markers of Inflammation Are Key Components
The Association for Eradication of Heart Attack today released a statement applauding ongoing efforts to improve the ability to predict heart attacks, but also urging physicians, the research community, and the general public not make hasty conclusions based on any one study.
The statement comes in response to media coverage regarding a study published in the New England Journal of Medicine last week that questions the effectiveness of testing C-reactive protein (CRP) levels to gauge heart attack risk.
"It is important that the medical community continue to further refine its understanding of the predictive nature of CRP testing and it is equally important that we consider the findings of each new study in the context of the growing volume of previous research," said Dr. Morteza Naghavi, the founder and president of AEHA. "The imbalanced conclusion from findings of the Danesh study published in the NEJM and the resulting media coverage wrongly questioned CRP's future as a useful method of identifying people at risk of heart attack. In fact, the study shows that even a moderate increase in a person's levels of CRP raise their heart attack risk by up to 50 percent. It would be very unfortunate if the mischaracterization of this study's findings results in confusion among physicians and their patients."
High levels of CRP are an indication of an activated immune system and inflammation, which has been shown in numerous studies as an important factor in the causal chain of heart attack. The research conducted by Danesh is the 22nd study to show CRP is a strong independent risk marker that indicates increased risk of future heart disease.
Unlike Danesh's report, previous studies used a cut-point of three instead of two (mg/dl) and consistently showed that high CRP levels increased heart attack risk by as much as 200 percent. Measurements of high-sensitivity CRP (hs-CRP) add to the risk levels estimated by current traditional methods. It is also expected that hs-CRP plasma levels to be useful for guiding lipid lowering therapies in individuals with normal cholesterol based on the National Cholesterol Education Program (NCEP) and thought to be at low risk according to traditional risk assessment. Unfortunately the current NCEP guidelines fail to detect more than 50 percent of people who are at risk of a near future heart attack, emphasizing the need for better guidelines to predict heart attacks.
"While we are hopeful that we will someday discover a more powerful and cost-effective risk stratification method for identifying those at risk of heart attack, we are not at that point yet," said Naghavi. "Therefore, it is more critical than ever that the medical community adopt comprehensive risk assessment guidelines that incorporate all of the tools that are available to practicing physicians today."
AEHA recently unveiled the three-step National Screening for Heart Attack Prevention and Education (SHAPE) Program, which would include assessment of traditional risk factors through the Framingham Risk Score and CRP testing for everyone over age 35; non-invasive imaging, such as a CT scan for those ranked as high risk through the Framingham Risk Score and or CRP; and intra-vascular ultrasound imaging for those found to have a high total plaque burden by CT.
A comprehensive approach to screening, such as the National SHAPE Program can be the best method of identifying at-risk, high-risk, and very-high-risk individuals. A person ranked very-high-risk is considered a vulnerable patient -- an example of "walking time-bomb" -- who must undergo aggressive treatment to prevent a near term heart attack and save their life. Sadly, today without SHAPE, every year about one million vulnerable patients in America -- and many more in Europe and the rest of the world -- suddenly experience a heart attack and most of them die within an hour.
In a symposium held by AEHA in conjunction with the annual gathering of the American College of Cardiology in March 2004, faculties of the symposium called on America and Europe to consider screening for the prevention of heart attacks. AEHA is actively pursuing further discussions with the world leaders in cardiology to finalize the SHAPE guideline and make it available to practicing physicians.
Originated from the Texas Medical Center in Houston, the AEHA is a non-profit organization that promotes education and research related to mechanism, prevention, detection and treatment of heart attacks. The organization is committed to raising public awareness about recent revolutionary discoveries that revealed arteriosclerosis (fat build-up in the arteries) as an inflammatory disease and opened exciting new avenues to challenge atherosclerotic cardiovascular diseases. The AEHA's mission is to eradicate heart attacks before the end of the century. Additional information is available on the organization's Web site at www.vp.org.