HEART ATTACK

     Cardiologist Robert Superko in Berkeley Heart Lab in Alameda, California, offers blood tests that go beyond the standard cholesterol check levels.   If his patient’s cholesterol levels are LDL Pattern B, (the bad cholesterol) the size of the particles becomes very important.  If they are extra small, they are more likely to produce a heart attack.  He says it may be because the smaller particles slip easily into the walls of the arteries, where they more readily become arterial plaque.  Pattern B patients also tend to have associated problems, including HDL (the good cholesterol) low levels and high triglycerides.  Their HDL may be less efficient at its job of ferrying away bad cholesterol.  What’s more, their blood vessels are prone to spasms, which can rupture plaque and “that can spell trouble,” says Superko.  Some research suggests as many as one in three American men and one in seven American women have genes that predispose them to LDL, Pattern B.  “Luckily, it is relatively easy to treat, requiring a diet low in saturated fat, exercise and regular doses of the B vitamin niacin to increase the size of the LDL particles.  But only take high doses of niacin under a doctor’s supervision because too much can cause serious side effects,” adds Dr. Superko.  “It could clear up in as little as six months but there is a subtle villain, inflammation if the immune system launches a misguided attack within the vessels of the heart.  A smoldering inflammation can lead to the formation of plaque that is prone to rupture that can result in blood clots.  A simple blood test can tell you if you are at risk by measuring levels of a molecule called C-reactive protein.  Eleven studies have now shown that people with high levels of CRP are at higher risk of having a heart attack. 

    One 71 year old patient had slightly high blood pressure and was active and healthy and any doctor might just remind her to exercise and shed a few pounds, but when she saw the doctor the next year, she left with a prescription for a cholesterol lowering drug.  Under new guidelines, her low risk was now borderline and needed medication.  New standards say to triple cholesterol drugs from 13.5 million to 36 million, since many more Americans are having heart disease problems than had been recognized,” says James Cleeman, executive director of the National Cholesterol Education Program panel that developed the guidelines.  “In countries with little heart disease, Cleeman adds, “the average levels are considerably lower in countries that have little heart disease.”  Diet could play an important part.