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Medical Edge Newspaper Column from Mayo Clinic
FAMILY HISTORY KEY IN ASSESSING EARLY HEART ATTACK RISK
DEAR MAYO CLINIC: I can’t believe it. I just got back from a class
reunion, where I heard about a former high school coach — a tremendous
athlete, teacher and role model — who dropped dead of a heart attack while
jogging. This is a man who performed in triathlons for the past 20 years.
I was shocked to hear that his father and one of his uncles had also died
of heart attacks in their 50s. I’m a coach myself now and could stand
to bone up on the facts behind this. People ask me what happened, and
I have no clue. — Cincinnati
ANSWER: A heart attack is the likely cause of your friend’s death,
given the strong family history of early coronary heart disease. In 2001,
17 percent of heart attacks (and other CHD “events,” such as chest pain
that is new, more frequent or severe) occurred in patients younger than
65. Although we have made major advances in the treatment of CHD, we can’t
always predict a heart attack.
Typically, doctors calculate a person’s risk of CHD based on conventional
risk factors: age, male gender, diabetes, high blood pressure, elevated
cholesterol and smoking. Although most patients who suffer a heart attack
will have one or more of these risk factors, some don’t. In fact, seemingly
healthy, fit people without any risk factors can have a heart attack.
For these individuals, there may be some other indicators. People should
pay special attention to a family history of CHD events before age 55.
There is an adage: “Know your family history; it may save your life.”
Patients with a family history of early-onset CHD need to be targeted
for aggressive preventive strategies, which include medications and lifestyle
changes. Risk profiling should go beyond assessment of the conventional
risk factors to include newer risk factors and imaging of the heart arteries.
A growing number of heart centers are doing just this. The newer risk
factors they now screen for are sometimes called “conditional” risk factors
because they appear to be medically significant only under certain conditions.
Five conditional risk factors are generally measured: homocysteine (homo-SIS-teen),
fibrinogen (fie-BRIN-o-jin), lipoprotein a (LIE-po-pro-teen a), LDL particle
size, and C-reactive protein. Most people who have early heart attacks
have an elevated level of one of these conditional risk factors. A CT
scan of the coronary arteries looking for calcium may also be useful to
detect early atherosclerosis in patients with family history of CHD.
Information derived from the expanded risk profile helps the physician
fine-tune an individual’s treatment. For example, a doctor may begin treatment
with a cholesterol-lowering medication (statin) in patients based on their
family history, the presence of an abnormal heart-calcium scan, and/or
abnormal levels of one or more of the conditional risk factors. The assessment
can also motivate a person to make healthy lifestyle changes, such as
beginning a regular exercise routine.
Iftikhar Kullo, M.D., Cardiovascular Medicine; Mayo Clinic, Rochester,
Minn.
Additional Resources:
Treatment of
Coronary Heart Disease
Appointment
Information
More
Information on Coronary Heart Disease
DEAR MAYO CLINIC: I saw on the news recently about a new treatment
you have for people like me: If I stand up too suddenly from lying down,
I feel dizzy. I sometimes even faint. I’m 35 and female. I have diabetes,
but I am hardly ever really sick. What is this treatment I heard about?
— Montreal
ANSWER: The treatment you describe is still in the investigational
stages in federally funded trials, and the results of the definitive study
have not yet been published. But it is promising, so follow the research
progress with your doctor. Here’s what’s involved:
Mayo Clinic developed and is researching a drug treatment to stop the
dizziness, light-headedness and fainting that patients experience when
they suffer from a common form of impaired nerve transmission known as
“autonomic failure.”
Autonomic failure leads to the sudden drop in blood pressure that causes
dizziness. It is a frequent side effect of diabetes and occurs when a
person suddenly changes body position, from lying down to standing up.
The medical term for this sudden dip in blood pressure is “orthostatic
hypotension.”
Results from a Mayo Clinic study of 15 patients treated with the drug
pyridostigmine (pi-rid-o-STIG-meen) are encouraging because all current
treatments for orthostatic hypotension cause unwanted side effects — including
stress on the heart. Pyridostigmine does not.
Phillip Low, M.D., Neurology; Mayo Clinic, Rochester, Minn.
Additional Resources:
Treatment with
Pyridostigmine
Appointment
Information
Information
on Orthostatic Hypotension
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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