Heart and Arterial Screening
Heart attacks and strokes are one of the leading causes of death and disability. Coronary artery disease (CAD) is the leading single cause of death in the developed world. Between 15% and 20% of all hospitalizations are the direct results of CAD. (1)
Current orthodox screening looks at some blood markers, irregular electrical impulses and changes that indicate poor blood flow. Abnormalities appear once disease has set in but are poor at predicting a problem. In more advanced screening, the structure and certain functions of the heart are measured through ultra-sound, a technique known as ECHOcardiography or radiography usually CT scanning
Cholesterol is carried around the body in complexes some of which are ‘sticky’ and others that are not. LDL cholesterol, VLDL and triglycerides are clearly associated with arterial disease and it is becoming apparent that many other factors are relevant including the actual size of the LDL particles. Many people have high cholesterol levels and do not occlude their arteries, whilst others with normal levels will have heart attacks and strokes. Conventional blood tests vary as to how many of these other factors are looked for. Most do not look at insulin and insulin resistance, the body’s inability to control blood sugar levels, and this factor is very important in calculating cardiac risk as high blood sugar damages arterial walls – to which LDL sticks.
Tests such as resting and exercise/stress ECGs are proving to be less than accurate, missing both existing disease and not giving much predictive information. Electrocardiography-based methods are routinely used as the first tools for initial screening and diagnosis. Clinical studies show sensitivities for prediction of CAD ranging in accuracy from 20% to 70% (2,3). An exercise ECG may not show an abnormality until over 70% of an artery is blocked (occluded) and a resting ECG may only show an abnormality in about 1 in a 1000 asymptomatic (people with no symptoms) patients screened.
Conventional blood tests such as those in conventional screening give a predictive value of 56% of coronary arterial disease where as adding in the more advanced blood screening tests raise the likelihood of diagnosing current arterial and heart disease to 86%. In other words conventional testing may miss 3 out of 10 cases of CAD. These might not be missed by undergoing more advanced studies.
Dr Sharma has designed various levels of screening that combine both conventional investigations with additional tests that may enhance the early detection and, more importantly, the prediction of arterial disease leading to heart attacks and strokes.
- Exercise/stress ECG
- Arteriograph - Link to info arguably the most scientifically established pioneering non-invasive test for arterial health and predictor of heart and stroke health risk. Click here for more information.
- The broadest of blood tests including LDL and HDL with particle size, Hypercholesterolemia and high blood fat levels- triglycerides. Insulin resistance and blood glucose,
inflammation marker - hsCRP, and some genetic markers such as Apolipoprotein (A and B), Lipoprotein (A), and LP-PLA 2
- Genomic Risk Profile – a look at the genetic make-up regarding risk of heart artery disease
- Echocardiogram
The most appropriate screens for any person are tailor made. This involves a gatekeeper consultation with Dr Sharma to discuss the options of more advanced tests. This may include some of the tests in the above screens as well as some of the following investigations:
- Cardiogenomics - the study of how different foods may interact with specific genes to increase the risk of common chronic diseases such as type 2 diabetes, obesity, heart disease and stroke.
This test born out of the Human Genome Project gives clues to predict the influence of life-style and diet on an individual's genetic makeup. The test does not predict who will and who wont
have a heart attack or stroke but may provide advise on how to reduce the likelihood
- Doppler ultrasound of carotid arteries or carotid and other major arteries
- CT calcium score (specialized low-dose x-ray of the heart arteries)
- In addition Dr Sharma can refer on to top cardiologists, most sympathetic to an integrated approach, for even more advanced and invasive tests if the individual so requires.
References
- OECD. OECD Health Data 2005: Statistics and Indicators for 30 Countries. Paris: OECD Publishing; 2005.
- Ammar, KA; Kors, JA; Yawn, BP. et al. Defining unrecognized myocardial infarction: a call for standardized electrocardiographic diagnostic criteria. Am Heart J. 2004;148:277284. [PubMed]
- Salerno, SM; Alguire, PC; Waxman, HS. Competency in interpretation of 12-lead electrocardiograms: a summary and appraisal of published evidence. Ann Intern Med. 2003;138:751760. [PubMed]
- http://www.arteriograph.hu/english/index.php
