Biomarkers and Risk of Heart Attacks

Wang and others published on a subject dear to my heart. Pardon the pun. This team evaluated ten biomarkers in 3,209 Framingham subjects over a follow-up period of 7.4 years to determine reliability.

Included in this list of 10 biomarkers were our old friends, C-Reactive Protein (a marker of inflammation) and Homocysteine (a marker of endothelial function and oxidative stress) but the remaining biomarkers are unfamiliar to most in health care delivery and are completely obscure to the general public. I cite them here only to make my point.

Not many old friends here but this tells us where we are today in terms of trying to predict who is going to have a heart attack and when. Although the B-type naturetic peptide and urinary albumin to creatinine ratio tests were marginally better than the rest, none stood significantly above, suggesting that their more common use in the near future is unlikely.

The most important thing to come out of this report is that none of these tests, even CRP and Homocysteine, the two most commonly used now, tells us much more than the same old CV risk factors the Framingham study gave us over 20 years ago: high blood pressure, obesity, diabetes, sedentary life style and smoking. There is one change however - no one is touting the merits of cholesterol levels as a significant risk factor. That, at least, is a major change that cardiovascular research scientists now seem to agree upon.

The old Bug-a-Boo from the fifties is now known for what it was - a failed national program based on inaccurate data and, in a manner of speaking, forced down our throats. The result of our low cholesterol/low fat diet of the past four decades has been today's epidemic of gross obesity and type two- diabetes with the incidence of cardiovascular disease unchanged (if not greater). I am not proud to have served under these conditions, so brainwashed I practically leaped aboard the anti-cholesterol bandwagon when it rolled around my office.

But we do need better biomedical risk markers. The longitudinal studies of the past decade have taught us that statins work not by cholesterol manipulation but by the inhibition of nuclear factor -kappa B, an amazingly ubiquitous transcription factor (NF-KB), the key to our immuno-defense system's function and a main weapon in the ongoing war with diseases of all kinds.

I predict that the biomedical marker of the future will be based on NF-KB in some way. This will tell us not only who needs statins but how much to give. Most importantly, statins then will not be based upon mevalonate pathway interference, which along with "cholesterol the enemy" have been two major blunders of medical science.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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Cholesterol is Not the Culprit
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