With media focus on Bill Clinton’s impending bypass surgery, the INTERHEART study that I briefly alluded to recently has received an early-release from the Lancet.
Some observations:
1) Smoking and a poor cholesterol ratio accounts for the majority of risk.
2) Psychosocial factors (“stress”) plays a significant role.
3) The cholesterol ratio they used was the ApoB/ApoA1 ratio. What does this mean? From UptoDate:
Specifically, measurement of plasma apo B and apo A-1 allow an assessment of the total number of atherogenic (LDL, VLDL, and IDL ["bad cholesterol"]) and antiatherogenic particles (HDL ["good cholesterol"]), respectively.
Some studies suggest that the ApoB/ApoA1 ratio has more predictive power than HDL and LDL in predicting heart disease. So what is the current thought about ordering apolipoproteins? Again, UptoDate recommends:
. . . assay methods need to be standardized and threshold and target values for diagnosis must be established before apo A-I and apo B are used routinely in clinical practice.
For now, measuring our standard lipid panel (total cholesterol, triglycerides, LDL and HDL) is good enough.
As a reminder, here are the current USPSTF guidelines for diabetes, smoking, cholesterol, hypertension, and coronary heart disease screening.
