A BETTER HEART SCREENING?

Byline: Denise Mann Medical Tribune News Service

Looking at a person's overall risk profile may be better than only screening for high blood pressure to determine who will go on to develop heart disease, researchers said.

The time has come to incorporate known risk factors such as smoking, obesity, existing heart problems and diabetes into heart-disease assessment strategies, researchers announced at a meeting sponsored by the American Society of Hypertension.

``Candidates for heart disease are best discerned from their cardiovascular risk profile rather than relying solely on their blood pressure elevation,'' said Dr. William B. Kannel of the Boston University of School of Medicine. ``In this way, people with mild high blood pressure can be more effectively targeted for treatment without needlessly alarming or falsely reassuring them.''

While it is true that hypertension is a major risk factor for strokes and heart attacks, ``if all else is favorable, then these people will be needlessly alarmed,'' Kannel said.

The opposite is also true, he noted, because if the patient is also obese, has high cholesterol and smokes, he may be falsely reassured that blood-pressure-lowering drugs will reduce his risk for heart disease.

But getting patients to lose weight, cut down on cholesterol and stop smoking is not always easy, Kannel said.

Doctors need to be much more persistent in encouraging overweight patients to lose weight and keep it off, he added.

When it comes to cutting back on cholesterol, most people think - mistakenly - that consuming less cholesterol means having to eat bland food, Kannel said.

``But it can be done without sacrifice,'' he added. The traditional Mediterranean diet, for example, which relies on olive oil, moderate amounts of wine, whole-grain breads and fish, has been shown to protect the heart.

``We need to use what we know more effectively,'' Kannel said. Unfortunately ``this multiple-risk assessment concept hasn't made great impact,'' but it is useful in helping doctors ``zero in on people who really are at risk.''

Heart disease has many causes, and ``to look at just one risk factor is to miss the big picture,'' said Dr. Steven A. Grover of the Montreal General Hospital in Canada at the same meeting.

In particular, Grover found that comparing total blood cholesterol levels, which include HDL and LDL cholesterol, to ``good'' cholesterol levels, was ``even more accurate than current screening methods,'' which rely on total cholesterol alone.

Combining this ratio along with age, sex, blood pressure, smoking and diabetes is the most effective risk-assessment tool that doctors have, he said.

HDL, or high-density lipoprotein, is considered ``good'' cholesterol because it helps the body get rid of cholesterol.

LDL, or low-density lipoprotein, is considered ``bad'' cholesterol because it is associated with clogged arteries and resulting heart disease.

Another expert at the meeting praised this multirisk approach.

Most current treatment strategies have only been based on a person's raised blood pressure or cholesterol levels, said Dr. Michael Alderman, chairman of the unified department of epidemiology and social medicine at Albert Einstein College of Medicine and Montefiore Medical Center in the Bronx, N.Y.

But all patients are different, and so cholesterol and blood pressure levels don't tell doctors everything they need to know, he added.