CARDIOVASCULAR SYSTEM

ATHEROSCLEROSIS

A recent set of guidelines issued by the American College of Physicians is creating a storm amongst the heart disease specialists because it contradicts recommendations from the federal government and the American Heart Association. The advice from the American College of Physicians, which represents over 85,000 specialists in internal medicine, rejects the concept of the universal screening for determination of the levels of serum cholesterol in young adults. The recommendation is that unless other risk factors, such as obesity, high blood pressure or family history of heart disease exist, there is no need to determine the level of serum cholesterol in healthy men under the age of 35. Such determination is not generally required in women who are under the age of 45.

There is no dispute about the necessity to monitor the serum cholesterol levels, and to take the appropriate actions for its reduction in people who are susceptible to heart disease. However, the advice suggests that it is safe to wait until the middle age to tackle the problem since cholesterol-lowering drugs can arrest and reverse the effects of high cholesterol within two to five years. The use of the cholesterol-lowering drugs in young adults is associated with a risk of liver damage and possibly cancer. In addition, such drug use has not been shown to lower the mortality. The proponents of the concept of screening programs argue that “young Americans deserve to know”, and that the advice is “likely to confuse the public and physicians.”. Additionally, if this advice is implemented, the young individuals who are at risk of heat attack will not be diagnosed.

BLOOD PRESSURE

Contrary to the previous small scale studies, a new study on the effect of blood-pressure drugs prescribed to men and women has shown that both sexes equally gain benefit from the treatment. Some of the earlier studies showed that white women did not benefit from the drug treatment, and that some drugs led to an increased overall death rate. In the four year study, 902 middle-aged men and women with mildly elevated blood pressure were placed on either a regimen of diet and exercise, or diet and exercise plus one of the commonly prescribed blood-pressure drugs. Two sets of data emerged from these studies. The improvement was greater for those who took the drugs. In addition, the amount of the drop in the blood pressure was the same in both sexes.

HEART ATTACK

According to Massachusetts researchers, men may experience a menopause-like condition associated with the decline in a sex-hormones called dehydroepiandrosterone (DHEA). As compared with other hormones, the amount of this hormone which is produced by the adrenal glands of both men and women declines more rapidly with age. Therefore it is suggested that such a decline in the steroid hormone level may be associated with an increased risk of heart attack and that aging men may benefit from hormone therapy. However, more evidence is required in support of these preliminary observations.

Healthy practices for the heart

A recent report has shown that despite a massive body of evidence that inexpensive interventions and certain simple changes in living habits can greatly reduce the risk of heart disease, many people, doctors and patients alike, are still not getting the message.

Current treatment for heart attacks costs about $51,000, and heart-bypass surgery for clogged arteries costs approximately $32,000. However, only 30 percent of people who have had a heart attack are counseled in the hospital not to smoke, and only 20 percent of heart-attack patients are on a cholesterol-lowering diet and only 30 percent are on cholosterol-lowering drugs.

The cost of counseling patients to quit smoking is between $1000 to $3000 for every year of life saved, and for those with coronary-heart disease, blood pressure-lowering drugs cost about $10,000. The cost of cholesterol-lowering drugs is only $4,700 for every year of life saved. Equally, cardiac reahbilitation, including exercise programs cost about $8000 for every year of life saved.According to the report, any intervention that costs less than $20,000 for every year of life saved is extremely cost effective. Therefore, it makes sense for both doctors to advise the patients of such healthy practices for the heart