Sumeet S. Chugh, MD
Sumeet S. Chugh, MD, associate director of the Cedars-Sinai Heart Institute in Los Angeles, director of the Oregon Sudden Unexpected Death Study.
What’s really at the root of cardiovascular disease? It’s a question many great minds continue to ponder. In spite of tremendous amounts of research, little new information has emerged to clarify why some people are especially vulnerable, while others are inexplicably robust. Cholesterol levels, C-reactive protein and other biomarkers haven’t helped pinpoint the actual cause or even added much to the early detection tool kit. As our national debate rages about health care, it seems evident that the billions being spent on prescription drugs to control these markers aren’t making much of a difference.
Could we spend these research dollars more productively? I asked this question of Sumeet S. Chugh, MD, associate director of the Cedars-Sinai Heart Institute in Los Angeles. Dr. Chugh also is the director of the Oregon Sudden Unexpected Death Study, which researches risk factors, triggers and genetic defects that relate to sudden cardiac arrest.
First, some background. Much of what we know about Americans and heart disease was gleaned from the long-term Framingham Heart Study, which began in 1948. Hundreds of published studies have been based on this research. Though many consider it flawed in that the participant base consisted primarily of Caucasian men and women living in the New England area, in fact its findings were largely echoed by the 2004 release of the huge Canadian Interheart Study, which looked at heart attack risk factors from 52 different countries. Certain key risk factors for heart disease were found to apply to both genders and for all racial/ethnic groups:
Over time, this research has been refined to arrive at our current understanding of cardiovascular disease as a multi-factorial condition. That is to say, multiple factors influence the development of heart disease and they contribute exponentially, not individually. Hence, a person who is overweight, sedentary, eschews fruits and vegetables and ends the day with a few martinis and regular arguments about money with his wife and kids becomes—almost certainly—a “ticking time bomb.” The good news is that the work of Dean Ornish, MD, founder of the Preventive Medicine Research Institute, and others has convincingly demonstrated that comprehensive lifestyle changes really can reduce the risk that heart disease will develop and sometimes can even reverse it. Nonetheless, the ongoing quest for the marker of the cause—and, of course, the highly profitable solution—continues.
Blood cholesterol: The association between blood cholesterol and heart disease has been discussed, debated and fine-tuned for years now. While elevated cholesterol is a marker for heart disease risk, it seems that associated factors causing it to oxidize can trigger the formation of plaque. Cholesterol, therefore, is associated with—but doesn’t necessarily cause—heart disease.
C-reactive protein: The marker that most recently stirred up excitement was C-reactive protein, but Dr. Chugh told me that the more closely researchers examine its validity as an important marker of cardiac risk, the clearer it becomes that it isn’t particularly useful. He said it merely affirms what doctors are able to ascertain from measuring established risk factors. “It doesn’t tell us anything new—it may turn out to be just another test that is adding to health care costs,” he said.
Calcium score: Along the same lines, Dr. Chugh noted CT cardiac scans also may be more widely used than is necessary. “Calcium in plaque increases risk for heart attack,” he says, “but the ratio of cost and benefit for this test may not be optimal.”
Dr. Chugh notes that he does, however, continue to believe there are important markers of cardiovascular risk that research has yet to reveal. “There are markers out there that will come to light. We hope to find them,” he says. He believes the most promising avenue is genome research and says there now are searches underway for both protective and harmful genes.
In the meantime, Dr. Chugh emphasized that research continues to fine-tune advice about how we can lower cardiac risk. For instance…
Taking even one step toward improving your heart health will be of benefit. Dr. Chugh points out that if you correct just one risk factor, such as normalizing your weight or giving up junk food to help with your blood glucose levels, your prognosis will improve. This is because cardiac risk factors aren’t separate and unrelated—they expand exponentially. “It’s not just individual factors but the combination of the risks,” he says. “Go for whatever ones you can and by doing so you will decrease and even reverse overall risk.”