Cardiac Risk: A Patchwork of Problems

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.

RESEARCH HISTORY

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:   
*Abnormal levels of blood lipids (cholesterol and its
various subtypes)     
*Smoking     
*Diabetes   
*High blood pressure     
*Abdominal obesity   
*Lack of regular physical activity   
*Low consumption of fruits and vegetables   
*Moderate alcohol consumption   
*And finally, and not surprisingly, stress (for example,
financial worries, combined with a life event, such as
separation or divorce) often becomes a heart attack risk.

MULTIPLE CAUSES FOR HEART DISEASE

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 --