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Scientists Tout New Cholesterol Test
Scientists Tout New Cholesterol Test -- Posted by Gumbo on 11-02-04 18:34
Scientists Tout New Cholesterol Test
MUNICH, Germany (AP) - A simple test that scrutinizes bad cholesterol more
closely may more reliably predict who is going to have a heart attack, new
research indicates.
The current test measures total cholesterol and the breakdown of good HDL
and bad LDL cholesterol. The new test, discussed Tuesday at the annual
meeting of the European Society of Cardiology, instead measures the ratio of
bad LDL cholesterol particles to good HDL cholesterol particles.
The smaller bad particles are called apolipoprotein B molecules and the good
ones are called apolipoprotein A1 molecules. A ratio of 1 to 2 is considered
low risk, while a ratio approaching 1 to 1 would be considered high risk,
and anything over that - where the small LDL particles would dominate -
would be very high risk.
If the LDL is mostly made up of small particles, that's bad because they are
dense and are the building blocks of plaque. The big ones are more easily
carried away by the blood flow.
The test was used in a major study investigating what causes heart attacks
because researchers suspected it might be a better predictor of heart
trouble than standard cholesterol tests.
The study followed 29,000 people in 52 countries. It compared 15,000 who had
suffered a first heart attack with someone of the same age, sex and location
who had not had a heart attack.
It found the standard cholesterol test did not correlate well with heart
attacks, but that the new method was a better indicator. A high ratio of
small LDL molecules to good cholesterol turned out to be the most important
factor linked to heart attack risk, before even smoking.
Patients with the worst test results were about four times more likely than
those with the best score to have a heart attack.
``Globally, 50 percent of the risk of a heart attack is predicted by the apo
B/apo A1 ratio,'' said the study's leader, Dr. Salim Yusef, a professor of
medicine at McMaster University in Canada.
``I was impressed,'' said Dr. David Wood, a cardiologist at Charring Cross
Hospital in London who was not connected with the research. ``It made a
significant independent contribution to risk prediction which was better
than the other risk markers.''
However, Wood said it is too early to tell whether the new test will
supplant the standard cholesterol test in the near future because it has
been a struggle to get doctors to routinely test for cholesterol, even with
the method that has been around for at least a decade.
``At the moment, the real challenge is to get doctors to measure lipids at
all, in order to assess risk, and to manage patients to the goals of both
total and LDL cholesterol,'' he said. ``If we can improve risk prediction by
the ratio of apo-B to apo-A1, that is going to help in targeting treatment
to the right patients, and that would be an improvement on what we're doing
now.''
Scientists believe genes determine an individual's ratio of small to large
LDL molecules and that only those with lots of small molecules would need to
be put on cholesterol-lowering medication. Doctors are constantly searching
for ways to better separate patients who would respond well to medication
from those who either wouldn't or don't need it.
One of the main practical advantages of the new test is that blood can be
drawn at any time. The current cholesterol test can only be done after the
patient fasts for 12 hours. A machine then reads the cholesterol molecules
and gives a ratio count.
Although the new test looks promising, said cardiologist Dr. Udo Sechtem, a
professor at the University of Tuebinden in Stuttgart, Germany, it will take
a mental adjustment, similar to getting people to convert to the metric
system.
``It will take a lot of data and a lot of experience,'' said Sechtem, who
was not connected with the study.
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