Hidden Heart-Attack Risks (PART 1) ~ Bloggerin Info

These factors can make you more vurnerable, yet won't show up on conventional tests.

DR. MARK GOLD was only seven when his father, age 42, has third heart attack. "The doctor said I should go into the bedroom and talk to my father," he recalls. "It was only later that realized he was telling me, 'Your father is dying. Say goodbye.' The older I get, the more I feel the pain of losing him so early."

Now 52, Gold has a son and daughter of his own. "I don't want to put them in the same position," he says.

Gold's own battle with heart disease began in 1988, when he felt mild chest discomfort while jogging. The-five-foot-seven-inch ophtalmologist weighed under 140 pounds and, other than his family history, had no commonly known risk factors for heart disease. His cholesterol was 203, just above the American Heart Association's "desirable" level of 200.

Yet an angiogram showed a blocked artery, and Gold was put on medication. I was doing everything right," he says. Nonetheless, one day in 1994 when he went out walking, the pain was there again.

This time doctors found two blocked arteries, so Gold had bypass surgery. "I knew I had a progressive disease that runs through my family," he says. "But what runs through it, I wondered."

Gold's question led him to Dr. Daniel Rader, director of the University of Pennsylvania's Preventive Cardiology Program, who gave him a battery of special tests. One blood test revealed a sky-high level of a worisome fat particle called Lp(a) that may raise heart-attack risks even when the usual cholesterol readings are fine. The typical Lp(a) reading in Caucasians and Asians is under 20; Gold was 88. Fortunately Rader was able to lower it by putting Gold on a special niacin regimen.

A growing number of programs similar to the one at the University of Pennsylvania are uncovering hidden heart-attack risks. Surprisingly many individuals can't assume they're safe. In the Framingham Heart Study, an ongoing analysis of some 11,000 residents of Framingham, Massachusetts, 17 percent of people with early heart disease had none of the "big four" controllable risks: high cholesterol, high blood pressure, diabetes or smoking.

Testing for hidden risks is "most important for people with an ominous family history---at least one-third of the population," says Rader.

"That means a heart attack or chest pain in a male relative by age 70, including grandparents, aunts and uncles."

Others who could benefit are those who already have a risk, such as high cholesterol or who have been diagnosed with heart disease, even though they have no known risk factors.

Here are five newly recognized heart-attack risk factors and what we know about them:

1. Lp(a)

Until now, the substance in the blood getting most of the blame for heart attacks has been "bad" LDL cholesterol. But researchers have begun to recognize that one particular member of the LDL family, Lp(a), carries an additional heart risk.

A Survey of women from the Framingham research showed that a very high Lp(a) level (generally 35 to 40) more than doubled the risk of heart attack. In a study of patients with premature coronary-artery disease, done mainly at Tufts University and New England Medical Center Hospital, there was an "excess" of Lp(a) in 19 percent of the group.

to be continued - Hidden Heart Attack Risks (PART 2)