Heart Risks: The Great Equalizers

Long-term study says most people have same risks for heart disease

TUESDAY, July 10, 2001 (HealthDayNews) -- When it comes to the risk of heart disease, most people are created pretty much equal no matter what their ethnic backgrounds are, a new report says.

Just a few risk factors -- age, sex, blood pressure, total blood cholesterol, levels of HDL cholesterol (the good, protective type), diabetes and smoking -- can tell almost anyone the broad likelihood of developing heart disease, the report says.

Those risk factors, developed by the Framingham Heart Study, with a few changes here and there, can be applied to a wide variety of ethnic groups, says the report by the Coronary Heart Disease Risk Prediction Group in the latest Journal of the American Medical Association.

That point is important because "not everybody is like a Framingham participant," says Dr. Peter Wilson, professor of medicine at Boston University, a member of the risk prediction group and laboratory director of the Framingham study. "It was largely a white, middle-class population, so we asked: How can you generalize from it? In what ways are people similar for prediction of heart disease, and in what ways are they different?"

After a 1999 workshop sponsored by the National Heart, Lung and Blood Institute, researchers applied the Framingham risk factors to six other studies of other ethnic groups, including blacks, Hispanic men, Native Americans and Hawaiians.

"The Framingham risk factors work pretty well across the study population groups. The relative risk for each factor is often about the same," says Wilson.

But relative risk is not necessarily the same as absolute risk, Wilson says. For instance, he says a Japanese-American man in Hawaii has a lower overall risk than his white counterpart in Massachusetts. "Relative risk transfers well, but when you talk about absolute risks, you need to be careful," he says.

Nevertheless, the factors listed by the prediction group allow a quick and relatively inexpensive way to determine the risk for most Americans, Wilson says. In fact, he says those factors were chosen with an eye on practicality and cost.

"You need a doctor's visit and a blood test," he says. "Everything else is inexpensive. For screening, you can do it for $25 or $50 for an adult."

He says some adaptations must be made. For most groups, screening would not include an electrocardiogram because "it does not provide much," Wilson says. But an ECG is a valuable screening tool for African-Americans because left ventricular hypertrophy, abnormal thickening of the heart muscle, is more common in middle-aged blacks than whites, he says.

Similar fine-tuning may be necessary for other ethnic groups, Wilson says. "We are now trying to focus on what we think is a low-cost payoff in every group, looking at factors such as inflammation and calcium in the arteries," he says.

Dr. Sidney Smith, chief science officer of the American Heart Association, reacts with a sigh of relief.

"Much of our preventive strategies have been dependent on the Framingham database," says Smith, professor of medicine at the University of North Carolina. "That database is largely a Western European population. As we enter the 21st century, the United States is becoming very ethnically diverse. Had this study not come out the way it did, it would seriously limit our efforts to extend our predictive ability."

Like Wilson, Smith says more work is needed to fine-tune the risk scale. "This study does show the feasibility of recalibrating scores. It also underlines the need for research for a greater understanding of cardiovascular risk in people of varying ethnic backgrounds."

The Framingham Heart Study, started in 1948, recruited more than 5,000 men and women in that area of Massachusetts to study causes of heart disease. The study was expanded to the second generation of original participants and has become one of the most respected of long-term studies.

What To Do: For more information on coronary risk factors, how to check them and what to do about them, go to the American Heart Association. The National Heart, Lung and Blood Institute has information about controlling high blood pressure.

SOURCES: Interviews with Peter Wilson, M.D., professor of Medicine, Boston University School of Medicine, Boston, and Sidney Smith, M.D., professor of medicine, University of North Carolina, Chapel Hill; July 11, 2001 Journal of the American Medical Association
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