3 Tests which can Predict Future Heart Attack

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Heart disease remains a leading cause of mortality globally, necessitating effective strategies for risk assessment and prevention. Among the array of diagnostic tools available, three tests stand out for their potential to predict future heart attacks. Each test offers unique insights into cardiovascular health, but their utility, limitations, and cost-effectiveness vary. Understanding the strengths and weaknesses of these tests is crucial for clinicians and patients alike in making informed decisions regarding cardiac risk assessment and management.

Rising Incidence of Heart Attacks in India:

Over the past three years, India has seen a significant surge in heart attack deaths, attributed by experts to the lingering effects of the Covid-19 pandemic. The latest data from the National Crime Records Bureau (NCRB) reveals a grim scenario, with 32,457 individuals succumbing to heart attacks in 2022, marking a substantial increase from the 28,413 deaths reported in the previous year.

Media snippets :

NDTV India : In Six Months, 80% Of Heart Attack Deaths In 11-25 Age Group In Gujarat: Minister

Times of India : Why heart attacks, strokes are striking early in India?

India Today : There is a rapid surge in deaths from heart attacks. Doctors explain why?

Hindustan Times : 2023 was another year for young adults & people in their thirties and forties to be concerned about their heart health as Bollywood diva & former Miss Universe Sushmita Sen dropped the news of getting a heart attack at the age of 47 .

Indian Express : Shreyas Talpade heart attack shows why men under 50 need to go for heart screening.

Economic Times : Did you know that India has witnessed a staggering 12.5% increase in heart attack cases in 2022 alone?

What can be done to prevent these early heart attacks ?

Preventing early heart attacks requires a multifaceted approach focusing on both lifestyle modifications and healthcare interventions. Here are some strategies:

1. Healthy Lifestyle: Encourage individuals to adopt healthy habits such as maintaining a balanced diet, engaging in regular physical activity, avoiding tobacco use, and moderating alcohol consumption.

2. Regular Exercise: Promote regular physical activity, aiming for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity exercise per week.

3. Healthy Diet: Encourage a diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats while limiting intake of saturated and trans fats, cholesterol, sodium, and added sugars.

4. Manage Stress: Implement stress-management techniques such as mindfulness, meditation, yoga, or relaxation exercises to help individuals cope with stress effectively.

5. Monitor Blood Pressure and Cholesterol: Regularly monitor blood pressure and cholesterol levels, and take steps to manage hypertension and hyperlipidemia through lifestyle changes and medications if necessary.

6. Control Diabetes: For individuals with diabetes, ensure proper management of blood sugar levels through medication, diet, exercise, and regular monitoring.

7. Weight Management: Encourage maintaining a healthy weight through a combination of balanced diet and regular exercise to reduce the risk of obesity-related heart issues.

8. Regular Health Check-ups: Advocate for regular health check-ups and screenings for cardiovascular risk factors, including blood pressure, cholesterol, diabetes, and family history of heart disease.

9. Medication Adherence: Ensure adherence to prescribed medications for managing underlying conditions such as hypertension, hyperlipidemia, and diabetes.

10. Public Awareness and Education: Promote public awareness campaigns and educational programs to increase knowledge about heart health, risk factors, warning signs of heart attacks, and the importance of seeking prompt medical attention.

Are there any specific tests to predict future heart attacks ?

Yes, specific tests such as:

1. high-sensitivity C-reactive protein (hsCRP),

2. lipoprotein(a) [LP(a)], and

3. NT-proBNP (N-terminal pro-B-type natriuretic peptide) can help predict future heart attacks by assessing inflammation, genetic risk factors, and heart stress levels, respectively.

Now let us know more about these Tests ;

What is High-sensitivity C-reactive protein (hsCRP)?

High-sensitivity C-reactive protein (hsCRP): This test measures the level of inflammation in your body. Inflammation is linked to the buildup of fatty deposits in arteries (atherosclerosis), which can lead to heart attacks and strokes.

Benefits of hsCRP :

• Early Detection of Inflammation: hsCRP can detect low levels of inflammation in the body, even when symptoms are not present. This allows for early intervention to prevent further cardiovascular damage.

• Correlation with Cardiovascular Risk: Studies have shown that elevated hsCRP levels are associated with an increased risk of heart attacks, strokes, and other cardiovascular events.

Inexpensive and Widely Available: hsCRP testing is relatively inexpensive and can be easily performed in most clinical laboratories.

Limitations: Non-specific marker, limited predictive value for individual patients.

What is Lipoprotein(a) [LP(a) Test?

Lipoprotein(a) [LP(a)]: LP(a) is a type of cholesterol that is genetically determined and can increase the risk of heart disease. High levels of LP(a) are associated with a higher risk of heart attacks and strokes.

Benefits of Lipoprotein(a) [LP(a) :

• Genetic Component: LP(a) levels are largely determined by genetics, meaning that individuals with a family history of high LP(a) levels may benefit from early screening and intervention.

• Independent Risk Factor: LP(a) is considered an independent risk factor for cardiovascular disease, meaning that even in the absence of other risk factors, elevated LP(a) levels can increase the risk of heart attacks and strokes.

• Potential for Targeted Treatment: As our understanding of LP(a) increases, there is potential for targeted treatments to lower LP(a) levels and reduce cardiovascular risk in high-risk individuals.

Limitations: Limited availability of testing, interpretation challenges, no established treatment currently.

What is NT-proBNP (N-terminal pro-B-type natriuretic peptide) Test ?

NT-proBNP (N-terminal pro-B-type natriuretic peptide): This test measures the level of a hormone released by the heart in response to stress or pressure. Elevated levels of NT-proBNP may indicate heart failure or an increased risk of heart attacks.

Benefits of NT-proBNP :

• Sensitive Marker for Heart Stress: NT-proBNP levels rise in response to increased pressure or stress on the heart, making it a sensitive marker for heart failure and other cardiac conditions.

• Prognostic Value: Elevated NT-proBNP levels are associated with an increased risk of adverse cardiovascular events, including heart attacks and death.

• Helps Guide Treatment: NT-proBNP levels can help guide treatment decisions in patients with heart failure, as higher levels are associated with worse outcomes and may indicate the need for more aggressive management.

Limitations: Non-specific marker, variability in interpretation, cost and availability issues in some settings.

However, it's important to note that these tests are just one part of assessing heart attack risk. Other factors such as cholesterol levels, blood pressure, family history, smoking status, and lifestyle choices also play significant roles. It's always best to consult with a healthcare professional for a comprehensive assessment of your heart health.

Which is the best Test among them ?

Determining the "best" test among hsCRP, LP(a), and NT-proBNP depends on various factors, including the specific clinical scenario, patient characteristics, and the purpose of testing. Each test has its strengths and limitations, and the choice often depends on the context in which it is being used.

Here's a brief overview:

1. hsCRP:

• Best for: Assessing inflammation-related cardiovascular risk, particularly in individuals without symptoms. 2. LP(a):

• Best for: Assessing genetic risk factors for cardiovascular disease, particularly in individuals with a family history of high LP(a) levels. 3. NT-proBNP:

• Best for: Assessing heart stress and prognosis in individuals with suspected or diagnosed heart failure.
  

In summary, there isn't a single "best" test among these options. Instead, the choice depends on the specific clinical context and what aspect of cardiovascular risk or disease is being evaluated. For example, hsCRP may be more appropriate for assessing general cardiovascular risk in asymptomatic individuals, while NT-proBNP is better suited for evaluating heart stress and prognosis in patients with suspected or diagnosed heart failure. Consulting with a healthcare professional can help determine the most appropriate test for an individual patient's needs.

Table 1. Comparing the three tests