Doctors need to think deeper about preventing heart disease and heart attacks, says a US expert who is visiting Australia.
“We have reached a limit in our ability to reduce heart attacks with the current definitions of the five main risk factors,” says Dr Mark Houston.
Many cases occur in people who don’t smoke and have no other obvious warning signs.
But that’s when doctors use traditional methods of testing blood pressure, blood sugar, cholesterol and body mass.
“A more logical and in-depth understanding is required,” says Dr Houston, a speaker at the BioCeuticals research symposium in Sydney on Friday and author of the book What Your Doctor May Not Tell You About Heart Disease.
“There has been a 50 per cent reduction in heart-related deaths, but we can do better,” he says.
Instead of looking only at body mass index, he wants doctors to focus on waist measurements and fat percentage as well.
“A man is obese or high risk when his waist circumference is 40 inches (101.6 cm) when measured just above the hip.
“For women it is 35 inches (89 cm).”
Many lives could be saved with a more scientific method of testing blood pressure, says Dr Houston, professor of medicine at Vanderbilt University Medical School in Nashville.
Any patient with an elevated blood pressure should be loaned a device to monitor themselves over a 24-hour period, as is becoming common in the UK.
“It’s not enough to measure blood pressure at a single point in time.
“Blood pressure during the night when you are sleeping is the most important driver of cardiovascular risks such as stroke, heart attack and heart failure.”
Doctors might change medications, dose and timing based on the test results.
The basic cholesterol test is also not enough, Dr Houston says.
“Patients should be given advanced lipid tests, which gives them and their doctors a much better understanding of their risk levels.”
Dr Houston also wants a re-think of blood sugar measurements.
“The risk for cardiovascular disease and heart attack starts at a fasting blood sugar of about 80 mg/dL (milligrams per litre of blood), but most labs still use 99 mg/dL as the upper limit. At that stage a patient already has a 19 per cent increased risk for a heart attack.”