The State of the Heart

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Statins were much in the news last week. They are so successful in preventing heart attacks that researchers are furiously investigating all the other things these drugs might be doing for the heart besides lowering cholesterol levels. It turns out that the noncholesterol effects of statins, such as controlling clotting and inflammation, may be as important as the cholesterol effects. In a study of patients given atorvastatin (Lipitor) as soon as they arrived at a hospital complaining of chest pain, it was found that those who took the drug for four weeks after their cardiac event were significantly less likely to be rehospitalized or feel increased chest pains than patients who did not take the statin. However, another study that looked at the effect of a different statin taken immediately after a heart attack showed no benefit in giving early treatment. Apparently not all statins are alike, at least in terms of protecting patients in emergency care.

TO BE OR NOT TO BE

Folic acid, already known to prevent certain types of birth defects, is emerging as the leader of the vitamin pack in protecting against heart disease. A member of the B-vitamin family, folic acid lowers levels of homocysteine, an amino acid that has been linked to greater risk of heart disease. While scientists are still trying to explain why--it may have something to do with homocysteine's tendency to promote blood clots and eat away the lining of blood-vessel walls--the newest research suggests that taking more folic acid can lower homocysteine levels and reduce the risk of coronary disease by half.

Meanwhile, an English study reports that it may take about twice the current U.S. Dietary Reference Intake of folic acid--in other words, 0.8 mg a day--to lower homocysteine levels enough to ward off a heart attack.

SEEING IS BELIEVING

Until quite recently, most cardiologists put little value on pictures of the heart. They assumed that it was impossible to get a truly accurate image of an organ in constant motion. But with improvement in the technology for snapping freeze-frames of the beating heart, physicians have started to rely more and more on images of the heart not just for looking at problem areas but also for predicting the likelihood of future heart trouble.

The whizziest new device, an ultrafast form of computer scanning called electron-beam computer tomography (EBCT), picks up the presence of tiny deposits of calcium in the heart. One study based on the scan showed that patients who build up 20% or more calcium each year have an 18-fold greater chance of suffering a heart attack than those with less calcium in their hearts.

Although it is not yet clear whether calcium deposits spotted by EBCT can accurately predict who will go on to have a heart attack, at the very least it's one more test that cardiologists can use to decide how aggressively to treat a patient who is at risk.