Washington, D.C., May 8, 2013 - Promising new research published online in the Journal of the American College of Cardiology reveals a simple blood test capable of predicting a heart patient’s near-term risk of suffering a heart attack or even death. The study identifies three cardiac biomarkers that when combined in an “aggregate score” serve as a strong predictor for identifying those at risk.
“These results have significant implications for the care of patients with heart disease,” said Stephen E. Epstein, MD, director, Translational and Vascular Biology Research at MedStar Heart Institute, headquartered at MedStar Washington Hospital Center. He and Arshed Quyyumi, MD, professor of medicine at Emory University School of Medicine, are the research study’s senior authors. “The information supplied by this biomarker test gives physicians more clarity in deciding which patients with a history of heart disease need extensive diagnostic testing and more aggressive treatment. It will also help identify low-risk patients who can now avoid unnecessary tests and treatments.”
The biomarkers identified are high sensitivity C-reactive protein (CRP), fibrin degradation products (FDP) and heat shock protein 70 (HSP70). In the study, a patient who tests positive for all three biomarkers has a 16.3% risk of experiencing a heart attack or dying within one year, compared to only 2.4% rate with no positive biomarkers. The individual, once identified as very high risk, may undergo additional testing including cardiac catheterization. The results of the additional tests, combined with the biomarker results, might lead to more aggressive therapy, including more intense medical treatment, angioplasty, or bypass surgery.
The research* examined blood samples of 3,415 patients from Emory’s Cardiology Biobank. Each patient had suspected or confirmed coronary heart disease and had been admitted for cardiac catheterization. Each had also been followed for cardiac events over an average length of 2.3 years.
“As a practicing cardiologist, this evidence is very exciting,” said Susan Bennett, MD, a cardiologist at MedStar Heart Institute. “The ability to use a simple blood test to determine whether a patient with heart disease is at high or low risk for future heart attacks or death has the potential to have a significant impact on treatment and surveillance options with that patient moving forward. Also, the ability to target treatments enhances our ability to provide better health, better care at a potentially lower cost.”
Each year, about 1.2 million Americans suffer a heart attack. It is the leading killer of both men and women. A heart attack occurs when one or more of the coronary arteries that supply blood to the heart are completely blocked and blood to the heart muscle is cut off. The blockage usually is caused by the build-up of plaque in the artery walls which, in certain individuals, has a predisposition to rupture. The rupture leads to the formation of a blood clot in the coronary artery, restricting blood flow to the heart muscle.
“Up until now, it was impossible to differentiate between the person with heart disease who has stable plaque, and not at high risk of a heart attack, versus the patient with unstable plaque, which is vulnerable to rupture and at very high risk for a heart attack,” added Dr. Quyyumi of Emory University School of Medicine. “This test will help us better manage our heart patients by telling us which most urgently need aggressive diagnostic evaluation and treatment.”
The study was based on prior long-term research that revealed there are multiple molecular pathways contributing to the development of vulnerable plaques and subsequent heart attacks. They include inflammation, cellular stress, and pathways predisposing to blood clots. The research examined these contributors both separately and combined until the biomarkers were narrowed down to just three: CRP, FDP and HSP70. Together, they better predict future risk of heart attacks and death and will ultimately change the way physicians are able to prioritize and treat patients with heart disease.
*Research title: *Aggregate Risk Score Based on Markers of Inflammation, Cell Stress, and Coagulation is an Independent Predictor of Adverse Cardiovascular Outcomes appeared online May 7 and will be published in the July 23 issue of the Journal of the American College of Cardiology