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November
19,
2010 -- 8:50am EST
The Gene of Damocles -- Assessing Heart Disease
Risk
A study
from the Mayo Clinic presented at this
week's American Heart Association Scientific Sessions in Chicago caught
my eye. Researchers looked at the medical records of 1,262
people who had no history of heart disease. Using the standard Framingham
Risk Score (FRS) which factors in age, sex, cholesterol levels,
blood pressure, diabetes and smoking status, they calculated the ten-year
probability of heart attack.
They then performed genetic tests on these patients' existing blood samples
to find if any of 11 genetic variants were present. Called single-nucleotide
polymorphisms (SNPs) these variants have been found to be potential
risk factors for heart attack.
As a result, about one-third of the
patients wound up being reclassified to a higher or lower risk
category. Genetic information was used to alter the standard FRS.
There's been much ado about adding new types of risk
factor information to the Framingham formula: the SHAPE guidelines,
for one, claim that
a Calcium score,
derived from a non-contrast CT scan, should be incorporated.
Of course, the
point of determining patients' risk factors for heart disease
is to help them modify the risk factors that are under
their control -- like stopping smoking, exercising more, etc. and
also possibly starting certain courses of medication, such as statins.
But the Mayo study reminded me of the "Sword of
Damocles" -- a story related by the ancient Roman Cicero about
a courtier Damocles who was given great fortune
by being allowed to trade places with his king, except that a sword
was positioned over
the throne he sat on, suspended by a single strand of hair.
Damocles soon gave up his new-found fortune, one moral of the story
being: "There can be nothing happy for the person over whom some
fear always looms".
Studies have shown that stress is certainly a factor
in heart disease. So, if one discovers that
his or her genes are putting
them at higher risk for a heart attack, a situation that really can't
be altered, won't the negative stress from that knowledge be a Damocles'
Sword and multiply the genetic risk factor's effect? I mean, sure,
it might be motivational to get one to stop smoking, eat better,
exercise more. But shouldn't we all be doing that anyway?
Just sayin'....
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