Genetics for personalized coronary heart disease treatment

November 12, 2008

Identifying a single, common variation in a person's genetic information improves prediction of his or her risk of a heart attack or other heart disease events and thus, choice of the best treatment accordingly, said researchers at Baylor College of Medicine in Houston.

These findings are being presented today at the American Heart Association's Scientific Sessions in New Orleans.

"This DNA variation at 9p21 chromosomal region is not a mutation; it is a genetic variant," said Ariel Brautbar, clinical postdoctoral fellow in molecular and human genetics at BCM and lead author of the study, which is one of the presentations designated "Best of Sessions" at the annual American Heart Association meeting.

"We already know that 9p21 DNA variation is associated with a greater risk of heart events, but now we have shown its direct usefulness to patient care by adding it to traditional risk factor measurements," he said. "This is done in order to establish better prediction of a person's risk for coronary heart disease and make appropriate changes in their treatment."

Brautbar and the Atherosclerosis Risk in Communities researchers followed 10,000 people already taking part in this large study of middle-aged Americans designed to investigate the causes and natural history of atherosclerosis.

Participants were already categorized, based on traditional risk factors, as low, intermediate, or high risk for heart disease events. Low risk was defined as having a less than 10 percent chance of having coronary heart disease in the next 10 years. People with a 10 percent to 20 percent chance in the next decade were considered intermediate risk. Anyone with a risk of 20 percent or greater is considered high risk. However, some people in the 5 percent to 10 percent risk range seem to have more than "low risk."

In Brautbar's study, many of those who have the genetic variation at 9p21 had a higher risk than previously thought. Nearly 20 percent in the 5 percent to 10 percent (low risk) range, and more than 16 percent in the 10 percent to 20 percent (intermediate risk) range had to be recategorized.

"It significantly improved our risk prediction," said Christie Ballantyne, chief of atherosclerosis and vascular medicine and professor of medicine at BCM. "Since many people's risk categories changed, the optimal treatment for these individuals had to be reevaluated."

Those already at intermediate risk were most affected by these results, Brautbar added.

"A person at high risk will be treated aggressively, regardless of whether he or she has this variation. A low-risk person with good health won't be treated differently either," he said. "However, someone in the intermediate risk group could be moved into a higher or lower risk category, depending on whether he or she has the genetic variant. This, in turn, could affect how he or she is treated."

The test to identify whether there is a variation at 9p21 involves taking blood or swabbing the inside of a person's cheek to obtain DNA.

"This study shows us that each person's particular genetic information may play a role in personalizing preventative treatment for that individual," Brautbar said.

Baylor College of Medicine

---

---

	Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure by Caldwell B. Esselstyn Jr. (Author) A powerful call for a paradigm shift in heart disease therapy. Based on the groundbreaking results of a twenty-year nutritional study by Dr. Esselstyn, a preeminent researcher and clinician, this book illustrates that a plant-based, oil-free diet can not only prevent and stop the progression of heart disease but can also reverse its effects. The proof lies in the incredible outcomes for patients who have followed Dr. Esselstyn's program, including a number of patients in his original study who had been told by their cardiologists that they had less than a year to live. Within months of starting the program, Dr. Esselstyn's patients began to improve dramatically, and twenty years later, they remain free of symptoms. Complete with more than 150...
	Heart Disease Prevention and Reversal: How To Prevent, Cure and Reverse Heart Disease Naturally For A Healthy Heart by John McArthur Heart Disease Prevention and Reversal: How To Prevent, Cure and Reverse Heart Disease Naturally. The information in this guide has been compiled from the research of 50 world renowned leading heart doctors and scientists. This is what you will find inside: Why Conventional Treatments Won't Cure Heart Disease Cholesterol Reduction Drugs Are Causing Serious Side Effects And Deaths!Bypass Surgery And Angioplasty Maybe UnnecessaryThe Hard Plaque Blunder - Atherosclerosis What You MUST Do To Cure, Prevent And Reverse Heart Disease Quickly Clear Out Your Arteries Quickly - No Surgery Or Drugs Eat To Cure, Prevent And Reverse Heart Disease - No Starvation DietsControl Cholesterol Naturally - No Starvation DietsCrucial Vitamins, Minerals And Herbs That You MUST...
	Reverse Heart Disease Now: Stop Deadly Cardiovascular Plaque Before It's Too Late by Stephen T. Sinatra (Author), James C. Roberts (Author), Martin Zucker (Contributor) While most books focus solely on the role of cholesterol in heart disease, Reverse Heart Disease Now draws on new research that points to the surprising other causes. Two leading cardiologists draw on their collective fifty years of clinical cardiology research to show you how to combine the benefits of modern medicine, over-the-counter vitamins and supplements, and simple lifestyle changes to have a healthy heart.
	What Your Doctor May Not Tell You about Heart Disease by Mark Houston (Author) Coronary heart disease has long been the number one killer in this country, and for decades, we have been told about five basic risk factors: elevated cholesterol, high blood pressure, diabetes, obesity, and smoking. But the truth is that heart disease is much more complex-- with close to 400 risk factors! In this innovative guide, Dr. Mark Houston helps readers discover the causes of heart disease, how to prevent and treat its debilitating effects via nutrition, nutritional supplements, exercise, weight management, and lays to rest to various myths (cholesterol is not the primary cause) based on scientific studies and medical publications. Readers will also learn how to indentify the risk factors most likely to endager them and construct an arsenal of non-pharmacological...
	Saving Women's Hearts: How You Can Prevent and Reverse Heart Disease With Natural and Conventional Strategies by Martha Gulati (Author), Sherry Torkos (Author) Mention the term "heart disease" and most people picture an overweight, middle-aged man. Yet the reality is that heart disease is the number one killer of women in North America, accounting for a third of all deaths in women and far surpassing the prevalence of breast cancer.Cardiologist Dr. Martha Gulati and holistic pharmacist Sherry Torkos separate the facts from the many myths surrounding heart disease and offer the latest information on both the conventional medical approach and the role of natural medicine in understanding this illness. Saving Women's Hearts examines the unique gender differences for women and provides valuable insight into the screening procedures, diagnosis, treatment options, and most importantly, prevention of heart disease. Written by the leading experts in...
	The Cure for Heart Disease: Truth Will Save a Nation English Edition by Dwight Lundell (Author), Todd R. Nordstrom (Editor), Sarah Loukota (Editor) The Cure for Heart Disease, although written in everyday language, is different than every other book exploring the number one killer of Americans. A riveting yet straight forward discussion that challenges public consensus, explains the reasons for the epidemic of heart disease, and provides an easy to follow guide to eliminate heart disease and reduce the risk of heart attach and other debilitating diseases.
	Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 2-Volume Set: Expert Consult Premium Edition - Enhanced Online Features and Print, 9e (Heart Disease (Braunwald) (2 Vols)) by Robert O. Bonow MD (Author), Douglas L. Mann MD FACC (Author), Douglas P. Zipes MD (Author), Peter Libby MD (Author) Braunwald's Heart Disease remains your indispensable source for definitive, state-of-the-art answers on every aspect of contemporary cardiology. Edited by Drs. Robert O. Bonow, Douglas L. Mann, Douglas P. Zipes, and Peter Libby, this dynamic, multimedia reference helps you apply the most recent knowledge in molecular biology and genetics, imaging, pharmacology, interventional cardiology, electrophysiology, and much more. Weekly updates online, personally selected by Dr. Braunwald, continuously keep you current on the most important new developments affecting your practice. Enhanced premium online content includes new dynamic cardiac imaging videos, heart sound recordings, and podcasts. With sweeping updates throughout, and contributions from a "who's who" of global cardiology, Braunwald's...
	Pathophysiology of Heart Disease: A Collaborative Project of Medical Students and Faculty (PATHOPHYSIOLOGY OF HEART DISEASE (LILLY)) by Leonard S. Lilly (Author) Revised and updated for its Fifth Edition, Pathophysiolgy of Heart Disease is a comprehensive, clear, concise, and easy-to-understand introduction to cardiovascular diseases. This best-selling text is written by internationally recognized Harvard Medical School faculty and select medical students during their initial encounters with patients with heart disease. This edition has improved consistency of coverage and level of detail and enhanced illustrations. A companion website on thePoint will include the fully searchable text and audio heart sounds, plus an image bank for faculty. Features :NEW! conversion of approximately 20 1-color line drawings to 2-color to make more use of 2- color; NEW! redrawing of approximately 15 existing 2-color line drawings to improve quality and presentation...
	Take a Load off Your Heart: 109 Things You Can Actually Do to Prevent, Halt and Reverse Heart Disease by Joseph C. Piscatella (Author), Barry A. Franklin (Author) Increase the odds of living longer with this bold, broad approach to cardiac health. A medically up-to-the-minute and easy-to-implement program, Take a Load Off Your Heart sets our four key steps to cardiovascular fitness, from assessing risk to managing stress, from improving diet to making a habit of exercise. It demystifies predictive markers such as trigylcerides and Syndrome X, and offers 109 simple, practical lifestyle tips - #22 Breathe deeply, #96 Drink black tea, #3 Increase your HDL level, #54 Walk briskly, #75 Give up dieting - for preventing, stabilizing and, yes, reversing heart disease.
	Heart 411: The Only Guide to Heart Health You'll Ever Need by Marc Gillinov M.D. (Author), Steven Nissen M.D. (Author) The definitive guide to heart health from two of America's most respected doctors at Cleveland Clinic, the #1 hospital for heart health in America. Are you one of the eighty-two million Americans currently diagnosed with cardiovascular disease—or one of the millions more who think they are healthy but are at risk? Whether your goal is to get the best treatment or stay out of the cardiologist’s office, your heart's health depends upon accurate information and correct answers to key questions. In Heart 411, two renowned experts, heart surgeon Marc Gillinov and cardiologist Steven Nissen, tackle the questions their patients have raised over their decades of practice: Can the stress of my job really lead to a heart attack? How does exercise help my heart, and what is the right...