Heart testing article lacked critical factors
The article about "new" tests being no more effective at predicting heart trouble (Dec. 21) is just as misleading as Dr. Wang's commentary in the New England Journal of Medicine.
Of course, the standard risk factors — high blood pressure, high cholesterol, family history, age, smoking, obesity, lack of exercise and diabetes — are all accurate predictors of heart disease.
Most importantly, they are all additive. In some combinations, they are exponentially indicative of increasing risks.
C-reactive protein and homocystine are only modestly additive, and this study did not even include ferritin and fibrinogen, which are also additive.
Beta natriuretic peptide (which was originally derived from brain tissue and is produced by a dilated heart) is much more important in diagnosing and managing heart failure than in predicting heart attacks.
The economic implications of insurance company limitation based on this study are all population statistical analyses.
One in a million doesn't matter if you're the one, and we deal with one patient at a time, and those algorithms and paradigms have to be applied to individuals. Population studies are only a starting point.
John R. Dykers Jr., MD
Siler City
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