The best medications and tests for your heart

With dozens of medications available to treat high blood pressure, doctors often fail to prescribe what the research shows works best. And that would be simple diuretics, one of the oldest — and cheapest — classes of drugs to treat high blood pressure.

Yet the most-prescribed drugs for high blood pressure are beta blockers. Now an analysis of more than 13 studies involving 105,000 patients finds that people on beta blockers have a 16 percent higher risk of stroke than those on diuretics.

The difference was so striking that the Swedish researchers conducting the study recommended beta blockers not be the first choice to treat hypertension. Talk to your doctor about switching.

"Bad news," your doctor says with a grim look. "Your cholesterol is a bit high." Before he can whip out his prescription pad and start you on a statin, ask for more details.

Specifically, a lipoprotein phenotyping, which, in addition to measuring HDL (good) and LDL (bad) cholesterol, measures amounts of two other types of blood fats: chylomicrons and very low-density lipoproteins (VLDL).

High levels of either can be far more risky in terms of developing heart disease than a high LDL. Plus, statins may have no effect on VLDL or chylomicron levels.

The results of the tests will let you know how serious your cholesterol levels are and whether you should start immediately on a statin or give lifestyle changes a try first.

A simple blood test — the C-Reactive Protein (CRP) Test has proven better than cholesterol screening at predicting a person's risk of heart attack.

Based on the theory that inflammation — perhaps as a result of chronic infections like gum disease or arthritis — contributes to coronary artery disease, the test measures CRP, the enzyme produced by the liver to combat inflammation.

It is currently available at teaching hospitals across Canada, says Dr. Jean-Claude Tardif, director of the Montreal Heart Institute Research Centre. Although a high CRP level doesn't immediately make you a candidate for heart surgery "it would give us another reason to be aggressive in terms of risk factor modification."

The good news? Statins — the most commonly prescribed drug for high cholesterol — also reduce CRP levels.

According to the Heart and Stroke Foundation of Canada, about half of all heart-attack victims have normal cholesterol levels.

Fortunately, a new test called coronary CT scanning holds promise as a non-invasive tool to identify plaque buildup. Although cholesterol can't be visualized on a CT, the inflammation in the plaque draws in calcium, which shows clearly on the scan. The amount of calcium correlates fairly well with the amount of plaque.

But there are drawbacks. First of all, with a price tag of upwards of $1.7 million, the newest and most highly detailed scanners, electron beam (EBCT) and multi-detector CT, are often available only to participants in research studies in this country. The exception: private providers like British Columbia's Canada Diagnostic Imaging (CDI) Centre, where patients can refer themselves for the test for $690.To top it off, CT scans can't detect fatty plaque, they require radiation and it is possible to get a "false negative."

About five percent of people with clean scans will actually have heart disease, admits Dr. Bruce Forster, director of the CDI. "We tell all our patients with a zero score not to take that as an invitation to go out and get a mozza burger. But [a high calcium score] is still the best single indicator of the likelihood of having a heart attack."

Know your options and exercise your right to inquire further into your own health.