Closer attention to traditional major risk factors is probably more useful for identifying patients at risk for coronary heart disease than adding new factors such as C-reactive protein to the evaluation, according to an article in the July 10 issue of the Archives of Internal Medicine.

Most of the traditional major risk factors for coronary heart disease are also modifiable, so physicians can advise patients on how to change lifestyle to reduce risk, according to background information in the article. In recent years, researchers have identified additional risk factors and chemical markers associated such as C-reactive protein that correlate with development of coronary heart disease.

In the current study, Aaron R. Folsom, MD, MPH, University of Minnesota, Minneapolis, and colleagues with the Atherosclerosis Risk in Communities (ARIC) Study assessed the benefits of screening for 19 novel chemical markers, including C-reactive protein, antibodies against infectious diseases, B vitamins and compounds involved in endothelial function. The Study enrolled 15,792 adults between the ages of 45 and 74 years in 1987-1989. The participants underwent a physical examination, including assessment of major risk factors, at the beginning of the study and every three years afterward. Four times during the follow-up period, researchers collected blood and DNA samples for analysis. Patients continue to be tracked for the development of coronary heart disease.

Several of the compounds tested, including C-reactive protein and vitamin B6, were significantly associated with disease. Researchers looked at each marker and assessed the probability that a participant who developed disease within a five-year period had a higher risk score than a participant who did not develop disease. Using this method, they determined that most of the novel markers did not significantly increase the ability of physicians to predict coronary heart disease.

“Although the significant and independent association of a novel risk factor with coronary heart disease often does not equate to improved prediction of coronary heart disease beyond that of basic risk factors, this does not imply that the novel risk factor is pathophysiologically unimportant or unsuitable as a target for intervention,” the authors wrote. “Based on the totality of evidence, however, C-reactive protein level does not emerge as a clinically useful addition to basic risk factor assessment for identifying patients at risk of a first CHD event.”

Routine screening is not warranted for any of the other 18 novel risk factors tested either, the authors concluded. “On the other hand, our findings reinforce the utility of major, modifiable risk factor assessment to identify individuals at risk for coronary heart disease for preventive action,” they wrote.

In an accompanying editorial, Donald M. Lloyd-Jones, MD, ScM, Northwestern University Feinberg School of Medicine, Chicago, and Lu Tian, ScD, wrote that the 19 novel markers studied may someday be useful in assessing risk in certain subpopulations, but for now physicians must focus on improving already recognized risk factors.

“We need to ensure that the tools we currently have for risk prediction are applied more broadly and routinely throughout clinical practice,” they wrote. “We must also address the enormous gaps between the promise of cardiovascular disease prevention and its reality. We have improved our recognition of those with an elevated blood pressure or cholesterol level, but fewer than one of three Americans with adverse levels of these factors are controlled to goal levels. These issues must be addressed and improved urgently.”