March 21st, 2012
04:18 PM ET

Red flag found for imminent heart attack

Most heart attacks hit without warning – when a blister plaque on the blood vessel wall ruptures. The resulting clot starves the heart of oxygen and nutrient-rich blood, causing a heart attack and possibly death.

Traditional diagnostic tools like treadmill stress tests only pick up major blockages in the blood vessels, but they don’t alert doctors to this type of impending catastrophe. That’s because the vast majority of heart attacks occur in people whose blood vessels are narrowed only slightly by cholesterol-laden plaque.

“We can’t detect these mild narrowings, which are almost exclusively responsible for heart attacks,” says Dr. Eric Topol, director of the Scripps Translational Science Institute in La Jolla, California.

But Topol and a team of researchers now think they’ve found a way to determine which patients are only days or weeks away from a heart attack.

In findings published Wednesday, Topol and his colleagues found abnormalities in the cells lining the surface of blood vessels, called endothelial cells, when the risk of a plaque rupture was high. When a heart attack was imminent, more of the endothelial cells were circulating and they were misshapen.

Topol says they hope to have a simple blood test ready next year to flag patients in immediate danger of plaque dislodging and causing a heart attack. Doctors would know in minutes if patients were on the brink of an attack.

Initially, the test would be given to people who arrive in a hospital emergency department with chest pain but were not currently having a heart attack. The test would show if a heart attack is likely in the coming days, and the patient could be given aspirin and prescription medications to prevent clots, Topol says.

In the future, Topol says he envisions an implant the size of a grain of rice that would analyze circulating blood and send an alert if a heart attack was imminent.

The Scripps researchers’ findings were published Wednesday in the journal of Science Translational Medicine, published by the American Association for the Advancement of Science

Every year, the American Heart Association estimates 1.5 million Americans have heart attacks; 785,000 are suffering their first heart attack, usually with no warning. Slow narrowing of the blood vessels over time can result in chest pain, called angina, but these mature plaques are less likely to rupture, Topol says.

Traditional risk factors for heart attacks include inactivity, obesity, high blood pressure, cigarette smoking, poor diet, high cholesterol and diabetes. But figuring out who was at highest risk of an imminent heart attack hasn’t been possible.

In search of a precise marker, the Scripps team looked at 50 patients who arrived at the hospital with chest pains but whose subsequent tests showed they had not had a heart attack. Topol says these were patients who likely had clot that dissolved on its own.

The researchers found the endothelial cells of these patients looked very different from those of healthy individuals in a control group. For starters, four times as many endothelial cells were circulating in the blood of patients on the verge of a heart attack. The endothelial cells were also larger, misshapen and frequently contained many nuclei.

The National Institutes of Health and the American Reinvestment and Recovery Act, better known as the stimulus, provided funding for the research.

soundoff (40 Responses)
  1. jimdakis

    when Jesus comes knocking you gota go rocking!

    March 21, 2012 at 17:45 | Report abuse | Reply
  2. c s

    According to Dr. Linus Pauling heart disease is caused by low level scurvy (vitamin C deficiency). Vitamin C is necessary to make collagen which hold the body together. According to Medline Plus, one of the chief symptoms of scurvy is bleeding gums. So if your gums are bleeding, you might have scurvy. If you gums are bleeding than other parts of your body are weak and the blood vessels are also weak. Take extra Vitamin C and see if your gums heal.

    March 21, 2012 at 18:42 | Report abuse | Reply
    • SixDegrees

      Linus Pauling used to be brilliant. A lifetime spent in chemistry labs inhaling heavy metal vapors, though, has left him mentally deficient. His rantings and ramblings about vitamin C are an acute embarrassment to a once-great scientist.

      March 21, 2012 at 18:52 | Report abuse |
    • c s

      "A lifetime spent in chemistry labs inhaling heavy metal vapors, though, has left him mentally deficient.". I doubt that he is mentally deficient. Read his book "How to live longer and feel better" and then you can judge his views on nutrition. In his book he enumerates many experiments that show the benefits of nutrition supplements. These experiments were done by many different doctors and scientists. So his opinion were formed by reading about studies that indicate the benefits of vitamins. Louis Pasteur was also a chemist and yet he brought forth many ideas about disease that ultimately proved true. Prescription medicine is applied chemistry. Linus Pauling was one the greatest chemists of the 20th century and surely knew more about chemistry than you or I.

      March 21, 2012 at 22:26 | Report abuse |
    • TakeYerMeds

      Wow! I love pseudoscientific babble – great example.

      March 21, 2012 at 23:05 | Report abuse |
    • Lets produce

      "Linus Pauling used to be brilliant." You are correct on that note. The rest of your post sounds like your speaking in present tense. The man has been gone for eighteen years.

      March 21, 2012 at 23:25 | Report abuse |
    • E

      Biased personal selection of chance findings while neglecting the true overwhelming body of evidence proves only the presence of a delusion.

      In plain English: cherry picking your facts to support your opinion + ignoring the majority rejecting it = you're crazy.

      Supplements have rarely been proven to help anything, unless there's an established deficiency.

      Vitamin C and E have been shown repeatedly to make no difference in heart disease outcomes.

      March 22, 2012 at 01:15 | Report abuse |
    • What Now

      I know we would all like to believe that there is some supplement or vitamin, or even some single ingredient like green tea or soybean that will cure all of our problems. Daily, research proves that is not the case. However, there is statistically significant research that indicates taking too much vitamin C is harmful. Also, there is currently not significant research to support taking supplements or vitamins unless your doctor has prescribed them due to deficiencies.

      March 22, 2012 at 09:02 | Report abuse |
    • Good grief

      Ignore SixDegrees. I've seen his/her postings on other articles, and they're usually rather rude.

      March 22, 2012 at 12:33 | Report abuse |
    • Ed - Spring, TX

      You need to quit reading the internet. If it sounds too good or too simple to be true, it usually isn't. Use some common sense.

      March 22, 2012 at 13:58 | Report abuse |
    • Bill

      C S
      There seem to be several causes of Heart attacks, trace mineral deficiencies, blood sugar issues, etc. Vitamin C would
      likely reduce the inflamation related to artery damage, but I do not see it as a "magic bullet" cure. It is one of several factors.

      March 22, 2012 at 16:39 | Report abuse |
    • Rinner

      Actually, Vitmanin C is water soluble, so if you take/ingest excess Vitamin C, you pee it out.. --> not harmful...

      April 5, 2012 at 15:30 | Report abuse |
  3. S N

    Dr. Pauling was not a physician; he was a biochemist. As much as he advanced the fields of chemistry and biochemistry, I doubt he had a clue about the pathogenesis of heart disease. Also, it is virtually impossible for someone in an industrialized country to have Vitamin C deficiency. There are plenty of fringe-medicine proponents who believe mega-doses of vitamins are the cure for all disease, when in fact controlled studies have dispelled most high-dose vitamin regimens as detrimental to health, or at least not in any way supportive of any benefit. Sadly, we're likely going to find out decades from now that the same holds true for many of the prescription medicines peddled for everything from high cholesterol to cancer.

    March 21, 2012 at 18:54 | Report abuse | Reply
    • c s

      Neither was Louis Pasteur; he was just a chemist too.

      March 21, 2012 at 22:27 | Report abuse |
  4. Chris

    Enough about Dr. Pauling – who cares? Great find – hopefully this will save a few lives.

    March 21, 2012 at 19:10 | Report abuse | Reply
  5. Don

    As a 65 year old man I am very interested in the study. Both of my parents and all four of my grandparents died of
    heart disease. Their deaths were all between the ages of 77 to 83. With that timetable in mind, I am determined
    to break the family curse through knowledge and practice of healthy living. Thank you CNN Health for this report.

    March 21, 2012 at 20:59 | Report abuse | Reply
    • E

      I applaud your attempt to break the cycle.

      We have made great strides in picking up heart attacks as they happen, but we still miss quite a lot.

      With Dr. Topol's work, it would be great to catch people on the verge of having one and cool it with meds.

      I can already see medicine shifting more and more to test strategies. It's always good to open up potential new ones to improve care for us all.

      March 22, 2012 at 02:03 | Report abuse |
  6. Dre

    As a 65 year old woman, I, too, am very interested in the study. Heart disease is rampant in my family. My Dad died of a massive attack at 53. I am currently taking meds to clean my arteries and thin my blood. I will mention this article to my doctor when I go next month. Again, thank you CNN Health for this report.

    March 21, 2012 at 22:06 | Report abuse | Reply
    • TakeYerMeds

      No such thing as medicines that "clean" one's arteries. Wish there were, though.

      March 21, 2012 at 23:04 | Report abuse |
    • Lets produce

      "No such thing as medicines that "clean" one's arteries. Wish there were, though." Actually, there are. Read Dr. Caldwell B. Esselstyn Jrs. book, "Prevent and Reverse Heart Disease. It's not a easy process but is possible if your willing to go the extra mile to get there.

      March 21, 2012 at 23:19 | Report abuse |
    • E

      1) Dr. Caldwell B. Esselstyn is a general surgeon who dealt with breast cancer, not a heart doctor and much less a heart surgeon. This is akin to a radio talk show host claiming s/he can do serious television journalism.

      2) His book cites a study of only 17 patients, and expands it to only a couple hundred. He censors those who don't follow his diet, which is not reflective of the real world. Most of his evidence is based on associations. Worse, diet is one of the most notoriously difficult factors to monitor, much less control, in a practical fashion.

      Many practice-changing heart studies have minima of thousands of patients, followed across many heart outcomes especially heart attacks and death and provide censored and uncensored analyses. Not simply heart angiograms. More importantly, quite a few have been designed to establish cause-effect more clearly.

      3) I have yet to see a serious heart organization, of which there many, endorse his work in this field.

      March 22, 2012 at 01:45 | Report abuse |
    • E

      Let me also add that the very idea "reversing heart disease" (i.e., plaque regression) is a controversial and contentious topic among experts in the heart world.

      March 22, 2012 at 01:51 | Report abuse |
    • Lets Produce

      "3) I have yet to see a serious heart organization, of which there many, endorse his work in this field." You find this surprising? Anytime you have large amounts of money at risk, don't expect main stream medicine to endorse anything that might jeopardize that cash cow. It's interesting how you question Dr. Caldwell B. Esselstyn but find no fault with main stream medicine which is entirely corrupted by money.

      March 22, 2012 at 11:04 | Report abuse |
  7. Lets produce

    Unfortunately, there are two sides to the coin. On one hand, new medical technology should be a good thing if it helps deter disease or death. On the other side of the coin, we are told that our ever increasing health care costs are a direct result of consumers DEMANDING more products and services. The big question is, can we afford more products and services. I disagree with the notion that we consumers are demanding more products and services. With the huge profit incentive to offer ever more products and services, we consumers don't have to demand anything for it to show up as the next great cure all for what ails us. I think it would be awesome if medicine could fix everything that needs fixing. The reality is that we simply can't afford that.

    March 21, 2012 at 22:12 | Report abuse | Reply
  8. pacman357

    I think those statistics are a bit misleading. IIRC, Dick Cheney has about 5% of the heart attacks diagnosed in the U.S. every year.

    March 22, 2012 at 05:47 | Report abuse | Reply
  9. Liz in Seattle

    Here's the question, though. If someone comes into the emergency room today and complains of chest pain without a heart attack in progress, what do they do? I am guessing they tell the person to take some aspirin and prescribe clot-preventing meds. In other words, they already do exactly what they would do if they had this test and it was positive. Not that it's bad to get comfirmation that a person is at high risk for an impending attack, but the test doesn't provide much benefit if you only give it to people who you assume are already at high risk. As for that rice-sized implant, well, I'll believe it when I see it. As someone in the medical device field I can definitely say that an advance like that is nowhere near becoming reality.

    March 22, 2012 at 12:16 | Report abuse | Reply
  10. John Harlen

    They do more than aspirin and clot prevention. Immediate angioplasty to open the arteries is one likely step.

    March 22, 2012 at 18:29 | Report abuse | Reply
  11. John Harlen

    Someday we will all have a gizmo in our commodes that checks us every time we "visit" and alerts us to any impending problems.

    March 22, 2012 at 18:30 | Report abuse | Reply
  12. Adam

    With 53 million that don't have insurance, at DoctorsForUninsured dot org we are trying to make office visits affordable so people can have access to office visits for checkups. Help us save lives.

    March 22, 2012 at 20:55 | Report abuse | Reply
  13. gina

    Anyone ever hear of moderation. Dont worry yourself. PATIENCE & TIME r the key. Half the things you worry about dont happen anyway it depends on genetics and what you do with past family tree medical knowledge.

    March 23, 2012 at 01:43 | Report abuse | Reply
  14. independentlyowned

    I'm curious how many of these patients were women. I'm not trying to "pull the feminist card," but within the last decade they discovered that heart disease does in fact affect women very differently than men (once they actually bothered to do studies with women). So I wonder if this is a universal finding, which would be a fantastic discovery! It's still fantastic regardless, but just saying.

    April 10, 2012 at 14:44 | Report abuse | Reply
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