2023-06-05 14:07:57
Cardiovascular risk factors such as smoking or obesity have long been established. But our imperatives of progress have neglected these trivial factors to propose more biological ones such as LDL, HDL, NT-proBNP, BNP, CRP, so many acronyms defining molecules whose rate varies according to the state of the heart and vessels.
For a long time, both cholesterol (HDL and LDL) ruled over these markers. But, for about twenty years it has been understood that inflammation, evaluated by CRP, plays an important role in cardiovascular diseases. Even heart failure whose clinical diagnosis is obvious now has its markers (NT-proBNP, BNP).
Until a group of 60 international researchers, worried about this kind of drift, carried out a meta-analysis involving 165,000 subjects and concluding that these markers were of little clinical significance. Other studies have shown that old markers of inflammation such as CBC and ESR may suffice. A hundred others have shown that the accumulation of these markers provides little clinical precision and that their use in clinical trials is often abusive and not very rigorous.
Some statistics have gone so far as to criticize the very validity of the markers. In heart failure, a high cholesterol level appears to be associated with better survival. In coronary patients too much “good” cholesterol becomes harmful. As for bad cholesterol, it would be neither the best risk marker nor the best therapeutic target.
But as nothing can prevent progress, in 2020, researchers proposed four markers to predict the risk of sudden death (reserved for patients who love strong sensations).
These controversies, inherent in biological variability and clinical unpredictability, are sometimes amusing, and are even more so the studies which naively note that biological markers meet clinical common sense. For example, a fruit-rich diet for 8 weeks is enough to lower many of these risk markers. Who would’ve believed that ? Or that the increase in N-glycans, themselves linked to sugar consumption, are good predictors of cardiovascular risk. It’s strange ! Or that lack of sleep increases CRP levels. How the hell is that possible? Or that the gamma GTs, markers of alcoholism are also good markers of cardiovascular risk. What a surprise ! This naïve science discovered resistin, a protein that increases in obesity, inflammation and atherosclerosis, and which marks the link between these three states. How unexpected!
Some now dare simply to show that physical exercise prevents hypertension, heart failure and all the risks, even when the markers are bad.
There are two ways to practice and consume cardiology: with or without markers.
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