By Dr. W. Gifford Jones
November 2, 1997
Why do we make life so complicated? How much better our lives would be if we could only take to heart the current expression ,"Keep It Simple, Stupid" (Kiss). This week I've got a big "Kiss" to pass along to readers and doctors. It's a simple, inexpensive, painless and speedy way to help people predict their chances of heart disease. And it's better than all the other complicated ways of predicting coronary heart disease (CHD).
CHD is the nation's # 1 killer. Last week, I commented on the Hungarian disaster. How Hungarians were digging their own graves due to faulty lifestyle. How this was carrying them off to the Great Beyond five to ten years sooner than their European neighbours.
But North Americans have little reason to feel smug. Studies show that 50 percent of Hungarians die from CHD. But our own 35 percent rate leaves much to be desired.
So how do we currently try to predict who will and who wont fall victim to the # 1 disease?
The stethoscope was the earliest way to predict trouble. Heart murmurs associated with leaky heart valves could be heard for the first time. These set the stage for a coronary attack years later.
But 99 percent of the time the heart sounds normal. So 99 percent of the time the stethoscope fails to predict future heart disease.
What about the electrocardiogram? It's been used for years to pin©point narrowed coronary arteries, an enlarged heart or abnormal beats.
But once again most people show a normal ECG. And knowing you have an normal ECG is not too reassuring. After all you can have a 100 percent normal ECG one day and drop dead from coronary attack the next day.
Because of this uncertainty researchers have been looking for years for a more reliable test. Now many physicians and the public think they've found it, the "blood cholesterol level".
But that problem of "uncertainty" keeps raising its ugly head. I have patients who have had high blood cholesterol for years. They're still playing tennis with no sign of angina. But some say their friends with low blood cholesterol died of a coronary years ago. Ô 0*0*0* Unfortunately trying to predict CHD by blood cholesterol levels is much like betting on a racehorse. Most of the time you're wrong.
There's another problem. We're spending untold millions testing patients' blood for cholesterol, triglycerides and high and low density lipoprotein. And the cost of cholesterol©lowering drugs boggles the imagination.
Now lets "Kiss" all this high powered testing goodbye. A study by the Canadian Heart Health Survey's Research Group (unfortunately not a KISS title) has the answer to predicting CHD.
Dr. Bruce Breeder is a professor in the Department of Community Health at the University of Saskatchewan. He and his colleagues studied 10,054 men and women aged 18 to 74.
What did they do? Fancy blood tests? Genetics testing? Not at all. You can't use that approach if you have a KISS mentality. They simply did a KISS test. They measured the waist circumference (WC) of all these patients at the end of normal respiratory expiration with the patients standing erect.
They found that (WC) is the single best way to predict heart disease risk. Patients with a WC between 90 centimeters (cm) (36 inches" and 100 cm. (40 inches) faced a considerable heart disease risk.
Moreover patients with a WC of 100 cm or more faced double the risk of hypertension and diabetes.
They also discovered another interesting fact. They found that WC was related to systolic and diastolic blood pressures.
Then they went a step further which could save the millions of dollars used for testing levels of blood fat.
Once again they used their tape measures to determine the WC and the hip circumference (HC). They found that the WC©HC ratio closely related to important lipid levels in the blood such as high density lipoprotein (HDL) levels, the total cholesterol to HDL ratio, and triglyceride levels.
So what's the "KISS" moral? Buy a simple measuring tape. You don't need a doctor to tell you when your WC is over 90 cm. Then do something about it. After all we've known for years that being shaped like an apple is a cardiovascular risk factor.
My congratulations to Dr Breeder and his colleagues. What a shame they won't get the Noble Prize in Medicine. It would emphasize that in an era of rocket science that simple ideas are still worth their weight in gold.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
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