This article was last reviewed on
This article waslast modified on 10 July 2017.

The risk of heart attack and stroke is increased in people with low blood fasting levels of high density lipoproteins (‘good’ cholesterol) and raised levels of low density lipoproteins (‘bad’ cholesterol) and triglycerides. Risk is increased by diabetes, raised blood pressure, a family history of heart disease, increasing age, obesity (particularly a ‘pot belly’), smoking and lack of exercise.

The Framingham Heart Study investigated the predictive value of 10 newer lab tests, including the amino acid homocysteine. The researchers used 3209 subjects aged between 40 and 80 years and followed them for up to 10 years. We have a news item about their 2006 report that the new tests added only a small improvement in the ability of conventional factors to find risk.

Dr Wouter de Ruijter, general practitioner and clinical researcher, with colleagues from the University of Leiden in the Netherlands, investigated the true predictive value of four of the new tests in very old people. Their findings were published on-line in the BritishMedical Journal on 8 January 2009. They had recruited 215 female and 87 male residents of Leidenaged 85 years who had no history of heart disease or stroke, and followed them for five years. All the classic risk factors were recorded at the beginning, as well as four of the new tests: homocysteine, folic acid, C-reactive protein and interleukin 6.

During the five year follow-up, 108 of the 302 participants died; 35 of the deaths were from heart attack or stroke. The Framingham risk score, which is based on the conventional risk factors, had identified only 12 of the 35 in the highest one third of the range of scores. In contrast, homocysteine concentration alone had identified 20 in the highest one third of the values.

The authors suggest that these findings make it worth checking in other groups of the very old because, if confirmed, homocysteine alone could be used to select old people who need preventive treatment. Dr de Ruijter said “The beneficial effect of statins… as a drug to be used… in secondary prevention in the elderly is evident, and such drugs could also be effective in primary prevention if the selection of patients at highest risk is accurate.”