We have all heard these scary statistics before. According to the American Heart Association, cardiovascular disease accounts for nearly 836,546 deaths in the United States. That is about 1 in every 3 deaths. On average about 2,300 Americans die of cardiovascular disease each day or 1 death every 38 seconds! Cardiovascular disease claims more lives each year then all forms of cancer and chronic lower respiratory disease combined. These numbers are not getting better!
Risk stratification is a tool physician’s use to identify and predict which patients are at high risk or likely to be high risk and prioritizing the management of their care in order to prevent worse outcomes. Risk stratification for coronary heart disease is important for several reasons. As we can see from the previous numbers it is rampant. The time from onset to death can be very brief and in at least 25% of people with coronary heart disease, it presents as sudden death. By establishing an initial primary risk level, healthcare providers can focus their efforts on those patients who stand to gain the most by making significant lifestyle changes.
There is a new area of DNA testing involving telomere length that may enhance a person’s cardiovascular disease risk stratification. Telomeres are biological clocks that determine the lifespan of a cell. They determine the number of times a cell can divide to create new cells. Telomeres protect the ends of each chromosome when they divide. Each time a cell divides the telomere gets shorted. When a telomere gets too short, the cell can no longer replicate and in essence dies.
Shorter telomeres have been associated with age-related disease and early mortality. Short telomeres have been implicated in a wide range of common diseases associated with aging. Telomere shortening plays a critical role in the process of age associated cardiovascular disease. Both environmental and genetic factors have been associated with individual variations in telomere length. Cardiovascular risk factors such as stress, sedentary lifestyle, smoking, obesity, hypertension, and diabetes mellitus have been considered to increase oxidative stress or inflammation, subsequently accelerating telomere shortening. In clinical practice, shorter leukocytes (white blood cells) telomere length is an indication oxidative stress and inflammation, and might be an effective biomarker for risk stratification for atherosclerosis and cardiovascular disease. However, healthy lifestyle and physical activity are protective factors to maintain telomere length. The association of leukocytes telomere length with coronary artery disease has been reported in several prospective epidemiological studies, although conclusive evidence of causal relationship is still lacking. Additional basic and well-designed clinical studies are required to validate these observations and further expand our knowledge of the complexities of telomere dynamics in humans.