They may also be able to determine what wayward genes are doing to cause heart disease, then design treatment to correct what your body is doing wrong.

"I think within the next 10 years we'll be able to do much better screening through genetic testing,'' predicts Dr. Andrew Keller, chief of cardiology at Danbury Hospital. "We'll be able to see that certain patients have a genetic predisposition for heart disease and better treat those patients.''

"There no question about it -- that's the future of heart care,'' agrees Dr. Joseph Frolkis, president of New Milford Hospital and head of its preventive cardiology program.

"It won't be confined to heart disease," Frolkis observed. "It's happening already in fields like cancer and diabetes.

"If we can find the genes that contribute to heart disease," he explained, "we can start asking what the mechanisms that cause heart disease are. Then we can ask 'Can we design a treatment for it?'''

Like many fields of medicine -- including cancer -- the treatment of heart disease is changing, in part because the huge breakthrough created by the Human Genome Project, the mapping of the human genetic code completed in 2003.

At the time researchers announced they'd finished the map, they predicted it would lead to revolutionary breakthroughs in medicine.

Frolkis said researchers are just beginning to make those breakthroughs. Knowing early in diagnosis that a patient is prone to heart disease is important because doctors can then target those patients who need medication and lifestyle changes the most.

The breakthroughs are also coming at a time when doctors are understanding how complex heart disease is. Frolkis said some new diagnostic tools, like intravascular ultrasound, are showing that for every clot that can cause a heart attack, there are hundreds that are forming with the potential to cause more problems in the future.

"That's just in the coronary arteries,'' Frolkis said. "It's a much more widespread problem than we thought.''

But those researchers, along with physicians and the general public, are winning the war against heart disease, even though it is still by far the most widespread and deadly disease in the United States.

The National Center for Health Statistics has reported that 654,092 Americans died of heart disease in 2004 -- about 28 percent of all deaths in the United States that year.

Add in 150,147 stroke deaths in 2004 -- an illness closely related to heart disease -- and the number jumps to more than 800,000. In comparison, about 550,270 Americans died of cancer in 2004.

At its peak in 1950, heart disease caused about 307 deaths for every 100,000 Americans. By 1996, according to the Centers for Disease Control and Prevention, that number had dropped to 134.6 per 100,000.

In 1999, the CDC listed that decline as one of the 10 most important public health advances of the 20th century in the United States.

Doctors know the risk factors for heart disease. They include family history, smoking, diabetes, high blood pressure, and cholesterol levels -- too much LDL cholesterol and not enough HDL cholesterol.

Control them, and you can control heart disease, medical experts advise.

Frolkis said doctors are always looking for new risk factors to determine the probability of a heart attack.

"We're interested in patients who don't have those risk factors and still have heart attacks,'' he said.

One leading candidate for a new risk factor is C-reactive protein -- the higher the level of this protein, which is an inflammatory agent, the greater the risk of heart disease.

"We're also aware of what we call the metabolic syndrome,'' Frolkis said. "That's the pre-diabetic condition that includes high blood pressure, obesity, high blood sugar, low levels of HDL cholesterol -- the good cholesterol, and high levels of triglycerides.''

As many as 47 million Americans have metabolic syndrome, putting them at a huge risk of developing diabetes. In turn, Frolkis said, having diabetes increases the risk of heart disease by seven to eight times over not having the syndrome.

Medical technology to treat heart disease has improved as well.

Danbury Hospital now has the Praxair Heart and Vascular Center, dedicated in May 2006, to offer advanced heart care procedures to the region, including open-heart surgery and both elective and emergency angioplasty.

Keller said that because of the cooperation of area physicians -- who want their patients treated close to home -- the hospital hasn't had to worry about meeting goals for it set by the state Department of Health Care Access -- 125 open heart surgeries and 200 angioplasties a year.

"We're doing twice that level,'' he said.

"We used to get about 1 percent of our cardiac patients from New York. Now we get 20 percent,'' he said. "If there is one thing I can point to as a sign of our success, it's our collaboration with doctors in New York, in New Milford.''

In January, Keller said, the hospital will open its electrophysiology unit, which allow it to treat patients with heart arrhythmias -- abnormal heart rhythms.

"It's the same as it was with open-heart surgery -- patients now have to go to Bridgeport Hospital or Westchester County Hospital to get this treatment, instead of getting treatment closer to home,'' he said.

To the north, New Milford Hospital is now operating its own cardiac catheterization lab to diagnose heart disease. In April, it began doing emergency angioplasty and has now done about 10, Frolkis said -- all with good outcomes.

Doctors now have another tool to fight heart disease -- the class of drugs known as statins. These cholesterol-lowering drugs have been proven over the last decade to reduce heart disease and help reduce the chances of a second heart attack.

"The two biggest advances we've made in prevention of heart disease is in smoking cessation and in the wide use of statins,'' Keller explained.

One of the challenges cardiologists face is to get patients to take them -- and to continue taking them year in and year out.

"There's clearly a group of patients who should be on statins that are not,'' Keller said. "If we can get those people on statins, you will see a further reduction in heart disease in the United States. No question.''

Doctors could also reduce heart disease in the United States by getting people to adopt a healthier lifestyle -- lose weight, eat healthy foods, get more exercise. But that may be an insurmountable challenge.

"It's a hard message to get out to patients,'' said Frolkis, who specializes in preventing heart disease. "It's even a hard message to get to physicians.

"You talk to them, and they know about the issues," he related. "You look at their patients' charts -- at patients' blood pressure and cholesterol -- and it's a different story.

"Patients have to take responsibility for this as well,'' Frolkis said. "You can tell them they need to get at least 200 minutes of exercise a week, to change their diet, change your lifestyle, but that's hard to do. It's much harder than just taking a pill.''

Contact Robert Miller


or (203) 731-3345.


Facts about

heart disease

� Heart disease is the No. 1 killer of both men and women in the United States " about 28 percent of all deaths.� In 2004, 654,092 Americans died of heart disease; another 150,147 died of strokes.� Heart disease kills about 7 million worldwide each year.� It costs the United States about $260 billion a year in medical care and lost productivity.

The rates of heart disease in the United States by ethnic groups, per 100,000 people, are:

� Whites: 259� Blacks: 206� American Indians: 80� Asians and Pacific Islanders: 78� Hispanics: 72

About 7 million Americans have some form of heart disease. Risk factors for the disease include:

� Family history� Cigarette smoking� Hypertension (high blood pressure)� High levels of LDL cholesterol and low levels of HDL cholesterol� Diabetes� Obesity� Lack of exercise