A team of physicians has developed a simple new tool to help primary-care providers rule out coronary heart disease (CHD) in persons with chest pain. The Marburg Heart Score employs five predictors that can be identified easily during the office visit: (1) patient’s age/gender; (2) known clinical vascular disease; (3) pain that worsens with exercise; (4) pain that patient assumes to be of cardiac origin; and (5) pain that is not reproducible with palpitation.
The scale was used on 1,249 patients presenting with chest pain to 74 primary-care practices in Germany, with follow-up data on symptoms, medications, and hospital admissions obtained six weeks and six months later to determine the presence or absence of coronary artery disease. The scale was shown to have a sensitivity as high as 87.1% and a specificity as high as 80.8%.
“The score is not meant to replace the clinical judgment of the primary-care physician, especially when he or she encounters a patient with findings highly suggestive of acute coronary syndromes or any other reason requiring urgent hospital care,” caution the developers of the prediction tool, which was described in an early-release article for the Canadian Medical Association Journal. “Rather, it is meant for the predominant number of remaining patients who present with chest pain and in whom coronary artery disease could still be the underlying reason.”
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Heart disease was also the focus of a meta-analysis that found no evidence of statins reducing mortality risk among people with no history of cardiovascular disease. Researchers examined data from 11 studies involving 65,229 participants, half of whom were prescribed statins while the remainder were assigned to placebo. Over an average follow-up of 3.7 years, 1,346 statin users died, compared with 1,447 members of the placebo groups. Although the statin users had lower levels of LDL than the placebo takers (134 mg/dL vs. 94 mg/dL), there was no association between risk of death and either LDL levels at the beginning of the study or average reduction in LDL levels.
“The present report suggests that all-cause mortality benefits are more modest in the short term, even among high-risk primary prevention populations, thereby indicating the need for further caution when extrapolating the potential benefits of statins on mortality to lower-risk primary prevention populations,” observed the investigators (Arch Intern Med. 2010;170:1024-1031).
