a "ticking time bomb."  The good news is that
the work of Dean Ornish, MD, founder of the Preventive
Medicine Research Institute, and others has convincingly
demonstrated that comprehensive lifestyle changes really
can reduce the risk that heart disease will develop and
sometimes can even reverse it.  Nonetheless, the ongoing
quest for the marker of the cause -- and, of course, the
highly profitable solution -- continues.

WHAT DO MARKERS TELL US?

Blood cholesterol: The association between blood
cholesterol and heart disease has been discussed, debated
and fine-tuned for years now. While elevated cholesterol is
a marker for heart disease risk, it seems that associated
factors causing it to oxidize can trigger the formation of
plaque. Cholesterol, therefore, is associated with -- but
doesn't necessarily cause -- heart disease.

C-reactive protein: The marker that most recently stirred
up excitement was C-reactive protein, but Dr. Chugh told me
that the more closely researchers examine its validity as
an important marker of cardiac risk,  the clearer it
becomes that it isn't particularly useful. He said it
merely affirms what doctors are able to ascertain from
measuring established risk factors. "It doesn't tell us
anything new -- it may turn out to be just another test
that is adding to health care costs," he said. 

Calcium score: Along the same lines, Dr. Chugh noted CT
cardiac scans also may be more widely used than is
necessary. "Calcium in plaque increases risk for heart
attack," he says, "but the ratio of cost and benefit for
this test may not be optimal."

Dr. Chugh notes that he does, however, continue to believe
there are important markers of cardiovascular risk that
research has yet to reveal.  "There are markers out there
that will come to light. We hope to find them," he says. He
believes the most promising avenue is genome research and
says there now are searches underway for both protective
and harmful genes.

MANAGING RISK In the meantime, Dr. Chugh emphasized that
research continues to fine-tune advice about how we can
lower cardiac risk. For instance...   
*Quitting smoking really makes a difference. Smoking is
known to lower HDL cholesterol, but the good news is that
after you stop smoking, levels of the good HDL start to go
up again.     
*Start strength training. The new advice  --  more vigorous
activity for less time (for example, jogging or running one
hour and 15 minutes total a week -- or  25 minutes three
days a week) plus two sessions of strength training each
week.  "We now know you need strength training for
increased muscle mass to help with balance and to
facilitate your ability