January 2025

Composite Score of 3 Heart Disease Biomarkers Excels

High-sensitivity C-reactive protein (CRP), low-density lipoprotein (LDL, the bad cholesterol), and lipoprotein (a) levels (LPa) are valuable, and treatable, predictors of 5- and 10-year risk for cardiovascular events. However, the ability to predict risk over longer periods of time could yield earlier treatments and reduced risks of morbidity and mortality.

A study of 27,939 women over a 30-year period attempted to consolidate those three biomarkers to see if it predicted risk. The primary endpoint was “a first major adverse cardiovascular event” like a heart attack, stroke, or death.

The average age at baseline was 54.7 years. Over 3600 events occurred during the study period. “Each biomarker showed independent contributions to overall risk” but the best predictor “incorporated all three biomarkers.”

This finding highlights the shift away from over-dependence on LDL cholesterol levels that clinicians manage with statin therapy. That systemic inflammation, as measured by CRP, and a genetically-determined blood lipid fraction (LPa) independently provide powerful predictive value, doctors now have more rationale to combine pharmacological therapies that reduce inflammation. For example, one common “anti-inflammatory agent, low-dose colchicine, was recently approved by the FDA for reduction of atherosclerotic events.” While no drugs yet have been approved to manage LPa, its addition to the long-term prediction model encourages healthcare providers to initiate treatment well in advance of such events.                             

NEJM Aug. 2024

Differential Benefits of Hip vs Quads Exercise for PFPS

Patellofemoral pain syndrome, or PFPS, is, like all medical syndromes, a composite of pathologies or maladies that fit under the umbrella, in this case, of anterior knee pain. There are many hypothesized factors that effect pain of the knee cap such as iliotibial band syndrome (ITB), bursitis, synovitis, etc. However, over the past 25 years or so, a consensus has developed around a therapeutic model that emphasizes strengthening the gluteus medius (Gmed) since so many exercises for the anterior thigh muscles – the quadriceps, or quads – only seem to aggravate the anterior knee itself. A recent study attempted to discern the effect of a 12-week hip-focused (HE) vs a quad-focused (QE) exercise program on pain and function in patients with PFPS at 12- and 26-weeks.

Two distinct patterns evolved. Those with more pain catastrophizing (greater fear of pain with movements that might exacerbate pain) seemed to benefit more from HE. A subgroup with a body mass index of 25 or more (overweight/obese) also benefitted more from HE. Those with more severe pain at baseline seemed to benefit more with QE.

It might be that one’s attitude toward pain and function is best managed by focusing on a body part that is not directly linked to the source of pain itself. For those who have more extreme pain, strengthening the muscles that control the joint – if you can find a safe, pain-free way to do so – might confer greater benefits in the long run. Logically, one could  conclude it’s valuable to do both HE and QE with the different therapeutic foci depending on how patients experience pain itself. 

JOSPT Nov. 2024

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