The electric thimble that detects the signs of heart disease YEARS before you feel ill...



We all know we should probably eat more healthily, take more exercise and cut back on alcohol, but unless there’s something obviously wrong, most of us blithely carry on.



That might change, thanks to a test that picks up the very first signs of heart disease, diabetes and even impotence by measuring the health of your artery walls.



Currently, the first warning signs of heart trouble are raised blood pressure, high cholesterol or excess clotting.



These are the problems GPs check for — but often by the time you have these symptoms, you are already on the road to heart disease.

The Endo-Pat could help patients at raised risk of heart disease because of their family history — yet who don’t have any other warning signs

However, a better early warning device could soon be available.



The Endo-Pat consists of two thimble-sized sensors that are placed over the index fingers to detect irregularities in blood flow.



These changes are a sign of damage to the lining of the blood vessels, the ‘endothelium’.

‘Heart problems begin in the endothelium,’ explains John Deanfield, professor of cardiology at Great Ormond Street Hospital, London, and a leading expert in cardiovascular diseases.



‘This is where signs of damage can show up long before the first symptoms appear. Testing the endothelium could allow us to spot who’s at risk and start treating them earlier.’



Testing the endothelium might also provide an early warning sign of other cardiovascular problems, such as impotence (caused by restricted blood flow to the genitals).

Early warning sign



It could also help patients at raised risk of heart disease because of their family history — yet who don’t have any other warning signs.

And, just as importantly, an endothelium test could be a valuable way to hammer home the risks.



‘People are reluctant to change their lifestyle when they don’t feel ill,’ says Dr Barry Zaret, a cardiologist at Yale University and an adviser to the manufacturer.

‘But if you can show proof of early damage with a test, they’re more likely to take it seriously.’

The role of the endothelium has only recently been discovered — until now, the focus has largely been on restoring blood flow in blood vessels damaged by heart

disease.

The Endo-Pat: Ttwo thimble-sized sensors are placed over the index fingers to detect irregularities in blood flow

But scientists have found that the lining of the blood vessels regulates

our levels of nitric oxide; this gas is important for stabilising blood pressure, stopping excessive clotting and preventing fat build-up.



In other words, if the endothelium isn’t working properly, you’re likely to suffer from high blood pressure and other cardiovascular problems.



Even children can be affected. ‘We’ve done studies that have found endothelium dysfunction (ED) in children as young as ten,’ says Professor Deanfield.



While lifestyle factors such as diet, smoking and lack of exercise are to blame, he has found other surprising causes.



‘Infectious disease, especially gum disease, can cause ED and so can mental stress.



‘Stress is often not considered as a classic risk factor for heart disease, but this new understanding of endothelium suggests how psychological factors have an effect.’



For a number of years, researchers have measured endothelial function using ultrasound, but the equipment is cumbersome.



The Endo- Pat, however, could be used in GPs’ surgeries.



The device is made in Israel by Itamar Medical and the company claims it is being used in research centres in more than 40 countries.



Last July it was approved for use in Japan’s national health insurance plan. It is also being used at the prestigious Mayo Clinic in the U.S.

No more unnecessary treatment



As well as identifying sooner those at risk of heart disease, a reliable ED test could help weed out people who don’t need treatment, says Dr Dermot Neely, chair of the Medical Research and Scientific Committee of the charity HeartUK.

‘It would also be useful to be able to identify people with highly resilient endotheliums. The ones who are going to live to 80 whatever risk factors they’ve got.’

But is the Endo-Pat the key? While there is no doubt about the need now to focus on the endothelium, British experts such as Dr Neely believe the device itself needs

more testing of its reliability.



Meanwhile, the Mayo Clinic is now carrying out research to find drugs and nutrients that repair the damage.



Professor Amir Lerman, expert in cardiovascular diseases at the Mayo Clinic, is looking at the dietary supplement L-arginine, an amino acid the body uses to produce nitric oxide.

He’s also been investigating green tea and various antioxidants. Another treatment option is with drugs such as statins and hypertension drugs, known as ACE inhibitors.



An even more radical approach is being taken at the University of Maryland school of Medicine, which has published a study showing that listening to ‘joyful’ music improves the way the endothelium works.

Professor Chim Lang, consultant cardiologist at the University of Dundee College of Medicine, says the Endo-Pat holds out the possibility of being able to track any treatment to see how effective it is.



The Endo-Pat is being used at 46 UK centres, mostly still for research.

■ See www.itamar-medical.com.