Top 10 Advances in Cardiology (AHA)
1. In selective high-risk groups, additional therapies help prevent a second stroke: Previous research has shown that to prevent a second stroke, “aggressive medical management” — treating and controlling high cholesterol, high blood pressure and blood sugar, as well as lifestyle behaviors such as smoking cessation and exercise — is better than stenting. But a study, SAMMPRIS, published in JAMA identified a subgroup of patients at higher risk for a recurrent stroke despite this medical management – and who need stenting. Investigators found that high-risk patients included those who had an old stroke in the area of the blockage, a new stroke or were not on a statin at the time they joined the study.
2. New possibilities for treating women with heart attacks: The study, in the American Heart Association’s journal, Circulation: Cardiovascular Imaging, found that women had a type of plaque thought to be vulnerable throughout the blood vessels, while in men, they were mostly found in the earliest part of the artery. The way plaques “broke” often was different as well. Men had larger size plaques even though the women in the study had more cardiovascular risk factors.
3. More options for valve replacements in the elderly: In high risk patients with aortic valve stenosis, treatment means either open-heart surgery or transcatheter aortic valve replacement. This study, which focused on older patients, compared surgery and TAVR by looking at the survival and stroke rates of intermediate-risk patients. The research, published in the New England Journal of Medicine, showed the rates were similar and that use of either procedure would produce similar outcomes.
4. Long-term study validates less-selective invasive treatment for narrowed neck arteries: In the past, the typical treatment for carotid arteries narrowing was carotid endarterectomy. And now, research, CREST study published in the NEJM and based on a 10-year follow-up, gives stenting more validation as an accepted alternative.
5. Better together: Managing blood pressure and cholesterol at same time helps lower heart risk: This research, called HOPE 3, is a combination of three articles published simultaneously in the New England Journal of Medicine that, taken together, conclude that reducing both blood pressure and cholesterol is better than doing either alone. It also provide further evidence supporting the benefits of statins in Asian and Hispanic populations.
6. Evidence we might be able to outsmart our genes: A study in NEJM found that among participants at high genetic risk for cardiovascular disease, a favorable lifestyle was associated with a nearly 50% lower relative risk than those with an unfavorable lifestyle that included smoking, obesity, lack of exercise and poor diet.
7. Disparity in counseling women and minorities with heart failure: Implantable cardioverter defibrillator (ICD) can be lifesaving by preventing sudden death in people with severe heart failure. But, according to this study of 21,000 patients published in Circulation, women and minority patients eligible for the device far too often aren’t counseled about it. The findings show as many as four out of five hospitalized patients with heart failure eligible for ICD counseling did not receive it, particularly women and minority patients.
8. Fainting could be a sign of pulmonary embolism in some patients: NEJM: In the past, fainting had not been considered high on the list of signs and symptoms pointing to PE. But researchers in the PESIT study used a diagnostic workup to assess the presence of the embolism and found it was present in about one out of six, or 18 percent, of the patients.
9. Advancing the treatment of severe strokes: This meta-analysis of patient data from five landmark trials shows the benefits of stent retrievers that snare large clots from the brain. The research published in The Lancet consolidates work that means providing timely treatment for these patients could have a global impact.
10. Two studies move the needle toward better prevention of heart disease:
· Lowering blood pressure to below 120/90, compared with 140/90, led to significantly lower rates of death and “cardiovascular events” among adults age 75 and older. The study, published in the Journal of the American Medical Association, extends the results of the recent SPRINT trial and could help clear up inconsistencies in how doctors set blood pressure targets for geriatric populations.
· Also this year, investigators in a separate project identified a gene variant that determines whether a carrier may have a lower risk of coronary heart disease than those without the gene variation (NEJM). This gene, called ANGPTL4, governs the action of lipoprotein lipase, or LPL, which plays a critical role in breaking down a type of fat in the blood produced by the liver, called triglycerides. High triglyceride levels are a contributor to heart disease risk. In this study, people with a specific genetic variation in the ANGPTL4 gene had lower triglyceride levels, higher “good” HDL cholesterol levels, and lower coronary artery disease risk than those who did not have the mutation.