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.
