| Reducing risks, improving medical
treatment and improving lifestyle behaviors key findings of cardiovascular research
in 2010 Research on reducing risks, improving medical treatment and improving lifestyle behaviors to fight the battle against heart disease and stroke are among the key scientific findings that make up this year's top cardiovascular and stroke research recognized by the American Heart Association/American Stroke Association. "We have come far in the past decade, reducing heart disease deaths by more than 27 percent and stroke deaths by more than 44 percent," said Ralph Sacco, M.D., president of the AHA and chairman at the department of neurology for the Miller School of Medicine at University of Miami. "But we know there is still much to be done in improving the lives of heart disease and stroke patients - and more importantly, in preventing these devastating diseases in the first place. Scientific research will help us lead the way. " Top Ten Advances in Cardiovascular Research in 2010 (in no ranking order): 1. Tailoring treatment for people with diabetes to reduce their risk of cardiovascular disease Heart disease death rates are two to four times higher for people with diabetes compared to people without diabetes. New research from the ACCORD Study Group offers insight into specific treatments that can reduce the risk of cardiovascular disease (CVD) in this group. The first study found that aggressive blood pressure control does not reduce CVD risk in people with type 2 diabetes at high risk for CVD. In a second study, a combination therapy with a statin plus a fibrate was no better at reducing risk than a statin alone in patients with type 2 diabetes at high risk for CVD. However, the combination lipid therapy may be successful in reducing CVD risk in those type 2 diabetes patients who had low HDL cholesterol and low triglycerides. These results will be helpful for targeting specific treatments that best reduce CVD risk in people with diabetes. The ACCORD Study Group - New England Journal of Medicine, March 14,2010; N Engl J Med 2010;362:1575-85. N Engl J Med 2010; 362:1563-74. www.nejm.org; Funding: National Heart, Lung, and Blood Institute and other National Institutes of Health divisions. 2. New advances for patients who aren't candidates for conventional valve surgery Many patients with severe aortic blockage have other medical conditions that make it risky for them to have conventional surgery to replace the blocked aortic valve. Transcatheter aortic valve implantation (TAVI) is an emerging alternative therapy to open-heart surgery in these high-risk patients. Two new studies support the evidence that TAVI can improve symptoms and outcomes - including quality of life - even over the course of several years. While there are some risks associated with TAVI, including strokes and other major cardiovascular events, the catheter-based procedure offers significant progress in this area. PARTNER Trial Investigators - New England Journal of Medicine,
Sept. 22, 2010; N Engl J Med; 363(17):1597-607. www.nejm.org;
Funding: Edwards Lifesciences. 3. Improving the way we reverse sudden cardiac arrest More than 300,000 people suffer out-of-hospital sudden cardiac arrest each year. Many die because the people around them didn't know how to or were uncomfortable performing cardiopulmonary respiration (CPR). Significant studies now report that chest compression only, or 'Hands Only CPR' for adults by bystander lay rescuers improves survival outcome. Public awareness campaigns resulted in increased use of hands only CPR, as well as improved survival rates. While the new procedure appears successful in adults, it is important to note that using conventional chest compressions with rescue breathing is still important for children stricken with sudden cardiac arrest. In October, the American Heart Association issued updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science, reflecting new advances in this field. Bobrow, et al - Journal of the American Medical Association,
Oct. 6, 2010; JAMAwww.jama.com;
Funding: Support from Medtronics Foundation;304(13):1447-54; 4. More options for reducing stroke risk in atrial fibrillation For the first time in more than 20 years there are viable alternatives to the primary prevention of stroke for patients with atrial fibrillation (AF). AF is a major risk factor for stroke and affects more than 2 million people over the age of 65. Coumadin has long been the standard anti-clotting drug used to reduce the risk of stroke for these patients. But it carries its own complications from bleeding, and managing the dose requires regular blood tests, making it difficult to manage for both patients and doctors. Now, several new drugs have been found to work as well as warfarin - and are simpler for patients to take - offering an important advance in this field. In October 2010, following further positive findings from the RE-LY trial, the U.S. Food and Drug Administration approved dabigatran for stroke prevention in AF patients. The ROCKET-AF trial presented at the American Heart Association's Scientific Sessions 2010. Rivaroxiban, apixiban, edoxaban and other oral anticoagulants are being or have been studied in AF and may show future promise. RE-LY - Lancet, Sept. 18, 2010; Lancet. 2010 Sep 18;376(9745):975-83;
www.thelancet.com. Funding:Boehringer
Ingelheim. 5. Adjusting pacing therapies can improve outcomes for heart failure patients Many heart failure patients experience arrhythmia. There are a number of devices available to treat arrhythmia, including implantable cardioverter difibrillators (ICDs), which can shock the heartbeat back into a normal rhythm. New studies show that adding additional resynchronization pacing to ICD therapy can lead to improved outcomes in an expanded group of heart failure patients. In addition, new types of ICDs (defibrillators without leads, for example) can offer options that reduce some of the risks associated with traditional devices. MADIT-CRT Trial Investigators - New England Journal of Medicine,
Sept. 1, 2009; N Engl J Med;361(14) 1329-1338. www.nejm.org;
Funding: Boston Scientific. 6. Hopeful new procedure for infants with congenital heart disease The Pediatric Heart Network's randomized trial of Norwood shunt types in infants with single-ventricle lesions showed that the type of shunt used makes a difference in outcomes. Better transplantation-free survival at 12 months is a possibility with this new understanding of the better shunt choice for these patients. This was the first large-scale randomized trial in congenital heart surgery, offering an approach that should provide answers to other questions in the future. Pediatric Heart Network Investigators - New England Journal of Medicine, May 27, 2010; N Englwww.nejm.org; Funding: National Heart, Lung, and Blood Institute. J Med; 362:1980-1992. 7. Finding the right anti-platelet therapy Selecting the right type of anti-clotting drug and the right dosage can be tricky, and risky. New research from the PLATO investigators has found that ticagrelor may improve outcomes and reduce adverse events better than the current standard, clopidogrel. The CURRENT-OASIS 7 Trial is exploring the optimal dosing of clopidogrel and aspirin in patients undergoing invasive surgery. These studies will help providers better understand the situations where new choices and dosages may improve results for the patient. PLATO Investigators - Lancet, Jan. 14, 2010; Lancet 2010;375:283-93. www.thelancet.com;
Funding: AstraZeneca. 8. Basic science findings offer insight into future progress Several studies this year brought the future of medicine closer to the present with new insight into emerging technologies. Findings from stem cell therapy have shown improved quality of life and survival in several early studies of patients with chronic heart failure and support the development of future cell-based therapeutics. A large animal study defined the basic mechanisms for heart muscle regeneration initiated by specific types of stem cells. The results demonstrated that these stem cells repair scarred myocardium through promotion of the generation of new heart muscle and blood vessel). A second study supported the notion that the heart has the capacity to regenerate large numbers of heart muscle cells several times during its lifetime. Being able to directly reprogram stem cells into working heart muscle is a big step toward use in therapeutic settings. The STaR-Heart Study showed that injecting the patient's own bone marrow stem cells into the heart improved hemodynamics and long-term survival in the treatment of chronic heart failure. Hatzistergos, et al - Circulation Research, July 29, 2010;
Circ Res.;107(7):913-22. http://circres.ahajournals.org;
Funding: National Heart, Lung, and Blood Institute. 9. Using science to support healthy lifestyle behaviors New science examining lifestyle behaviors in adults and children, with particular emphasis on physical activity and consumption pattern, show that such conditions as obesity and hypertension are positively influenced by a change in diet with decreasing sodium levels. Results from the school setting suggest that the earlier one starts to adopt healthy behaviors the better the effect on health outcomes. Furthermore, physical activity is an important lifestyle factor in improving cardio-metabolic factors, especially in those trying to reduce weight. Bibbins-Domingo et al - New England Journal of Medicine, Jan.
20, 2010; N Engl J Med 2010;362:590-9. www.nejm.org;
Funding: American Heart Association Western States Affiliate; University of California,
San Francisco Clinical and Translational Sciences Institute 10. Get With The Guidelines participation eliminates disparity gaps in care Racial and ethnic disparities have been found in the quality of care delivered to patients with cardiovascular disease and achieving equity and addressing disparities has implications for quality, cost, risk management, and community benefit. These findings are the first to show that participating in a quality improvement program, such as Get With The Guidelines-Coronary Artery Disease, can eliminate racial and ethnic disparities of care while increasing the overall use of evidence-based care for heart attack patients. Cohen et al - Circulation, June 1, 2010; Circulation;121(21):2294-301;
http://circ.ahajournals.org;
Funding: GWTG-CAD is supported by the American Heart Association in part through
an unrestricted education grant from Merck/Schering-Plough Partnership. |