Promising basic science, new devices, improved protocols and prevention hold the potential to upgrade outcomes.
By Cindy Sanders
The science, basic understanding and treatment protocols of cardiovascular disease and stroke have come light years in a matter of decades. Yet, heart disease remains the number one killer of both men and women in America and stroke, a leading cause of disability.
The 2013 statistical update from the Centers for Disease Control and Prevention (CDC), American Heart Association (AHA) and National Institutes of Health (NIH) notes that approximately 600,000 people die from heart disease in the United States each year—that is one of every four deaths. Additionally, more than 795,000 Americans suffer a stroke annually. While mortality rates have improved, nearly one in every 18 deaths is still attributable to stroke.
While turning the tide on America’s top killer remains a daunting task, researchers have much to celebrate when it comes to improved treatments, earlier detection and better options for primary and secondary prevention. Each December since 1996, the AHA has compiled a list of top 10 advances from the year. For 2012, resuscitation, cell regeneration, a new high blood pressure treatment and developments in stroke devices were listed among the year’s key scientific findings.
No. 1 Extended CPR Saves Lives
A study of hospitals using the Get With The Guidelines resuscitation quality improvement program found higher survival rates among cardiac arrest patients who received CPR for longer times compared to those hospitals with shorter duration rates.
Patients at hospitals with the longest median duration of 25 minutes for resuscitation efforts had a 12 percent higher likelihood of being revived than those at hospitals with the shortest median time of 16 minutes. While more research is needed, the study raises interesting questions that could change standard medical practice.
No. 2 Converting “Non-Beating” Heart Cells into “Beating” Ones
The emerging frontier of myogenesis holds great promise that damaged or lost heart muscle due to congenital defects, heart attack or other disease might one day be replaced. Two studies in mouse models published in 2012 demonstrated methods to reprogram readily available cardiac fibroblasts into beating heart muscle cells in vivo. The authors concluded their findings suggest a potential regenerative strategy in the human heart.
No. 3 Biopsied Heart Cells
Two separate human trials showed that cells from heart biopsies could be purified and replaced in the patient’s heart with improved heart function and reduced scarring.
One phase 1 trial used an infusion of autologous cardiac stem cells resulting in patients typically having improved LV systolic function and reduced infarct size. The second phase 1 trial used cardiosphere-derived stem cells on patients following a heart attack. In comparison with the control group at six months, those receiving infused CDCs showed reduction in scar mass, increases in viable hart mass and regional contractility, and regional systolic wall thickening. However, there were not notable differences in end-diastolic volume, end-systolic volume and LVEF between the two groups at six months, and the experimental group had more serious adverse events than the control group.
No. 4 “Disconnecting” the Kidneys to Treat Hypertension
A hyperactive sympathetic nervous system is believed to be a major contributor to hypertension. Four recent studies have concluded that renal denervation is a safe and effective means of lowering high blood pressure that has proven to be resistant to other treatments.
No. 5 Pediatric Progress in Transplant Bridging, Kawasaki Disease
A U.S. study highlighted a new procedure to dramatically extend the life of children under the age of 16 awaiting a heart transplant. Traditionally, the children would have been placed on an ECMO device, but the study showed the smaller ventricular assist device (VAD) might buy significantly more time for these children. The longest duration on the Excor pediatric VAD (Berlin Heart) was 192 days as compared with 28 days on ECMO (using data from previous heart failure patients with similar disease and severity).
A Japanese study found a new, highly effective treatment to prevent coronary abnormalities in children suffering from the rare but fatal autoimmune disorder Kawasaki disease, which causes inflammation and long-term damage to blood vessels. In the randomized study, the experimental group received prednisone in addition to the standard intravenous immunoglobulin given to the control group. Incidence of coronary artery abnormalities was 3 percent in the prednisone group vs. 23 percent in the control group.
No. 6 Say “No” to Sugary Drinks
Two clinical trials in 2012 provided definitive evidence of what was intuitively known— consuming sugar-sweetened beverages is linked to overweight and obesity. Randomized controlled studies out of the Netherlands and United States both found reducing the consumption of sugar-sweetened beverages reduced or slowed weight gain and fat accumulation in children and adolescents.
No. 7 Global Health Impact of ECHO Screening
Rheumatic heart disease is a global health issue effecting more than 15 million. Using ECHO screening in a clinical trial in Uganda caught three times as many children with rheumatic heart disease than the traditional use of a stethoscope only.
No. 8 New Stroke Devices
Recent clinical trials found SOLITAIRE and TREVO devices to be more effective at clearing blocked blood vessels in the brain than the MERCI device.
However, the randomized, multicenter CLOSURE trial found that percutaneous devices used to close small holes between the upper chambers of the heart in certain stroke populations didn’t prevent subsequent strokes any better than less invasive standard medical therapy.
No. 9 Benefits of Ideal Cardiovascular Health
Two studies in 2012 highlighted the huge impact of modifying behaviors to decrease the risk of heart disease and stroke. Ideal cardiovascular health is determined by seven components — not smoking, getting regular exercise, consuming a healthy diet, and achieving normal ranges for body mass index, cholesterol, blood pressure and blood glucose.
In a meta analysis using data from 18 cohort studies, researchers found marked lifetime risk differences for those with an optimal risk-factor profile that held true across gender and race. For 55-year-old men who achieved ideal cardiovascular health, the risk of death from cardiovascular disease through age 80 compared to those who had two or more of the major risk factors was 4.7
percent vs. 29.6 percent. For women, the risk was 6.4 percent vs. 20.5 percent.
In a second study from the CDC, researchers found “the number of ideal metrics was significantly and inversely related to mortality from all causes and diseases of the circulatory system.” Compared to those who met none of the seven ideal metrics, those who met five or more had a 78 percent reduction in risk for all-cause mortality and an 88 percent reduction in risk of death from circulatory diseases.
No. 10 Bypass vs. Drug-Coated Stents for Diabetics
A large clinical trial found diabetic patients with multiple clogged arteries fared significantly better when treated with bypass surgery than with drug-coated stents. The bypass group was less likely to die or have a heart attack within five years compared to those receiving drug-coated stents.
However, other researchers have pointed out the statistics for this trial were mainly gathered from diabetics with triple vessel disease and that additional research needs to be conducted on diabetic patients with single or double vessel disease.