Heart disease is the number one killer of men and women in the U.S., but game-changing new techniques and technologies may make it possible to predict and prevent heart disease—soon.
The clock is ticking
Since the 1950s, heart disease deaths have declined by a whopping 70 percent. That’s good news, but heart disease is still the number one killer in the United States, and the steady decline in deaths tapered off starting in 2011, says Nakela Cook, MD, MPH, chief of staff at the National Heart, Lung and Blood Institute (NHLBI) in Bethesda, MD, at an NHLBI-sponsored media conference in New York City.
Rates of obesity, high blood pressure, diabetes, and other risks are on the rise and becoming more prevalent in children, and that threatens to reverse all of our hard-won gains. Are you at risk?
Heart disease prevention? There’s an app for that
Activity tracking and calorie counting apps can help turn the tables on heart disease risk factors like obesity. Technology is also changing the way that people with heart disease communicate with their doctors, and this interaction may save the lives of countless others. Apps such as Omron Wellness allow users to transfer data from their blood pressure monitor to their smartphone, and they can review a month’s worth of readings with their doctor to get a much better picture of their progress over time. Other trials such as CONNECT-HF are harnessing technology to develop specific strategies that will make it easier to recover from heart failure. The trial, which will include 8,000 heart patients and their post-hospital wellness, involves regular check-ins by phone or text to see what interventions help and what doesn’t.
And ultimately this type of data may have even bigger applications, says Dr. Cook. “Medicine will be more like Google and Amazon, and we will be able to take the data we have collected from individuals to guide community health.”
Everything old is new again
Some heart medications that have been around for decades are incredibly effective at lowering risk for heart disease. Taking a daily baby aspirin is one of the ways to reduce the risk of heart attack and stroke. Another oldie but goody, Enalapril, is used alone or with other drugs to treat high blood pressure; combined with other medications, it can also treat heart failure, says Ileana L. Pina, MD, MPH, a professor of Medicine, Epidemiology, and Population Health at the Albert Einstein College of Medicine, and an Associate Chief for Academic Affairs at the Montefiore Medical Center in New York City. “It’s a superb drug and it is cheap. Newer isn’t necessarily better,” she says. “We can reverse your heart disease and reverse the chance of heart failure by 50 percent with available medications,” says Dr. Pina. Prevention and early detection also make a big difference.
We need the equivalent of breast cancer screening for the early detection of heart disease, says David C. Goff Jr, MD, PhD, NHLBI’s director of the Division of Cardiovascular Sciences. For a while, heart experts pinned their hopes on coronary calcium scans that use x-rays to identify calcium deposits in the arteries. Calcium deposits are an early sign of heart disease, but newer tests may spot heart disease even before calcification sets in. While not ready for prime time yet, computed tomography angiography (also called CT angiography or CTA) can detect narrowing of the arteries—one of the earliest signs of future blockages. “Right now this is being used to screen high-risk individuals, but we are trying to get the dose of radiation and cost down so it has a wider application,” he says.
New high blood pressure guidelines
Now that nearly half of Americans qualify as having high blood pressure thanks to new hypertension American Heart Association guidelines, doctors hope to help more people avoid heart disease. High blood pressure is now defined as readings of 130 mm Hg and higher for systolic pressure (the bigger number), and 80 and higher for the diastolic pressure. (The old guidelines were 140/90 and higher.) In addition, the prehypertension category is now non-existent. By casting a wider net, about 14 percent more people will be diagnosed with high blood pressure—and catching this heart disease risk factor earlier gives all of us a better shot at turning things around.
Inflammation is the new high cholesterol
Doctors now realize that inflammation can cause a number of diseases and conditions—and heart disease is on the list. The million-dollar question is whether lowering levels of inflammation will prevent heart attacks. An NHLBI study seeks to answer this pressing question. “Many medications lower inflammation levels, including an older drug called methotrexate (MTX), and the aim of this study is to see if MTX, which is taken orally and is inexpensive, can in prevent a heart attack,” Dr. Goff says. “We should have answers within four or five years,” he says. A new anti-inflammatory drug, canakinumab, slashed the risk of heart attack, stroke, and cardiovascular death in people who’d already had a heart attack, largely by cooling inflammation. People in the study had high levels of the inflammatory marker C-reactive protein (CRP) in their blood.
“These findings represent the end game of more than two decades of research, stemming from a critical observation that half of heart attacks occur in people who do not have high cholesterol,” says principal investigator Paul M. Ridker, MD, director of the Center for Cardiovascular Disease Prevention at Brigham and Women’s Hospital, Boston, US, in a news release.
Precision or personalized medicine is a buzz word in cardiology circles. This new way of thinking about treatment aims to eliminate some of the trial and error associated with prescribing medications by factoring in genetic characteristics. This has already changed the way many cancers are treated and is among the most groundbreaking cancer research of 2017. “If we target the people who stand to benefit the most, we will get better efficacy with fewer side effects. That’s the premise and the promise of precision medicine,” says Dr. Goff. So where are we today? Doctors know that finding the correct dose warfarin—prescribed to stave off a second heart attack—is based in part on genes that alter warfarin metabolism. And some people have genes that increase the likelihood that cholesterol-lowering statins will trigger serious muscle pain and weakness, according to research in Nature. This advance knowledge can result in smarter and safer medication use.