I've spent for three days at the 65th annual meeting of the American College of Cardiology in Washington, D.C.. Cardiologists from around the world are gathered here to present new research on cardiovascular disease. While the speech described Dr. Gary Gibbons, Director of the national heart, lung, and Blood Institute, a phenomenon I have much heard recently by doctors, the I in my role as editor in Chief of the Harvard heart letter have interviewed: the challenge of success.
What does that mean? Since 1950, the death rates from cardiovascular disease by 70%, thanks to two important trends are collapsed. One is the decline of smoking and improvements in cholesterol and blood pressure. The other is the boom in new therapies, including better medicines, operations and high-tech procedures, to repair an array of heart problems.
The challenge today is to find a new drug or procedure, which raises the already high bar,. "You want to test a new drug and show that it makes a difference, you have it compared to standard therapy," says Dr. Jorge Plutzky, Director of the clinic lipid / prevention and Co-Director of preventive cardiology at the Brigham and women's Hospital and faculty member at the Harvard Medical School. Standard therapy can contain up to five different medicines that already reduce heart attacks. This high standard can help to explain why not several large studies that show a performance presented at the Conference.
The following is a brief summary of two such studies and two with positive results - created buzz among experts at the meeting. All were online today in the New England Journal of medicinepublished.
Procedure for the persistent hypertension loses luster
A procedure, which doctors hope helps people with difficult to control - high blood pressure, not succeeded, his earlier promise. Renal denervationcalled, involves threading a thin wire (catheter) in the arteries to deliver the kidneys. A small device on the catheter tip provides bursts of energy, which some of the supply of the kidney, that blood pressure regulation is involved in damage nerves. But were in a strictly controlled study, whose Teilnehmer at least three drugs in control their blood pressure, not more effective than a sham procedure proved the renal denervation. Still, study guide, what Dr. Deepak Bhatt of Harvard affiliate Brigham and hospital (and medical editor of the Heart letter) says that he is cautiously optimistic renal denervation, remains an investigational drug in the United States.
No benefit from a targeted treatment reduce heart attacks
Another study tested a new drug called Darapladibto lower blood levels of fat and protein particles known as LP-PLA2 is designed. Higher blood levels of LP-PLA2 were linked to a higher risk of heart attacks and related problems. For the trial, more than 15,000 people with stable coronary heart disease either Darapladib or a placebo - fastened with a statin cholesterol and other heart-disease drugs to reduce.
During the follow-up, the nearly three and a half years lasted about the same number of people in the placebo and the treatment had a heart attack or stroke group, or died from cardiovascular disease. In other words, not much Darapladip.
Lowering cholesterol with an once monthly injection?
In the area of "promising but still preliminary", an injectable drug called Evolocumab , the levels of harmful LDL cholesterol is reduced by more than half. It belongs to a class of medications called PCKS9 inhibitors, work by promoting the ability of the liver to remove LDL from the blood. In a year-long study, the participants took a pen-like device to inject Evolocumab once per month. Some people took the drug alone, with changes in diet. Others took it in addition a statin or other cholesterol-lowering medication. In all groups of Evolocumab drastically reduced LDL. A separate investigation of the Evolocumab showed similar LDL lowering in people, not in a position to take a statin because of intolerable side effects.
But just because Evolucumab will not lower LDL means it prevents that heart attacks or lowers the risk of heart disease to die. "The proof of the pudding results show long-term studies on safety and efficacy,", said Harvard Professor Dr. Peter Libby, Chief of the heart-cardiovascular medicine at Brigham and women's Hospital, during a press conference on the research. These studies are underway, with results expected in a few years. Notable also: Statins generic very little cost that newer drugs are likely to be very expensive.
Replace defective aortic valve without surgery
For older adults with a stiff, otherwise aortic valve offers to replace a procedure known as Transcatheter aortic valve replacement (TAVR) a less-invasive alternative to surgery to the valve. TAVR delivers the new valve to the heart via a catheter in an artery in the bar thread and out-maneuvered then carefully into the heart. TAVR is currently only available for people, the too sick or frail admitted for valve replacement surgery as. Early touchstones for TAVR found that people, underwent had the procedure recovers faster, but undergoes a surgery in the face of a slightly higher risk of stroke than those. The new study found a lower risk of stroke in the TAVR group than in the surgery group presented at the ACC meeting. Support for the technology for more people who were receiving rather than people who a year later had surgery to life, TAVR.