Final thaughts from The American Heart Association 2011 meeting

on Friday, 18 November 2011.

Where we are and where we are going in the treatment of Heart Disease

The end of the 2011 American Heart Association meeting. It is good to think where we are. I think this has been a most interesting meeting. Heart medicine is moving into several new areas of treatment. My personal view is that Cardiac Surgery and Angioplasty are now mature techniques. Further improvements are likely to be marginal. We know that the ideal way to treat most heart attacks is to
open the blocked artery with a balloon as quickly as possible. For some cases changing the way we use blood thinners at the time of the procedure can increase the chances of success.

What is really exciting to me as a practicing cardiologist is that we are seeing the application of science to treat conditions for which we now have few options. We know that developments in the medical treatment of heart disease slow but do not stop its progress.

At this meeting it was clearly shown that statin drugs Atorvastatin and Resuvastatin used to lower cholesterol levels in the blood actually cause improvement in the
narrowings in the heart arteries which lead to angina and heart attacks. We now have evidence of benefit for the use of some additional drugs at an earlier stage of heart failure.

We heard of the development of Transcather Aortic Valve implantation - sometimes called TAVI. In this technique a new aortic valve is inserted into a patient through an artery - usually one at the top of the leg. This was first tried with very encouraging results in patients who were felt to be inoperable using conventional open heart surgery. More recently studies were done in patients who were considered operable but at high risk. The study showed better outcomes in this group. Over the coming years. I think research will tell us if this can be extended further into lower risk patients.

Less invasive surgery using a clip to repair leaky mitral valves was also discussed. It seems to me that there is still much work to be done to perfect this technique although there have been some positive results.

We had a lot of discussion of the use of a new generation of blood thinners taken by mouth and not needing regular blood tests to monitor their effect.
These are now licenced for use in the USA and Europe - and one, dabigatran, is currently being assessed by NICE in the UK. I suspect we are
going to see them very widely used in the next few years.

I think the most interesting work was the description of the first study of human stem cells to repair damaged heart muscle. This was an idea which seemed most improbable even 30 years ago. Now we are at the beginning of the actual use in man. I am sure we are going to hear a lot more about this in the next few years.

The other area that holds out much promise is the recognition that we do not yet understand all the factors which make us prone to heart disease.

Diabetes, raised cholesterol and raised blood pressure have all been known for some time. We know that there is no single gene that causes
heart disease but are beginning to understand that a number of genes are involved. Work is going on to measure the levels of some relatively simple
molecules in the blood which may act as additional "markers" of our risk of developing various diseases - so we may be able to treat earlier to
prevent or at least delay their onset.

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