“The key to all of cardiovascular disease is prevention,” said John T. Eagan, Jr., MD of CardioVascular Associates in Birmingham, “because once you have the disease, it’s too late. You have the disease, and it’s chronic and becomes a situation where it’s not curable. Once you’ve developed it and then you’re treated, you’re looking at a lifelong treatment.
“The best way to extend your life is to get it early and prevent the disease before it takes off. The way you prevent it is to address the risk factors. If you have multiple risk factors, you need aggressive early treatment, including medical therapy, even as what we call primary prevention.”
Mortality Rate Reduced
Cardiovascular mortality rates have declined dramatically over the past 20 years. According to Eagan, there are multiple reasons for the decline, prevention being number one. In this regard, he cited the treatment of risk factors, like smoking, as well as treatment of hypertension, hyperlipidemia and elevated cholesterol, along with better treatments for diabetes and the screening of high-risk patients.
“There also are other things that are done medically,” Eagan said, “including medications and revascularization, that have impacted overall death from cardiovascular diseases. Those things would be new medications: anticoagulant medications like blood thinners, medicines for hypertension. There have been a number of studies that have shown reduction in mortality with certain anti-hypertension medications, including ACE inhibitors and beta-blockers. The treatment for hyperlipidemia has dramatically reduced cardiovascular mortality using statins such as Lipitor and Crestor.”
Advances in Diagnosis and Treatment
In addition to prevention and medical treatment, cardiologists have better ways to diagnose the disease earlier and determine appropriate treatment.
“There have been innovations in stress testing, echocardiogram, ultrasonography and imaging with CAT scans and PET scans,” Eagan said. “CT and PET technology has rapidly advanced where we have better detection of this disease at an earlier time in its course. We can treat earlier and then affect outcomes.
“In addition to that, we’ve had incredible changes in revascularization strategies,” including:
- The da Vinci robot, which offers less invasive surgical revascularization techniques with lower risk and better outcomes for patients who are not candidates for medical treatment or interventional therapy.
- Improvements in drug-eluding stents and all stent types in angioplasty.
- Developments of stents for other uses, such as PAD and carotid disease, that have decreased the overall risk of procedures and improved outcomes.
- Other percutaneous devices for heart disease, including shunt closure devices that can be placed without open surgical techniques. Eagan said, “On the horizon, from that standpoint, are percutaneous valve replacements, valves that can be put in through a sheath without doing open cardiac surgery to replace someone’s diseased cardiac valve.”
Pacing
“We now have biventricular pacemakers, which resynchronize cardiac conduction and do well for patients who have congestive heart failure and cardiomyopathies,” Eagan said. “They can improve these patients’ symptoms. There’s continued development in technology of defibrillators. These defibrillators show over and over again that they improve lives and reduce the risk of sudden cardiac death.”
He added, “Also in the line of pacing we have improvements in catheter ablation techniques. We can ablate the sources of arrhythmia such as ventricular tachycardia and atrial fibrillation. This is rapidly developing and improving where we can treat atrial fibrillation, which has been very difficult to treat in the past. We now have a technique that can cure you of this common disease.”
Obesity and Sleep Apnea
Two related hot topics in cardiology are obesity and sleep apnea. Eagan said CardioVascular Associates is screening more obese patients for sleep apnea than in the past.
“Obesity is one of our risk factors that is ever increasing, certainly in the United States,” he said. “And along with obesity, we’re seeing increased incidence of sleep apnea. Patients that have sleep apnea have a higher risk of cardiac diseases and sudden cardiac death. So there’s an impetus now to tackle the obesity problem in the United States and also to treat more aggressively sleep apnea, which goes along with the obesity problem, to reduce risk of cardiac death and other conditions associated with that.”
Upcoming Developments
A number of improvements in pharmacology affecting cardiovascular health are expected. Although Pfizer stopped development of its HDL-raising drug torcetrapib because of increased risk of hypertension, Eagan believes the new drugs will be developed to raise HDL, the good cholesterol, further reducing cardiovascular events.
He added that Cardiologists are waiting for stem cell research to mature. “Stem cell research is rapidly being developed,” he said. “There is potential for a number of cardiovascular applications for use of stem cells, such as repair of damaged hearts, of cardiomyopathies, and to improve cardiac output and cardiac function in patients that have irreversibly damaged hearts.”
He went on, “They’re going to be able to develop and make blood vessels with stem cell research to replace peripheral vessels, arteries, aortas and coronary arteries. So stem cell research stands on the horizon as a huge development that could impact the treatment of cardiac disease in the future.”
Eagan said although is it difficult to keep up with all the developments in cardiology, the information is now easier to obtain.
“We can easily access the new data instantaneously in this instant-information age that we live in through the Internet.”
February 2008
