According to local doctors, two areas of advancements have been drastically changing the heart health field: Finding less invasive ways to perform heart procedures and focusing more on genetic therapies.
“Probably the biggest thing is TAVR, a way of replacing the aortic valve without having to do open heart surgery,” Donald Nardone, MD, cardiologist, UPMC. “We do them here.”
TAVR (transcatheter aortic valve replacement) is a minimally invasive surgical procedure that repairs the valve by wedging a replacement valve into the aortic valve’s place, according to the American Heart Association’s website.
While not necessarily a new procedure, it is being used for more patients.
“Initially it was for people who are very, very high risk for open heart surgery, but studies have been done and it has transitioned into a procedure available for patients in all risk categories,” Nardone said.
Benefits include a shorter hospital stay — usually in and out in one day — and a much quicker recovery. There is a question of durability, Nardone said: It is not yet known how long the valves will last and whether they would be a good option for younger patients.
John Pfeiffer, MD, cardiologist at Heart and Vascular Center of Evangelical, in Lewisburg, talked about leaky mitral valves, which don’t close properly, thus allowing some blood to flow backward into the heart. They can sometimes be treated with medication, but for severe cases, a new, tiny mitral clip can repair or replace the valve in a less invasive procedure than traditional open heart surgery.
“I think we’ll see more of that in the future, techniques of less invasive options,” Pfeiffer said.
Sandy Green, MD, associate interventional cardiology at the Cardiovascular Center for Clinical Research, Geisinger Medical Center, in Danville, agreed.
“The name of the future is two-fold,” he said. “I think we’re going to be able to do a lot to keep people from having a heart attack or having valve problems or heart failure because of advances in medicine. And we’re going to be able to fix a lot of those problems without having to do open heart surgery.”
Prevention a priority
Newer medications will help patients control cholesterol and other heart issues.
“Finding ways to lower the risk of having a heart attack, stroke or other potentially fatal cardiovascular problem is a priority for researchers,” Nardone said.
He pointed out the benefit of a new class of medications that includes the PCSK9 inhibitors, a twice-monthly injection that can achieve a 50 percent drop in cholesterol levels.
“These drugs affect cholesterol numbers and also reduce the risk of heart disease and stroke,” Nardone said.
“They’re good for people who can’t take statins or are on a high level of them. They’re very, very effective, so that’s pretty exciting for the treatment of cholesterol.”
Pfeiffer mentioned Repatha, a PCSK9 inhibitor that he has prescribed to patients.
“I’ve seen good results in terms of lowering cholesterol,” he said. “The problem is, it’s expensive.”
The American Heart association now suggests a more aggressive treatment of high blood pressure, which is probably the number one risk factor for stroke, heart disease or kidney failure.
“Treating the blood pressure to a normal level has become more important,” Nardone said.
Sorting through statistics
About 5.7 million adults in the United States have heart failure, according to the Center for Disease Control.
“Heart failure occurs because the heart doesn’t pump well, or because it doesn’t relax and fill properly with blood,” Nardone said, adding that the drug Entresto helps people who have a bad heart pump.
Today, Nardone said, overall incidences of heart disease have somewhat declined, but he fears that trend may reverse because more young people are smoking and dealing with obesity and diabetes. “I hope that we don’t see that trend start to reverse itself.”
“Most cardiac conditions increase with age,” Pfeiffer said, noting that as the Baby Boomer generation ages, incidences of heart disease will increase. “People used to die of heart attacks in their 60s.”
People with heart disease are now living longer and having a better quality of life than they used to.
“When we started doing stents, there’s no question we saved a lot of lives,” Pfeiffer said. “That’s the really exciting thing with medicine, I think, where we can say we saved your life with this treatment. Those kinds of things really make you feel great about the medical field.”
“In general, the incidence of heart disease is still very common, but at least for a while there it was heading in the right direction,” Nardone said. “And for people who do have heart disease, it’s not always a terminal diagnosis anymore. The treatment for valve problems, heart failure, coronary disease, that’s gotten to the point where there’s much more that you can do for people.
“I would say the incidences of heart disease are fewer, but maybe as a society we don’t take as good care of ourselves as we should.”
Something the average person doesn’t have to worry about is dealing with cancer and cardiovascular problems at the same time. But with the advancements in the treatment of cancer with targeted medications, new cardiology problems have arisen.
Targeted medications attack specific molecules inside cancer cells, causing little or no damage to healthy cells.
But all drugs have side effects, and among those of targeted meds are heart problems.
This has led to a new field that Nardone is interested in: cardio oncology, with an emphasis on trying to assess the risk of having heart complications during targeted medication treatment.
Doctors in this field would collaborate with a patient’s family doctor and oncologist to find ways to prevent or treat heart complications during targeted medication treatment “to get them the cancer treatment they need and try to minimize the possibilities of cardiac side effects,” Nardone said.
Steps for success
All three doctors emphasized that it’s better to avoid heart problems than to treat them.
“If we take care of ourselves … then that’s the most important, the best thing,” Nardone said.
“We’ve got to get people off the couch and get out and enjoy the outdoors as much as possible. If I could stress anything, it’s much better to prevent heart problems than it is to treat them.”
“No. 1, don’t smoke,” Pfeiffer said. “No. 2 would be regular exercise, and then a healthy, common-sense diet. Keep on top of risk factors like hypertension and diabetes. Make sure you keep those types of things controlled.”
He and Green both mentioned the emerging studies of genetic medicines to keep hearts healthy by controlling risk factors like diabetes, high blood pressure and cholesterol.
“The two things I’m optimistic about are artificial intelligence in medicine,” Pfeiffer said, “and genetic therapies for conditions that have an underlying genetic basis.”
“I think we’re going to be able to regrow heart tissue, as well,” Green said. “I think that’s the future of cardiology. I mean, when that stuff gets here, it’s going to make the stuff we’re doing now look like we’re in the Stone Age.”