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Top Heart Disease Treatment And Prevention Advancements In 2023
As 2023 comes to a close, cardiologists are reflecting on some of the advancements and breakthroughs in their field over the past 12 months.
Heart disease is a pressing issue in the United States. The American Heart Association reports that more than 130 million adults (about 45.1% of the population) will develop some form of cardiovascular disease by 2035, which will lead to $1.1 trillion in projected total costs.
This reality means researchers and clinicians are invested nationwide in developing better interventions and treatments to address the rising prevalence of heart disease among Americans.
To put in perspective how serious this is, heart disease stands as the leading cause of death regardless of gender and spans most racial and ethnic groups in the United States, according to the Centers for Disease Control and Prevention (CDC).
Heart disease kills one person for every 33-second interval nationwide.
Healthline spoke with several experts who weighed in on the major breakthroughs and innovations of the past year as well as promising developments on the horizon in 2024.
Dr. Joseph C. Wu, Ph.D., FAHA, American Heart Association president and director, Stanford Cardiovascular Institute and Simon H. Stertzer Professor of Medicine & Radiology at Stanford School of Medicine, said that glucose-lowering drugs have been a game changer for people with type 2 diabetes, helping them to reduce cardiovascular events and improve their heart health.
Research is now suggesting these same drugs may also improve heart health in people with obesity who aren't also living with diabetes.
"In one trial of semaglutide, a medication shown to lower the risk of heart problems in people with diabetes and approved for long-term weight management, people with heart failure with preserved ejection fraction and obesity fared better on the drug than on placebo," Wu said.
What is preserved ejection fraction?
Wu explained that this happens "when the heart muscle becomes thick and stiff and can't pump out enough blood to meet the body's needs."
"The semaglutide group had greater reductions in heart failure-related symptoms, greater improvements in the ability to exercise and greater weight loss," he added.
Wu also singled out a late-breaking trial of the GLP-1 (glucagon-like peptide 1) receptor agonist drug that was presented at the American Heart Association's Scientific Sessions 2023.
In that trial, researchers looked into whether semaglutide benefitted people who are living with overweight or obesity who did nothave diabetes, but who had cardiovascular disease.
The findings show that the drug was "superior to placebo in reducing cardiovascular-related death, nonfatal heart attacks, and nonfatal strokes," Wu told Healthline.
Dr. Steven Nissen, a cardiologist at Cleveland Clinic, pointed to a different type 2 diabetes medication that he said is also a "blockbuster" — tirzepatide.
He cited findings released this year that showed thecardiovascular benefits of the dual-acting GIP and GLP-1 agonist, which was originally made available solely for diabetes under brand name Mounjaro, and was recently approved for weight loss and the treatment of obesity under the name Zepbound.
"We've had these drugs, but we didn't really know whether they'd have a favorable effect on cardiovascular outcomes on people who are being treated for obesity," he said.
The research conducted on this drug had a "very robust result," Nissen stressed.
It was shown to have a 20% reduction in body weight for people who were overweight, while showing clear, "promising hard endpoints" of lower risk of cardiovascular death, stroke, myocardial infraction, or heart attack.
"That's a big reduction, it's a turning point in the battle against obesity," he added.
Dr. Karol Watson, PhD, an attending cardiologist and a Professor of Medicine/Cardiology at the David Geffen School of Medicine at UCLA, said all of the big 2023 developments in cardiovascular health center on preventive measures for lipid and hypertension management.
Watson, who is also the director of the UCLA Women's Cardiovascular Health Center, the UCLA-Barbra Streisand Women's Heart Health Program, the co-director of the UCLA Program in Preventive Cardiology, and director of the UCLA Fellowship Program in Cardiovascular Diseases, told Healthline that the big goal is "trying to figure out how to get people to take their medications in the least invasive way possible."
Watson said that, traditionally, you had daily pills people would take or injectables they would have to receive every two weeks. Today, there are more options.
"Now, there is data on the injectables people can do every every six months. Now, there are longer gaps [between injections]. The whole idea is one and done and doing something people will find easier for them. And, it works," Watson explained. "The problem is, these things are not going to be cheap."
The findings of the drug zilebesiran, which showed the potential to lower pressure with an injection every six months, were presented at the American Heart Association's Scientific Sessions 2023.
Watson added that this kind of injectable "makes it easy for people to get the medication they need." She reiterated a big problem persists.
"These [medications] are easy, you have one injection every six months," she said, "but they are not cheap. That is the problem."
Wu pointed back to the 2023 Scientific Statement from the American Heart Association, which offers a summary of cardiovascular-kidney-metabolic (CKM) syndrome. He said this is "an interconnection between obesity, chronic kidney disease, diabetes, and cardiovascular disease, which is linked to premature death and disability."
He said concretely pointing out this relationship is one of the big cardiovascular headlines of the year.
"The statement summarizes what is known about CKM syndrome and how to prevent and manage it. It highlights a new way to calculate risk of the syndrome, as well as gaps in knowledge and needed research," Wu added. "An accompanying Presidential Advisory helps define CKM syndrome and offers guidance on the prevention and treatment of the syndrome across different clinical and community settings."
Wu pointed to research on endovascular thrombectomy, a minimally invasive surgical procedure used to remove a stroke-causing blood clot from an artery in the brain, as another one of 2023's big stories.
This procedure restores blood flow and prevents further brain damage and disability. It's the standard form of treatment for either small or medium-sized strokes.
"Until now, it wasn't clear if endovascular thrombectomy would also benefit people with larger, more severe strokes, which account for up to one-fourth of all strokes.
In a study of people with severe strokes from China and in another trial of people in North America, Europe, Australia, and New Zealand, researchers found endovascular thrombectomy within 24 hours of a stroke was superior to standard medical care," Wu said.
This research showed that these individuals who received this treatment showed signs of experiencing fewer disabilities and "were more functionally independent during the three months after treatment."
He pointed to a third study of those treated for severe stroke in Europe and Canada who showed similar outcomes.
"Those who underwent endovascular thrombectomy were more functionally independent than those who had standard medical treatment, alone. This study also showed that thrombectomy patients were less likely to die," Wu added.
What do these experts see in the year to come? All three cited innovations in gene editing.
Watson said "we are starting to see the era of gene editing."
She pointed to research out of New Zealand that shows, for the first time, gene editing technology can reduce low-density lipoprotein (LDL).
"What we've seen in the small group of the principle study, what we've seen in these first 10 patients, is that [we saw] durable LDL reduction, but of the 10 patients, two of them had very serious adverse events — one died and one had a heart attack, so the questions of safety will always persist," she added.
Watson and Wu said that, even more promising, is the FDA approval of a cure for sickle cell disease that harnessed the same CRISPR gene-editing technology. The approval of Casgevy is a major breakthrough — the first medicine that utilizes CRISPR to receive U.S. Approval, according to NBC News.
Nissen pointed to the number of drugs in development for treating lipoprotein (a), or Lp(a), as a development to keep front and center for the coming year. He said "this is a condition, which is a heart disease risk factor in 20 percent of the population that has never been treatable."
Now, what is known as RNAi, or RNA interference, is being utilized to reduce Lp(a). Nissen said he and his team have published several articles on these new therapies, and one of them involves a clinical trial for a drug called pelacarsen, which he is chairing.
This study has enrolled 8,300 patients and "is now well along toward completion," he said.
"If successful, it will be the first time ever that we can treat this disorder, everyone is waiting for the results of the trial," he said.
Additionally, beyond these innovations, Wu said he's excited about the FDA Modernization Act 2.0, which opens the door for moving beyond mandatory animal testing and toward a new era of using stem cells, organoids, artificial intelligence and machine learning, and in computer models for drug discovery.
Ease Up On Drinking To Cut Your Risk For 'holiday Heart Syndrome,' Doctors Warn
Rum-laced eggnog, mulled wine, or a hot toddy all sound good around the holidays, but too much imbibing can increase your risk of "holiday heart syndrome," doctors warn.
Holiday heart syndrome is the unofficial name for a notable increase in patients seeking treatment in ERs for heart rhythm problems caused by too much booze around December, said Dr. Sharon Reimold, chair of cardiology at the University of Texas Southwestern Medical Center in Dallas.
"It's common for people to go to multiple parties during this time of year," Reimold said in a university news release. "You go to one party and have a drink or two, go to the next party and have a couple more. It's the cumulative effect of alcohol that can put you at risk, sending your heart into atrial fibrillation."
Atrial fibrillation (AFib) involves irregular and rapid beating of the heart's upper chambers. The most common symptoms include shortness of breath, lightheadedness, chest pain, heart palpitations and rapid heartbeat.
AFib increases a person's risk of stroke and heart failure, Reimold said.
That's why even though symptoms can be sporadic and usual clear up within 24 hours, they should not be ignored, she said. People experiencing heart problems should always seek medical care.
Although there's a holiday-generated bump in cases around December, AFib can occur any time too much alcohol is consumed, Reimold said. Studies have shown that a significant percentage of new AFib cases are linked to boozing it up.
Too much food, particularly salty foods, can also increase risk of AFib.
Folks should pay attention to how much they're drinking and eating during holiday festivities, and practice moderation, Reimold said.
Guidelines for moderate alcohol consumption call for no more than two drinks a day for men and one drink a day for women. A drink is defined as 8 ounces of beer, 5 ounces of wine or 1.5 ounces of spirits.
Party hosts should offer non-alcoholic beers or wines, or "mocktails" that contain non-alcoholic spirits, Reimold added.
More information: The Cleveland Clinic has more about holiday heart syndrome.
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Holiday Heart Syndrome: Here's Everything To Know About Festive Illness
It is likely that you or your guests may suffer from "holiday heart syndrome" during holiday parties and family get-togethers, which is an illness that is caused by excessive alcohol consumption.
If you intend to celebrate the holidays with a few glasses of wine, the following is what you need to know about holiday heart syndrome.
Even if it might be more complicated than that, the National Library of Medicine (NLM) said that holiday heart syndrome could be caused by the relationship between excessive alcohol use, high levels of stress, and dehydration.
"If you get holiday heart syndrome, here's how it'll feel: One moment, you'll be chatting with relatives, refilling your glass, and nibbling on apps or dessert. In the next moment, you may feel shortness of breath, chest pain, dizziness, or heart palpitations (a feeling that your heart is beating faster than usual)," Dr Regina S Druz told Health, adding that people can even feel lightheaded or pass out.
The only surefire approach to prevent the terrible symptoms of this syndrome is to abstain from alcohol entirely, as it is the cause of the condition.
"There's no known number of drinks that will lead to holiday heart since every individual's tolerance differs," Dr Druz added.
"Some behaviors, however, are known to increase the likelihood of arrhythmia when combined with alcohol," She noted — like not being properly hydrated or indulging in rich foods.
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