ADVANCES IN CARDIOVASCULAR DISEASE
ADVANCES IN
CARDIOVASCULAR DISEASE
The
The
A closer Look
at Current and Future Innovations and Their Implications for our Profession
The combination of new knowledge, new technology,
and new wisdom about lifestyle and personal choices will continue to shape our
approach to cardiovascular disease over the next year and beyond.
Our recent discovery that
three genes in the thrombospondin family are linked
to premature heart attack is an example of how genomics may allow us to create
predictive models for susceptibility, prevention and improved management.
Advances in pharmacogenomics are leading us into an era of truly
personalized medicine, with therapeutics that target individual vulnerabilities
to cardiovascular disease. Proteomics and the task of identifying all the
proteins in the body is more complex, but the result
may be the development of new therapeutics able to mimic the effect of proteins
that inhibit and even reverse the development of atherosclerotic plaque. Such
an agent, ApoA-I Milano/phospholipid
complex, demonstrated a statistically significant regression of atherosclerosis
in a recent Cleveland Clinic-led Phase II clinical trial.
We must support more
aggressive solutions to the epidemics of obesity and diabetes, and address the sedentary lifestyle that is a crucial
contributing factor to heart disease. Obesity has now superseded smoking as the
nation’s leading public health challenge. It is not unreasonable to expect
medical professionals at all levels to set the example for patients in diet and
habit, and the food options we offer or implicitly endorse. Fast-food purveyors
and food manufacturers, in general, need to remove transfats
and markedly reduce saturated fats as constituents; restaurants and other
eating establishments need to broaden their menu choices to prioritize healthy
alternatives. Insurers and employers should reward individuals who make
beneficial lifestyle changes, such as losing weight, adopting a regular,
intensive exercise program or quitting smoking.
New imaging choices — from
CT scanning to intravascular ultrasound — are transforming cardiac
catheterization. Coronary angiography is giving way to the helical CT scan,
which can not only detect the calcium deposits associated with atherosclerotic
plaque, but is able to identify potentially unstable non- calcified plaque
within the arterial wall (Combined with cardiac MRI, it will be possible in the
near term to develop a full roadmap for treatment, improving
pre-revascularization planning and making diagnosis less invasive.
Finally, the conclusive
implication of inflammation in the development of coronary artery disease is
generating new approaches to detection and prevention. This reinforces the role
of aspirin and statins in primary and secondary
prevention, and indicates the necessity for Creactive
protein (CRP) testing for all patients at intermediate or high risk of
cardiovascular disease.
The
Eric J. Topol, M.D., Chairman,
Cardiovascular Medicine
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