Heart disease
still the most
likely reason you'll
die
POSTED: 3:06 p.m.
EST, November 1,
2006
By Mary Carter
CNN
(CNN) -- It may be
America's No. 1
killer, but people
aren't scared enough
of heart disease,
says a top U.S.
research
cardiologist.
"We've done a good
job of advertising
to people that we're
doing better with
heart disease, so
people tend to sort
of feel good about
it," said Dr. Robert
Califf, vice
chancellor for
clinical research at
Duke University
Medical Center. "We
have bypass surgery
and stents and drugs
that work; the
[mortality] rates
are declining."
It's true that U.S.
heart disease deaths
overall are down.
From 1993 to 2003,
cardiovascular
disease death rates
dropped 22.1
percent.
But more than
910,000 Americans
still die of heart
disease annually,
according to the
American Heart
Association. And
more than 70 million
Americans live every
day with some form
of heart disease,
which can include
high blood pressure,
cardiovascular
disease, stroke,
angina (chest pain),
heart attack and
congenital heart
defects.
"It's sort of
accepted as part of
the background
noise, even though
it's far and away
the mostly likely
reason that you or I
will die,'' Califf
said.
And it will get more
likely, he said.
"We're just on the
front end of the
baby boomer
epidemic, where the
projections on the
amount of
cardiovascular
disease are climbing
steadily over the
next 10 years," he
said.
"We're delaying the
disease, but we're
not preventing it,"
said Dr. Steven
Nissen, president of
the American College
of Cardiology and
chairman of
cardiovascular
medicine at the
Cleveland Clinic in
Ohio.
Prevention is key,
the experts agree,
and Americans know
what to do: Eat a
healthy diet, keep
their weight in
check, exercise and
don't smoke. But
instead, obesity and
diabetes rates
continue to rise.
Roughly two-thirds
of Americans are
overweight or obese,
according to the
National Center for
Health Statistics.
And the epidemic is
spreading to
teenagers and
children.
"We can't expect
significant change
until it becomes a
cultural mandate,"
said Dr. Leslie Cho,
director of the
Cleveland Clinic's
Women's
Cardiovascular
Center. "When
society as a whole
makes conscious
decisions to eat
better and as a
default plan be more
active, then we're
going to do better."
But could that
happen anytime soon?
"I don't know," she
said. "If you had
asked me if New York
City was going to be
smokeless, I would
have said no a
couple of years
ago." The city's
proposed ban on
transfat in
restaurant food is
another potential
advance, she said.
Looking for the new
drug
In the meantime,
Nissen and other
heart experts see
cause for optimism
in new drugs and
surgical techniques
that help improve
quality of life and
could one day
reverse the effects
of heart disease.
Nissen is leading
clinical trials of a
drug that appears
significantly to
raise HDL, or
high-density
lipoprotein. HDL is
known as the "good
cholesterol" because
it collects deposits
from artery walls
and sweeps them back
to the liver.
The introduction
nearly 20 years ago
of statins, drugs
that can cut LDL,
the low-density
lipoprotein or "bad"
cholesterol that
carries cholesterol
through the body,
revolutionized
treatment of heart
disease.
"We're about to do
it again with HDL,"
said Nissen, who is
optimistic about the
future of
HDL-raising drug
treatment.
By combining the new
drugs with the old
statin standbys,
"we're going to be
able to get a lot of
people's HDL higher
than their LDLs.
That's going to make
a difference,"
Nissen said.
Torcetrapib, the
focus of Nissen's
trials, is more
effective than
previously tested
HDL-raising drugs,
he said, and in pill
form, it's more
practical than its
predecessor, which
had to be injected.
Its notable side
effect so far has
been a possible one-
or two-point rise in
a patient's blood
pressure.
But the drug has not
been without
controversy. Its
maker, Pfizer Inc.,
originally planned
to market
torcetrapib for use
only in combination
with the company's
top statin, Lipitor.
Doctors and others
complained that the
proposed combo pill
would require
patients taking
other statins to
switch to Lipitor.
Last summer Pfizer
withdrew that plan
and agreed to sell
torcetrapib alone.
Nissen expects to
get final data from
the study next year.
Last month, though,
Pfizer appeared to
be lowering
expectations,
telling analysts
that its pursuit of
Food and Drug
Administration
marketing approval
was really the
beginning of a
broader conversation
about the drug's
overall value. The
company said it
would not be
surprised if more
data were required
before the FDA OKs
the drug.
Another drug being
closely watched that
may be approved for
U.S. sale in 2007 is
rimonabant, which
blocks receptors in
the brain that can
help reduce the risk
of heart disease and
type 2 diabetes.
The drug made by
Sanofi-Aventis has
been found to cause
weight loss and,
more specifically,
loss of abdominal
fat. Fat around the
middle is linked to
an increased risk
for heart disease.
Available in Europe
under the brand name
Acomplia, rimonabant
works both in the
central nervous
system, blocking a
brain receptor that
triggers cravings --
the so-called
"munchy receptor" --
and peripherally, in
fat cells.
Duke's Califf noted
that depression has
been reported as a
significant side
effect in testing of
rimonabant. He said
he believes more
research is
warranted.
"The battlefield of
medicine is littered
with drugs that
ought to work but
don't," he said.
Seeking stem cell
discoveries
The quest for new
treatments continues
in many directions.
The use of stem
cells, both
promising and
controversial, has
not had the
hoped-for success in
improving heart
function.
In September, three
studies in the New
England Journal of
Medicine showed only
small improvements
in patients' cardiac
function after they
received stem cells
from their own bone
marrow.
But Dr. Robert
Simari, a researcher
at the Mayo Clinic
in Rochester,
Minnesota, found
some unanticipated
results that are
being studied
further. The
research, he said,
showed that stem
cells seemed to have
a protective effect
against more heart
attacks, death or
the need for a
subsequent stent or
bypass surgery.
"I'm thinking these
trials are telling
us something about
cell delivery that
we might not have
imagined," Simari
said. "That the
effect might be more
global and
protective than one
might have
considered."
Rather than
suggesting that bone
marrow cells could
repair a heart by
becoming heart
cells, the Mayo team
is using cells
already destined to
become endothelial
cells, which make up
the lining of blood
vessels, to try to
repair the vessels
themselves.
"We think of if it
almost as a cellular
bandage at a site of
injury," he said.
Simari said he
thinks the delivery
of cells could help
fight the problem of
post-treatment
clotting. Emerging
data shows an
increased risk of
potentially deadly
clots in patients
who have received
drug-eluting stents
to help keep their
arteries open. The
drug-coated stents,
considered
revolutionary in
heart disease
treatment in the
last two years,
appear to do better
than their
bare-metal
predecessors at
keeping the arteries
open.
But in an October
guest editorial in
the online journal
of the American
College of
Cardiology, two
doctors asserted
that the widespread
use of the devices
has led to more than
2,000 extra deaths a
year from clots.
They called for a
rethinking of the
stents' use. The FDA
plans to hold
hearings in December
to seek more
information on the
issue.
Simari said one
remedy could be to
create a nonclotting
surface on the
stents. He said he
believes the best
way to do that is to
get the normal
healing process
started as quickly
as possible. "We can
do that very quickly
by applying cells,"
he said.
But when it comes to
heart disease,
preventive measures
are still the best,
according to
experts.
"Even though there
are medications that
are coming out,
still the hardest
thing to do is the
best thing for you,"
said the Cleveland
Clinic's Cho. "I
think the problem is
that everybody in
America kind of
knows what to eat.
But it's just a
matter of portion
control and a matter
of changing your
lifestyle so that
you do pick good
things."
In the meantime,
doctors and
researchers will
continue to seek
ways to improve
patients' quality of
life.
"Lifestyle and
prevention are
always the better
strategy, and I
believe that and I
work at that,"
Nissen said. "But
when you can't
prevent the disease,
we're going have
better tools to
treat it."
