Cardiovascular disease (CVD) remains the number 1 killer across the globe, accounting for around 31 percent of all deaths in 2012.
With this in mind, it is no surprise that cardiology researchers have been particularly focused on identifying ways to stop the deadly disease in its tracks, as well as finding strategies that could enable heart specialists to make earlier and more accurate diagnoses.
New insights this year include the potential for future risk calculations to include genetic markers, and one study even used nanosized porous magnetite frameworks for thrombolytic agents.
In terms of everyday practice, other research findings included confirmation that ST-elevation myocardial infarction (STEMI) mortality can be reduced if emergency medical services are able to get patients directly to centers that offer percutaneous coronary interventions.
In this review, we look back at some of the most popular and potentially game-changing medical research news of 2016, targeted specifically at heart specialists.
Making progress toward CVD prevention
New statin guidelines
It may be almost 7 decades since the launch of Framingham, but research continues into the risk stratification and prevention of CVD.
The United States Preventive Services Task Force (USPSTF) updated its statin guidance in November.
It gave a primary prevention recommendation based on strong evidence (grade B recommendation) that:
- All adults over the age of 40 with a 10-year CVD risk of more than 10 percent be offered statins at a low to moderate dose if they have one or more of dyslipidemia, diabetes, hypertension, or if they smoke
- If the 10-year risk was lower - between 7.5 percent and 10 percent - and there was at least one of these risk factors, the recommendation that the statin regime be offered was not as strong
- There was insufficient evidence to include any statin recommendation for adults aged 76 years and older.
Using genetics to pinpoint CVD risk
The future of risk stratification could include genetics, which are left out of the 10-year calculations. Clinical use may be some way off, but research is building on the early predictive power of genomic risk score, especially when added to traditional calculations.
A study published in the European Heart Journal in September found that this was particularly true for people over 60 years of age.
"So far, we've been missing half the picture, but given the great strides being made by genomics in understanding human disease, we expect this approach to one day be part of routine clinical practice," notes study co-author Dr. Gad Abraham, of the University of Melbourne in Australia.
Pinpointing trends in hypertension
Hypertension is a well-known risk factor for CVD; according to the Centers for Disease Control and Prevention (CDC), around 1 in 3 adults in the United States have high blood pressure, which raises their risk of stroke, heart disease, heart failure, and other cardiovascular events.
In November, Medical News Today reported on a study in The Lancet that looked at worldwide trends in the prevalence of raised blood pressure. The research pooled measurements from some 19 million adults.
The findings indicate that high-income countries have reduced blood pressures, and that the prevalence of hypertension has transitioned into low-income nations.
The authors call for a "multifaceted approach using both population-based strategies throughout the life course and individual lifestyle management and treatment through primary care systems."
Gender bias in primary prevention
General practitioners (GPs), especially male ones, are more attentive to primary prevention in men than in women, finds a study published in the European Journal of Preventive Cardiology in November.
Use of either the French scale or the Systematic Coronary Risk Evaluation scale was less frequent in women than in men (odds ratios of 0.64 and 0.63, respectively). The gender bias was less distinct when patients saw a female GP, however.
The authors call for better training.
Improving CVD diagnosis
Blood test for MI
A device announced in May by manufacturer Philips cuts the myocardial infarction (MI) blood test wait to 10 minutes, although current plans are for availability in Europe only.
Cardiac troponin I levels are measured from a droplet of blood by the handheld Minicare I-20 system. Results are comparable to laboratory testing, for which emergency physicians must wait an hour or more.
Active adults may be misdiagnosed with heart disease
In a study reported by MNT in August, researchers suggested that many active adults face the risk of being misdiagnosed with heart disease.
The authors report that moderate to vigorous physical activity can enlarge the heart by increasing the size of the heart muscle walls, and that this occurs in 1 in 5 adults who engage in 3-5 hours of exercise per week. The team warns that this increase in heart size could be mistaken for heart disease.
"Detectable changes to the heart on an MRI [magnetic resonance imaging] scan are common in elite endurance athletes but some heart conditions, like cardiomyopathy, can be diagnosed by detecting similar changes," notes Dr. Noel Faherty, of the British Heart Foundation.
"This study demonstrates the importance of documenting the MRI appearance of healthy, active people's hearts, so normal adaptive changes are recognized by doctors and not mistaken for disease," he adds.
Using mammography to detect early CVD
From analyzing the digital mammograms of 292 women, the researchers found that the imaging method detected breast arterial calcification - a buildup of calcium in the breast arteries - in 124 of them. Of these women, 70 percent also had coronary arterial calcification, which is an early sign of CVD.
The researchers say that this finding indicates that digital mammography could be useful for the early detection of CVD in women.
"Many women, especially young women, don't know the health of their coronary arteries," notes study co-author Dr. Harvey Hecht, professor at the Icahn School of Medicine at Mount Sinai in New York City, NY. "Based on our data, if a mammogram shows breast arterial calcifications, it can be a red flag, an 'aha' moment, that there is a strong possibility she also has plaque in her coronary arteries."
Finding better treatments for CVD
Faster treatment times for STEMIAn American Heart Association project to improve treatment times for STEMI found that it could accelerate them.
The main factor in better treatment times was achieved when emergency medical services took patients directly to centers that could offer percutaneous coronary interventions.
Some 484 hospitals and 1,253 emergency service agencies treated 23,809 STEMI presentations in the project.
"In line with the fullest implementation of the project, we began to observe trends toward lower in-hospital mortality compared with national data toward the end of our measurement period," said Dr. James Jollis, clinical professor of medicine at the University of North Carolina in Chapel Hill and one of the study authors.
"Ideally, paramedics using a 12-lead EKG [electrocardiogram] can recognize if an artery is blocked, diagnose STEMI in the field, and route patients straight to specialized hospitals as they notify the hospital to activate the heart catheterization team immediately."
Dr. James Jollis
Improved thrombolysis drugs
More targeted thrombolytic drugs may become possible, thanks to nanosized porous magnetite frameworks for urokinase molecules that can be localized by strong external magnetic fields.
The authors of the study, published in Scientific Reports in June, say that the strategy may become particularly useful for "floating and decomposing blood clots, for which conventional surgical methods are essentially futile."
First author Andrey Drozdov says: "Usually, in order to achieve a prolonged effect for such drugs, the enzyme is placed inside a polymeric matrix. The enzyme is then gradually released from the matrix and eventually loses all activity."
"We, on the other hand, experimentally demonstrated that enzymes protected using our approach do not lose therapeutic properties over extended periods of time and even after repeated use. The rate at which the new drug can dissolve the clot outperforms unprotected enzymes by about 4,000 times."
New model to identify causes of ventricular fibrillation
In a study published in PLOS Computational Biology in June, researchers constructed a multiscale numerical model to study the electrophysiology of heart failure.
The team "studied how changes at the single cell electrophysiology affect the voltage wave propagation at the tissue and full biventricular level, and the resulting ECG."
They hope that the model will link cellular and tissue level changes to ECG and pinpoint triggers of ventricular fibrillation.
Published in PLOS Biology in August, the study concerned AGGF1. The researchers explained:
"Our data demonstrate that autophagy is essential for effective therapeutic angiogenesis to treat CAD and MI; AGGF1 is critical to induction of autophagy and AGGF1 is a novel agent for treatment of CAD and MI."
Are there any other studies that you believe have advanced CVD prevention, diagnosis, or treatment this year? What big developments do you think 2017 will bring? Use the comments feature to add your thoughts.