Notes from the Heart…

Having just returned from the American College of Cardiology Sessions in Chicago, my mind is swimming in the latest and greatest in cardiac care and treatment.  I arrive at my place of work armed and ready to apply these principles to caring for my patients.  What I learned, however, surprised even me.

As an interventional cardiologist, I firmly believe in the power of simple interventions, such as balloons and stents which I use routinely, to impact the length and quality of life.  But, in the end, everyone knows that these therapies close the barn doors after the horses have left.  They are helpful, but if you need them, then in many ways you have waited too long.

What impressed me most was the emphasis in the cardiology community on prevention, and some of the new and impressive research that is looking at non-medical interventions.  Here are some of the latest and greatest news, in layman’s terms:

• Meat is Murder? Much has been made of the recent paper in Archives of Internal Medicine on red meat consumption being linked to early mortality.  While impressive, it still remains one article.  At the ACC however, a host of supportive data was presented which bolsters this paper, and transforms it from an interesting single study to a major cog in a big wheel of diet modification.  While I am most definitely NOT ready to advocate a vegan lifestyle, I think a universal recommendation opting for greater incorporation  of plant products into our diets with fewer meats is absolutely appropriate at this point.  I was impressed not just with the breadth of research, but of the quality and scientific rigor which went into many recent studies in this field–something that had previously been sorely lacking.
• Size Does Matter.  A major boost for obesity surgery at this meeting was the study looking at its effects on diabetes.  While it was well known that bariatric surgery (particularly the gastric bypass) could improve the state of control of cardiac risk factors, this study compared it to medications, and it came out better.  This is no surprise, really.  By treating the underlying cause (truncal obesity) of insulin resistance, you will achieve better results than by masking or compensating for the insulin resistance that causes Type II diabetes.
• Blood pressure drugs got you down? Not to worry, for too much longer anyway.  A simple, catheter based treatment called “renal denervation” which affects the various complex neural pathway causing hypertension has shown very promising results at treating hypertension with minimal side effects.  Its use as a routine treatment is still years off, but look for a fast-track approval process for patients with very severe high blood pressure beginning sometime in 2013.
• Stents are not the work of the devil.  Over the past five years, oversimplified analysis of the COURAGE trial had led many to feel that coronary stenting had no role in the management of blocked coronary arteries causing chest pain.  A recent major study (FAME II) was stopped early, however, because stents showed so much benefit.  The difference? In the second study, the operator had to objectively prove a stent was necessary first.
• Neither are surgeons.  As interventional cardiologists such as myself take over everything from clogged arteries to aortic valve replacement, many prematurely mourned the death of the field of cardiac surgery.  Not so.  Recent registry data showed that in many patients good old bypass surgery led to better outcomes than even the newest stents.  In addition, newer questions have been raised about the outcomes from minimally invasive (catheter based) aortic valve replacement.  These need to be answered before rapid, widespread adoption of this procedure.
• Don’t believe the hype: I have received countless phone calls already this week asking for the newest cholesterol medication which promises to be a “wonder drug.”  This is truly shocking to me, because usually when I want to start cholesterol medication, I am met with a lot of resistance.  To top it off, the newest drug is an injectable medication studied in only a small fraction of the patients that the other therapies have been studied in.  This medication may indeed have an eventual role in management of severely high cholesterol, but its rapid demand reeks of pharmaceutical company influence in everything from clinical trial design and presentation, to the timing and tone of press releases.  High cholesterol is a big money industry, and let’s get something straight: these companies are only interested in selling you their product.  If you happen to get better while using it, well that’s OK too.

Medicine continues to change on an almost daily basis, and cardiology changes faster than most other fields.  These are but a few of the new and exciting perspectives that I gained at the annual American College Conference.  And I’m sure by next year, they’ll all be wrong again.

Posted by Aamer Jamali on March 29, 2012

https://aamerj.wordpress.com/2012/03/29/notes-from-the-heart/