Are we on the brink of a cure for heart disease? That was the question whispered by usually cautious cardiologists at the American Heart Association’s annual meeting in Philadelphia last week.
Over three jam-packed days, many ground-breaking scientific discoveries were presented by the world’s leading experts. Many of these will have a major impact on millions of patients around the world.
But most surprising was a series of pioneering efforts to “rewrite” DNA, in some cases permanently, to stop the body’s production of harmful cholesterol and lower high blood pressure, two major risk factors for heart attacks and strokes. It was a therapeutic method.
Initially, these treatments will be limited to only patients with the most severe disease and urgent need, as uncertainties regarding side effects have not yet been identified. But if these drugs deliver on their promise, the pills like statins, blood thinners, and beta-blockers that millions of people take every day to reduce their risk of heart disease will be a thing of the past. There is a possibility that
Professor Karol Watson, a Los Angeles-based cardiologist, summed up the atmosphere: [therapies] ” she said. “We are exploring uncharted territory with completely new therapeutic strategies, new molecules, and new mechanisms.
“This is something we could only dream of a few years ago and never thought we would see in our lifetime.”
Professor Tim Chico, from the British Heart Foundation, a top cardiology researcher, said the findings prompted a “shift in perspective”, adding: “Instead of managing cardiovascular events later in life, “Administering these new approaches to patients offers hope that cardiovascular disease can be cured.” . ”
100,000 people in the UK are admitted to hospital each year with a heart attack, and heart disease causes one in four deaths.
Thanks to medical advances, many lives have been saved, with the number of survivors already exceeding 7.6 million, or approximately one in seven adults.
Last week’s Mail on Sunday reported that the twice-yearly jab dilevesiran could lower blood pressure by “switching off” key genes. The results obtained in this trial could equate to a 20% reduction in his risk of heart attack or stroke.
They also revealed that a second experimental drug, Verve-101, could cut LDL (or “bad”) cholesterol levels in half after a single dose. This is done by making small but important changes to the DNA of the liver cells.
There was more good news. This time for people affected by a lesser-known type of cholesterol called lipoprotein (a).
Also known as Lp(a), this level is thought to be as harmful as the well-known LDL, and one in five adults may have high levels.
Only recently have cardiologists begun to understand the important role the heart plays in heart disease. Experts say elevated Lp(a) levels are usually caused by genetics, not lifestyle, and require a referral to a specialist for testing.
There is also no treatment, except for apheresis, a dialysis-type treatment that is connected to a machine that mechanically removes cholesterol from the blood.
But all this could change. Leposisilane, the first drug to reduce Lp(a) to near-nonexistent levels, was introduced last week.
Once again, genes are the target. Leposisilane inhibits the production of an important protein needed to make Lp(a) in the liver.
Among the 48 volunteers tested, one jab reduced Lp(a) by an average of 94 per cent. In some cases, no lipoproteins are detected, which may mean the heart risk has been reduced to almost zero.
Levels have been stable for a year and will remain stable going forward. More research is needed to see if this translates into fewer heart attacks and strokes, but the excitement over these early findings was palpable (see box on the right). And her three other drug treatments to lower Lp(a) are in the pipeline.
Professor Steven Nissen, who led the Leposisilan trial, said: “People have never heard of Lp(a), but high Lp(a) levels are linked to heart attacks, independent of other risk factors such as high LDL. “You need to listen because it doubles your risk of cancer and stroke.” And now we will be able to treat it. ”
Kaushik Ray, professor of cardiology at Imperial College London, said: “Currently, one of the only options for people found to have high Lp(a) is apheresis.” Not many hospitals offer it, which puts patients in a difficult situation.
“Discoveries like this are important. These are exciting times.”
While these developments are encouraging, there are a range of other announcements that will undoubtedly have a more immediate impact on UK patients now or in the not too distant future. Read on to find out more…
Control blood pressure and reduce dementia risk
Controlling high blood pressure may significantly reduce the risk of dementia, according to a major study.
The first clinical trial of its kind followed more than 34,000 Chinese hypertensive patients for four years. The average age of the volunteers at the start of the study was 64, and half were given intensive treatment by their doctors, including regular check-ups, medication, diet and lifestyle support to lower their blood pressure to healthy levels. The other half received regular treatment with medication from their GP, just like patients in the UK.
The majority of patients offered intensive therapy achieve healthy blood pressure goals, and by the end of the 4-year period, the likelihood of these patients developing symptoms of dementia or memory loss is lower than usual care. ” was 15 percent lower than the group.
Professor Jean Tsuru, a New Orleans-based epidemiologist, said finding ways to prevent dementia is a “public health priority” since there is no cure. He added: “We have demonstrated that lowering blood pressure is effective in reducing the risk of dementia in patients with hypertension.”
Professor Keith Ferdinand, a cardiologist also from New Orleans, said the study provided important clues about the causes of dementia and solid strategies to help reduce risk.
“We used to accept increased blood pressure as part of aging,” he says. “There were also concerns that the drug might lower blood pressure in older patients due to concerns about the risk of side effects.
“The message is clear that doctors should not accept high blood pressure levels because we know from other studies that these drugs are safe.”
“Of course, we should still be cautious and not prescribe high doses to patients who suffer from side effects, but we should aim for strict blood pressure control and lower blood pressure.”
Damage caused by heart attack can be reduced by diabetes drugs
Giving heart attack survivors low-cost diabetes drugs could help them recover and prevent more serious illness, heart experts say.
The drug dapagliflozin is already used to treat heart failure. Heart failure is a debilitating and incurable disease that often occurs after a heart attack damages the muscles and stops their normal pumping function.
But in a trial of 4,000 patients, cardiologists suggested the therapy immediately after a heart attack, before heart failure begins, to see if it could prevent heart failure from worsening.
The results suggest that the tablets reduced the risk of subsequent stroke, heart failure, heart rhythm problems, or another heart attack and improved patients’ quality of life.
People taking dapagliflozin may also be less likely to develop type 2 diabetes or kidney disease.
They also lost about 5 percent of their body weight.
Professor Stefan James, a Swedish cardiologist who led the study, said: “We saw a clear clinical benefit from starting dapagliflozin immediately after a heart attack.”
At about 1 pound per tablet, Dapagliflozin is known as an SGLT2 inhibitor and can help control high blood sugar levels in diabetics by reducing the amount of glucose absorbed by the kidneys and excreted in the urine.
Heart failure affects around one million people in the UK and causes extreme shortness of breath and fatigue. Previously, one in five people died within a year of diagnosis, and only a third survived for more than 10 years.
Critics said heart patients were already given many drugs, including cholesterol-lowering statins, blood pressure drugs and blood thinners, and another drug would add to the “medication burden.” .
But Professor James said: “Patients preferred taking dapagliflozin. When the trial ended, participants asked if they could continue as they felt better.”
Professor Ray added: “We now know that if your muscles are severely damaged after a heart attack, you don’t need to wait to prescribe dapaglifozine.”
Stroke treatment drug that does not cause internal bleeding
A new blood-thinning jab has been hailed as the “holy grail” of stroke treatment after research showed it was far safer than drugs on offer on the NHS.
Approximately one in five people over the age of 80 has a heart condition that increases the risk of blood clots that can cut off blood supply to the brain and cause a stroke.
They rely on blood thinners, also known as blood thinners, to reduce this risk. However, there are also major drawbacks. The drug can cause internal bleeding.
Warfarin, a blood thinner, caused serious bleeding, including fatal brain hemorrhages, in up to 16% of patients.
For this reason, over the past two years there has been a move to switch NHS patients to new anticoagulants that are thought to be safer, called direct oral anticoagulants (DOACs). But earlier this year, the Mail on Sunday revealed concerns that one of the most commonly prescribed of these, rivaroxaban, may be more risky than originally thought. did.
The drug, also known as Exarelto, is safe for most patients to take, but it has been linked to severe gastrointestinal bleeding, which can affect any part of the digestive system from the mouth to the anus. This is a potentially dangerous condition.
But another option may soon emerge. In a head-to-head study, the new injectable abelacimab reduced the incidence of major bleeding by 81 percent compared to rivaroxaban.
The study’s lead author, Boston-based cardiologist Professor Christian Ruff, said the study proved avelacimab to be “extremely safe”, adding: “I’ve been in this field for a long time and this… It was the holy grail: patients don’t have to worry about bleeding and it prevents blood clots.”
Abelacimab works in an entirely new way, blocking factor XI, a protein involved in the clotting process. However, unlike other blood thinners, it does not affect the activity of thrombin, the other major blood clotting compound.
This means that patients may form normal blood clots in response to injury, but not large abnormal blood clots like those that form in the heart.
Professor Chico said the development was “incredibly exciting”, adding: “We need research now to show that it reduces the risk of stroke.”