“At this time of year, it’s gratifying to reflect on scientific progress in the prevention and treatment of cardiovascular diseases and stroke,” said Donna Arnett, Ph.D., president of the American Heart Association. “Cardiovascular disease research is truly helping people lead longer, healthier lives and the American Heart Association is pleased to be at the forefront of supporting, promoting and translating many important discoveries into practice.”
The association has been compiling an annual list of the top 10 major advances in heart disease and stroke research since 1996.
The association’s top research advances for 2012 include:
1. Extended CPR saves lives
The effect of the duration of CPR on meaningful recovery is uncertain. A study of hospitals using the Get With The Guidelines-Resuscitation quality improvement program found survival was higher for cardiac arrest patients who received CPR for a longer amount of time. Patients at hospitals with the longest median duration of 25 minutes for resuscitation efforts had a 12 percent higher likelihood of being revived compared with patients at hospitals with the shortest median time of 16 minutes. Patients who survived after longer efforts did not appear to have substantially worse neurological function vs. patients who responded early. This study’s unique findings raise critical questions about resuscitation duration and have the potential to change medical practice.
2. Converting “non-beating” heart cells into “beating” heart cells
Myogenesis (methods for growing new heart muscle) is an emerging frontier, with promise that robust approaches can be found to replace heart muscle lost or injured in heart attacks or other disorders, or not appropriately formed as is the case with some types of congenital heart disease.
Two studies showed methods for reprogramming readily available “non-beating” heart muscle cells (non-cardiomyocytes) into “beating” heart muscle cells (cardiomyocytes) that could be used to replace heart cells and repair scarring.
3. Biopsied heart cells improved heart function and reduced scars
Two human trials, each using different types of cells, showed that cells from heart biopsies could be purified and replaced into the patient’s own heart, improving heart function and reducing scarring.
4. “Disconnecting” the kidneys might be the key to treating high blood pressure
The sympathetic nervous system controls most of the body’s internal organs. A hyperactive sympathetic nervous system is believed to be a major contributor to hypertension. Now, four studies conclude that renal denervation — a procedure that reduces the functional connection between the sympathetic nervous system and the kidneys — is safe and effective at lowering high blood pressure resistant to other treatments. Surgery is not required; instead a catheter delivers small bursts of radiofrequency energy to ablate, or reduce, part of the sympathetic nervous system’s connection to the kidneys.
5. Progress for children in transplant bridging and Kawasaki Disease
Two studies found significant improvements for treating children with heart disease. A study led by U.S. researchers highlights a new procedure that dramatically extends the life of children under age 16 who are awaiting a heart transplant. Traditionally, these children would have been placed on ECMO, an external device that helps deliver oxygen-rich blood through the body when the heart is unable to. But a smaller device called VAD (ventricular assist device) may buy time for children awaiting transplant.
A second study conducted in Japan identified a new and highly effective treatment to prevent coronary abnormalities in children suffering from Kawasaki disease — a rare but deadly autoimmune disease that causes inflammation and long-term damage to the blood vessels.
6. Why children and adolescents should “just say no” to sugary drinks
Although we’ve known for years about the association between consuming sugar-sweetened beverages and overweight and obesity, two clinical trials this year provided definitive evidence. Both independently concluded that reducing the consumption of sugar-sweetened beverages reduces weight gain in children and adolescents. The studies are the first-ever randomized controlled trials showing that calories from sugar-sweetened beverages can harm children’s health.
7. Global impact: ECHO screening for rheumatic heart disease
Rheumatic heart disease is a major global health problem, especially in Africa, Asia and the Pacific, affecting more than 15 million people. A clinical trial done in Ugandan children showed that an echocardiogram (ultrasound of the heart) is highly effective at screening for rheumatic heart disease — an inflammation of the heart valves that occurs as a result of certain types of Streptococcus infections. In this largest-ever screening trial of African children, the echocardiogram detected three times as many cases of rheumatic heart disease as the traditional use of the stethoscope only.
8. Devices for stroke
This year marked several important developments in the use of medical devices for treating stroke. The SOLITAIRE and TREVO devices were found to more effectively clear blocked blood vessels in the brain than the MERCI device, benefitting a significantly greater percentage of patients. On the other hand, the CLOSURE trial found that devices that closed small holes between the upper chambers of the heart (patent foramen ovale) in certain stroke patients did not prevent subsequent strokes any better than standard medical treatment.
9. Ideal cardiovascular health practices lead to longer life, lower risk
Two notable studies this year highlighted the huge impact lifestyle factors can have in lowering heart disease and stroke risk and in helping people extend their lives. People with “ideal cardiovascular health,” as measured by seven components — health behaviors (not smoking, regular exercise and healthy diet) and health factors (ideal body mass index, cholesterol, blood pressure and blood glucose) had the lowest risk.
10. Bypass surgery vs. drug-coated stents for diabetes patients
A large clinical trial found that patients with diabetes who had multiple clogged heart arteries fared significantly better when treated with bypass surgery vs. drug-coated stents. These patients were less likely to die or have a heart attack within five years if they underwent bypass surgery compared to treatment with drug-coated stents. Patients like the ones studied represent about a quarter of all patients undergoing heart procedures in catheterization labs. The study suggests that bypass surgery should be considered an important treatment option for such patients.