ADVANCES IN CARDIOVASCULAR DISEASE
The Cleveland Clinic Heart Center:
The Cleveland Clinic Heart Center is a leader in the innovation and care of heart disease. The commitment of our Heart Center doctors and scientists to the prevention and cure of heart disease has led to the result of innovative care, better outcomes, and improved quality of life for heart patients.
A closer Look at Current and Future Innovations and Their Implications for our Profession
The combination of new knowledge, new technology, and new wisdom about lifestyle and personal choices will continue to shape our approach to cardiovascular disease over the next year and beyond.
Our recent discovery that three genes in the thrombospondin family are linked to premature heart attack is an example of how genomics may allow us to create predictive models for susceptibility, prevention and improved management.
Advances in pharmacogenomics are leading us into an era of truly personalized medicine, with therapeutics that target individual vulnerabilities to cardiovascular disease. Proteomics and the task of identifying all the proteins in the body is more complex, but the result may be the development of new therapeutics able to mimic the effect of proteins that inhibit and even reverse the development of atherosclerotic plaque. Such an agent, ApoA-I Milano/phospholipid complex, demonstrated a statistically significant regression of atherosclerosis in a recent Cleveland Clinic-led Phase II clinical trial.
We must support more aggressive solutions to the epidemics of obesity and diabetes, and address the sedentary lifestyle that is a crucial contributing factor to heart disease. Obesity has now superseded smoking as the nation’s leading public health challenge. It is not unreasonable to expect medical professionals at all levels to set the example for patients in diet and habit, and the food options we offer or implicitly endorse. Fast-food purveyors and food manufacturers, in general, need to remove transfats and markedly reduce saturated fats as constituents; restaurants and other eating establishments need to broaden their menu choices to prioritize healthy alternatives. Insurers and employers should reward individuals who make beneficial lifestyle changes, such as losing weight, adopting a regular, intensive exercise program or quitting smoking.
New imaging choices — from CT scanning to intravascular ultrasound — are transforming cardiac catheterization. Coronary angiography is giving way to the helical CT scan, which can not only detect the calcium deposits associated with atherosclerotic plaque, but is able to identify potentially unstable non- calcified plaque within the arterial wall (Combined with cardiac MRI, it will be possible in the near term to develop a full roadmap for treatment, improving pre-revascularization planning and making diagnosis less invasive.
Finally, the conclusive implication of inflammation in the development of coronary artery disease is generating new approaches to detection and prevention. This reinforces the role of aspirin and statins in primary and secondary prevention, and indicates the necessity for Creactive protein (CRP) testing for all patients at intermediate or high risk of cardiovascular disease. Recent Cleveland Clinic Heart Center research on patients undergoing percutaneous coronary intervention found that pre-treating patients with high CRP levels with the antithrombotic agent clopidogrel decreased the rate of myocardial infarction or death for those with CRP levels in the highest quartile. This indicates a clinical role for measuring CRP prior to interventional procedures and targeting medical therapies accordingly. With the growing body of research knowledge on the role of inflammation, we can look forward to a new generation of drugs and lifestyle recommendations specifically targeting inflammation in coronary artery disease and rhythm disturbances.
The Cleveland Clinic Heart Center will continue to be at the forefront of these and other advances in heart care. We are pleased to share our interests and knowledge with you through Cardiac Consult, and we thank you for your collegiality and many referrals over the years.
Eric J. Topol, M.D., Chairman,