Texas Medical Center News


Vol. 21, No. 2		February 1, 1999

AHA Announces 1998's Top 10 Research Advances

Gene therapy to grow new blood vessels to the heart, strong confirmation that "super-aspirin" IIb/IIIa receptor blocker drugs prevent blood clots, the importance of inflammation throughout the blood in cardiovascular disease, and a study on the deadly effects of smoking fewer than 10 cigarettes a day are among the top 10 research advances in heart disease and stroke during 1998, says Valentin Fuster, M.D., Ph.D., president of the American Heart Association.

The list, first created in 1996, recognizes achievements in basic and clinical research that may have the greatest impact in improving the prevention and treatment of cardiovascular disease, the nation's No. 1 killer.

1. Gene therapy to create a "natural" bypass to circumvent plaque obstructions in the heart's blood vessels
In the new century many people with heart disease may be routinely treated with a genetically engineered therapy that induces the growth of new blood vessels to and from the heart. These new vessels would help restore blood flow to the hearts of people whose arteries are obstructed by fat-laden plaque. In the past year, scientists have reported findings with two growth factors, FGF-1 and VEGF.

2. "Super aspirin" does super job in fighting heart attack and stroke
Like aspirin, the drugs called platelet IIb/IIIa receptor blockers keep blood platelets from clumping and forming blood clots that can trigger a heart attack or stroke. However, the platelet blockers - sometimes called "super aspirins" and sold under the generic names of eptifibatide, tirofiban and abciximab - are more potent than aspirin. They are also administered through an intravenous "drip," or infusion. Studies are now under way to test the combination of platelet blockers and clot-dissolving medicines in heart attack patients.

3. Inflammation and heart attacks
Aspirin may have another benefit for people at high risk for heart attacks and stroke. Aspirin is an anti-inflammatory drug, and recent research suggests that the body's inflammatory response to an unnatural condition in the body - a virus or other microbe, high blood cholesterol levels, or cigarette smoking - may play a role in cardiovascular disease.

4. Detecting people at risk for heart attack and stroke through non-surgical imaging technology
This year, scientists described research showing how magnetic resonance imaging (MRI) can detect plaque obstructions that are prone to rupture in the carotid artery and the thoracic aorta. Their preliminary findings suggest that the MRI can be adapted to freeze-frame the beating heart so that "unstable" plaque in the coronary arteries also can be detected. If the imaging technology proves effective, it could lead to advances in diagnosis and treatment for people who are at high risk of having a heart attack or stroke.

5. Heart cells may recover as result of left ventricular assist device
This year, two separate groups of researchers published reports in Circulation: Journal of the American Heart Association indicating that the heart tissue of people with congestive heart failure can recover some of its function. In both studies, the "treatment" was the left ventricular assist device (LVAD), which takes over the pumping action of the heart for patients with severe heart failure who are awaiting heart transplantation surgery.

6. Tobacco's deadly effects: fewer than 10 cigarettes daily dramatically increase risk of death
In a study reported at the AHA's Scientific Sessions this year, about 13,000 men in the United States, Europe and Japan were monitored for 25 years. The scientists found that men who smoked fewer than 10 cigarettes daily had a 30 percent higher risk of death from heart disease or lung cancer than men of the same age who did not smoke. For men who smoked 10 or more cigarettes a day, the risk skyrocketed to 80 percent.

7. Impact of diet and exercise on blood cholesterol levels
Studies showed that diet effectively lowers high LDL levels in people who have inherited the E-4 variant of the apolipoprotein E, a genetic variant associated with high LDL, or who have a form of LDL that is called "pattern B." In addition, people with "pattern B" LDL typically have low levels of "good" (high-density lipoprotein or HDL) levels, which can rise to normal levels as a result of diet. About 15 percent of the population have the E-4 variant and about 25 percent have "pattern B" LDL. If LDL levels can not be reduced by diet, add exercise - another message of research this past year. Increased physical activity can enhance the effects of low fat diet in reducing LDL levels.

8. Community education campaigns get more people to the emergency room
A study examined the influence of community campaigns in educating the public about heart attack symptoms and the need for rapid action. In the cities where the education campaign occurred, more people with heart attack symptoms came to the emergency department. There also was a 10 to 15 percent increase in the number of people choosing to call Emergency Medical Service (EMS)/911 for transport. The long-term goal is to reduce the time people delay seeking emergency care for heart attack because the quicker that people seek treatment, the greater their chances of surviving the heart attack and reducing damage to the heart.

9. Epidemic of cardiovascular disease and stroke

The AHA has updated the way it computes age-adjusted death rates from heart attack and stroke, resulting in death rates that scientists say more realistically depict the true burden of cardiovascular disease. The new death rates are published in the AHA's 1999 Heart and Stroke Statistical Update. It was also reported this past year that developing countries like China and India are facing an epidemic of heart disease and stroke similar to what the U.S. faced 30 years ago that could take an economical toll on their countries.

10. Nobel Prize for discovery of nitric oxide
"The discovery of nitric oxide and its function is one of the most important in the history of cardiovascular medicine," says Dr. Fuster about the awarding of the 1998 Nobel Prize in Medicine to three American scientists for their discoveries about nitric oxide, a colorless gas that makes blood vessels dilate by relaxing the vessels' smooth muscles. Nitric oxide is a key component of blood pressure. Fifty million Americans have high blood pressure, a major risk factor for heart disease and stroke.

- From the American Heart Association

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