Heart disease: Types, causes, and treatments
Top Heart Disease Treatment And Prevention Advancements In 2023
As 2023 comes to a close, cardiologists are reflecting on some of the advancements and breakthroughs in their field over the past 12 months.
Heart disease is a pressing issue in the United States. The American Heart Association reports that more than 130 million adults (about 45.1% of the population) will develop some form of cardiovascular disease by 2035, which will lead to $1.1 trillion in projected total costs.
This reality means researchers and clinicians are invested nationwide in developing better interventions and treatments to address the rising prevalence of heart disease among Americans.
To put in perspective how serious this is, heart disease stands as the leading cause of death regardless of gender and spans most racial and ethnic groups in the United States, according to the Centers for Disease Control and Prevention (CDC).
Heart disease kills one person for every 33-second interval nationwide.
Healthline spoke with several experts who weighed in on the major breakthroughs and innovations of the past year as well as promising developments on the horizon in 2024.
Dr. Joseph C. Wu, Ph.D., FAHA, American Heart Association president and director, Stanford Cardiovascular Institute and Simon H. Stertzer Professor of Medicine & Radiology at Stanford School of Medicine, said that glucose-lowering drugs have been a game changer for people with type 2 diabetes, helping them to reduce cardiovascular events and improve their heart health.
Research is now suggesting these same drugs may also improve heart health in people with obesity who aren't also living with diabetes.
"In one trial of semaglutide, a medication shown to lower the risk of heart problems in people with diabetes and approved for long-term weight management, people with heart failure with preserved ejection fraction and obesity fared better on the drug than on placebo," Wu said.
What is preserved ejection fraction?
Wu explained that this happens "when the heart muscle becomes thick and stiff and can't pump out enough blood to meet the body's needs."
"The semaglutide group had greater reductions in heart failure-related symptoms, greater improvements in the ability to exercise and greater weight loss," he added.
Wu also singled out a late-breaking trial of the GLP-1 (glucagon-like peptide 1) receptor agonist drug that was presented at the American Heart Association's Scientific Sessions 2023.
In that trial, researchers looked into whether semaglutide benefitted people who are living with overweight or obesity who did nothave diabetes, but who had cardiovascular disease.
The findings show that the drug was "superior to placebo in reducing cardiovascular-related death, nonfatal heart attacks, and nonfatal strokes," Wu told Healthline.
Dr. Steven Nissen, a cardiologist at Cleveland Clinic, pointed to a different type 2 diabetes medication that he said is also a "blockbuster" — tirzepatide.
He cited findings released this year that showed thecardiovascular benefits of the dual-acting GIP and GLP-1 agonist, which was originally made available solely for diabetes under brand name Mounjaro, and was recently approved for weight loss and the treatment of obesity under the name Zepbound.
"We've had these drugs, but we didn't really know whether they'd have a favorable effect on cardiovascular outcomes on people who are being treated for obesity," he said.
The research conducted on this drug had a "very robust result," Nissen stressed.
It was shown to have a 20% reduction in body weight for people who were overweight, while showing clear, "promising hard endpoints" of lower risk of cardiovascular death, stroke, myocardial infraction, or heart attack.
"That's a big reduction, it's a turning point in the battle against obesity," he added.
Dr. Karol Watson, PhD, an attending cardiologist and a Professor of Medicine/Cardiology at the David Geffen School of Medicine at UCLA, said all of the big 2023 developments in cardiovascular health center on preventive measures for lipid and hypertension management.
Watson, who is also the director of the UCLA Women's Cardiovascular Health Center, the UCLA-Barbra Streisand Women's Heart Health Program, the co-director of the UCLA Program in Preventive Cardiology, and director of the UCLA Fellowship Program in Cardiovascular Diseases, told Healthline that the big goal is "trying to figure out how to get people to take their medications in the least invasive way possible."
Watson said that, traditionally, you had daily pills people would take or injectables they would have to receive every two weeks. Today, there are more options.
"Now, there is data on the injectables people can do every every six months. Now, there are longer gaps [between injections]. The whole idea is one and done and doing something people will find easier for them. And, it works," Watson explained. "The problem is, these things are not going to be cheap."
The findings of the drug zilebesiran, which showed the potential to lower pressure with an injection every six months, were presented at the American Heart Association's Scientific Sessions 2023.
Watson added that this kind of injectable "makes it easy for people to get the medication they need." She reiterated a big problem persists.
"These [medications] are easy, you have one injection every six months," she said, "but they are not cheap. That is the problem."
Wu pointed back to the 2023 Scientific Statement from the American Heart Association, which offers a summary of cardiovascular-kidney-metabolic (CKM) syndrome. He said this is "an interconnection between obesity, chronic kidney disease, diabetes, and cardiovascular disease, which is linked to premature death and disability."
He said concretely pointing out this relationship is one of the big cardiovascular headlines of the year.
"The statement summarizes what is known about CKM syndrome and how to prevent and manage it. It highlights a new way to calculate risk of the syndrome, as well as gaps in knowledge and needed research," Wu added. "An accompanying Presidential Advisory helps define CKM syndrome and offers guidance on the prevention and treatment of the syndrome across different clinical and community settings."
Wu pointed to research on endovascular thrombectomy, a minimally invasive surgical procedure used to remove a stroke-causing blood clot from an artery in the brain, as another one of 2023's big stories.
This procedure restores blood flow and prevents further brain damage and disability. It's the standard form of treatment for either small or medium-sized strokes.
"Until now, it wasn't clear if endovascular thrombectomy would also benefit people with larger, more severe strokes, which account for up to one-fourth of all strokes.
In a study of people with severe strokes from China and in another trial of people in North America, Europe, Australia, and New Zealand, researchers found endovascular thrombectomy within 24 hours of a stroke was superior to standard medical care," Wu said.
This research showed that these individuals who received this treatment showed signs of experiencing fewer disabilities and "were more functionally independent during the three months after treatment."
He pointed to a third study of those treated for severe stroke in Europe and Canada who showed similar outcomes.
"Those who underwent endovascular thrombectomy were more functionally independent than those who had standard medical treatment, alone. This study also showed that thrombectomy patients were less likely to die," Wu added.
What do these experts see in the year to come? All three cited innovations in gene editing.
Watson said "we are starting to see the era of gene editing."
She pointed to research out of New Zealand that shows, for the first time, gene editing technology can reduce low-density lipoprotein (LDL).
"What we've seen in the small group of the principle study, what we've seen in these first 10 patients, is that [we saw] durable LDL reduction, but of the 10 patients, two of them had very serious adverse events — one died and one had a heart attack, so the questions of safety will always persist," she added.
Watson and Wu said that, even more promising, is the FDA approval of a cure for sickle cell disease that harnessed the same CRISPR gene-editing technology. The approval of Casgevy is a major breakthrough — the first medicine that utilizes CRISPR to receive U.S. Approval, according to NBC News.
Nissen pointed to the number of drugs in development for treating lipoprotein (a), or Lp(a), as a development to keep front and center for the coming year. He said "this is a condition, which is a heart disease risk factor in 20 percent of the population that has never been treatable."
Now, what is known as RNAi, or RNA interference, is being utilized to reduce Lp(a). Nissen said he and his team have published several articles on these new therapies, and one of them involves a clinical trial for a drug called pelacarsen, which he is chairing.
This study has enrolled 8,300 patients and "is now well along toward completion," he said.
"If successful, it will be the first time ever that we can treat this disorder, everyone is waiting for the results of the trial," he said.
Additionally, beyond these innovations, Wu said he's excited about the FDA Modernization Act 2.0, which opens the door for moving beyond mandatory animal testing and toward a new era of using stem cells, organoids, artificial intelligence and machine learning, and in computer models for drug discovery.
AHA Selects 2023's Leading Cardiovascular Research
The American Heart Association (AHA) has released its list of the most important developments in CVD research for 2023, which runs the gamut from major trials of interventions and medical therapies to cohort studies providing insights into health inequities, the impact of healthy eating, and more.
The AHA has been doing this since 1996, according to a press release.
"Every year, we compile an overview of scientific research that advances our understanding of how to prevent, treat, and manage heart disease and stroke," Mariell Jessup, MD, AHA's chief science and medical officer, said in the release. "Whether the science points to new ways to treat long-known health conditions, disparities in care, or how to prevent some of our most pressing problems, such as high blood pressure, diabetes or obesity, the findings help people, healthcare professionals, policymakers, and others make better informed healthcare decisions."
On this year's list are multiple areas in which major randomized trials have provided impactful results. That includes two trials showing clinical benefits from using the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide (Wegovy; Novo Nordisk)—initially developed as a treatment for type 2 diabetes—in high-risk patients with heart disease: STEP-HFpEF in patients with heart failure with preserved ejection fraction and SELECT in patients with overweight or obesity and preexisting CVD, but no diabetes.
"While these developments are certainly promising, an editorial in the New England Journal of Medicine warns the high cost of these medications may make them inaccessible to many who need them and should not deter public health efforts to fight the root causes of the nation's obesity epidemic," the AHA states.
Other consequential trials released in 2023, according to the AHA's compilation, included:
Another development highlighted by the AHA was a phase I study of zilebesiran, a novel injectable RNA-interference agent that inhibits the production of angiotensinogen in the liver with the aim of reducing blood pressure; patients with hypertension saw reductions in both angiotensinogen and BP. Later in the year, the phase II KARDIA-1 study showed that treatment reduced ambulatory systolic BP through 6 months in patients who weren't on any other antihypertensive drugs.
The AHA also put a spotlight on evidence linking obesity, chronic kidney disease, diabetes, and CVD and on a new condition called cardiovascular-kidney-metabolic (CKM) syndrome. This was the subject of a scientific statement and a presidential advisory released by the association in October and has been incorporated into the PREVENT equations, which physicians can use to estimate 10- and 30-year risks of MI, stroke, and heart failure.
Rounding out this year's list of top research news are cohort studies demonstrating a link between adherence to healthy dietary patterns recommended in the Dietary Guidelines for Americans and lower mortality risks across racial/ethnic groups and underscoring the impact of social determinants of health on disparities in CVD.
To the latter point, the AHA pointed to a study in the Journal of the American Heart Association showing that even though CVD mortality declined overall in the US from 2009 to 2018, rural counties and those with higher proportions of Black residents continued to have higher mortality levels. And in a study published in the New England Journal of Medicine, Black and Hispanic individuals who suffered a witnessed cardiac arrest were less likely than their white counterparts to receive bystander CPR, irrespective of the racial/ethnic makeup or income level of the neighborhood in which the event occurred.
"As noted in a related editorial," the AHA says, "efforts to improve bystander CPR rates may be complicated 'by a legacy of structural racism that has left many of our communities segregated and with inequitable social determinants of sudden cardiac death.'"
6 Heart Healthy New Year's Goals You Should Be Setting Right Now
The start of the year can feel like a time of endless possibilities — when you decide you'll finally clean out your closet, find love, or shed those stubborn 10 pounds. The reality, of course, is that realistic New Year's resolutions are about setting priorities, not trying to fix everything at once.
This year, consider prioritizing your heart health. It might not be as trendy or flashy as other New Year's resolutions, but there are plenty of reasons to do so. Heart disease is the leading cause of death for women, men, and nearly every racial and ethnic group in the United States, according to the Centers for Disease Control and Prevention (CDC). And the factors that often contribute to heart disease — like high blood pressure, increased blood lipid (cholesterol and triglyceride) levels, and prediabetes or type 2 diabetes — can begin long before you're diagnosed with any heart condition or experience a cardiovascular event like a heart attack or stroke.
When it comes to prioritizing heart health, "Some people are really shocked into action," says Helga Van Herle, MD, a cardiologist and associate professor of clinical medicine at the Keck School of Medicine at the University of Southern California in Los Angeles. That could happen, she says, following a diagnosis of heart disease or being prescribed a cholesterol-lowering medication.
But you may be able to avoid getting to that point by taking action now — and nudging your lifestyle in a heart-healthy direction. "Some of the basic stuff that rings true is actually the most important" when it comes to heart health, says Evan Shalen, MD, a cardiologist and assistant professor of medicine at Oregon Health and Science University in Portland.
Here are six simple goals you can set right now to prioritize your heart health.
1. Schedule an Annual CheckupIf you already have a diagnosis of heart disease, you may be seeing your doctor on a regular basis. But for most people without heart disease, it's important to get a sense of your heart risk by seeing a doctor for an annual checkup.
"Knowing your numbers is very important," says Eugene Yang, MD, a cardiologist and clinical professor of medicine at the University of Washington in Bellevue. These numbers include measurements such as your body weight, blood pressure, blood cholesterol and triglycerides, and tests (such as hemoglobin A1C) that can show prediabetes or type 2 diabetes.
Your doctor can use these numbers to calculate your 10-year and lifetime risk of having a cardiovascular event, Dr. Van Herle notes — meaning how likely you are to have a heart attack or stroke, or require certain procedures like a stent placement, in the next 10 years and for the rest of your life. Knowing your risk level, she says, is a good starting point for a discussion about what you can or should be doing to reduce that risk. That's especially important, she says, "if you have medical conditions that portend a higher risk of heart disease, like hypertension, high cholesterol, or diabetes."
2. Stay Physically ActiveWhen it comes to lifestyle habits, "The No. 1 recommendation that I give people is to make sure they're staying active," says Dr. Shalen. And that's not just for older people, or those with a high cardiovascular risk based on their numbers. "As I see people aging, the ones that are able to stay active and feel well later in life are generally folks who have also been active throughout their life," he notes.
The American Heart Association (AHA) recommends that most adults get at least 150 minutes of moderate-intensity physical activity each week — something that can be integrated into your daily activities, like walking your dog, biking to work, gardening, or dancing. You can gain even more health benefits by getting at least 300 minutes (five hours) of weekly moderate-intensity activity, and by doing resistance or weight training at least twice a week.
If you're already getting the minimum amount of activity and are in decent shape, Shalen recommends pushing yourself a bit. "When you're walking, walk faster or maybe do a little bit of jogging mixed in," he suggests. "Or seek out a hill that you can walk up, so that there's some sort of progressive element."
As you engage in more challenging or strenuous physical activity, your heart and the structures it interacts with (such as blood vessels) become more efficient, and your muscles get better at using oxygen — all of which improves your cardiovascular health over time.
3. Make Realistic Lifestyle ChangesPhysical activity is, of course, just one area where someone could make heart-healthy lifestyle changes. But when it comes to setting goals, try not to set yourself up for failure or disappointment.
"I think part of the way to be more successful is to create modest goals," suggests Dr. Yang. "Think about one thing that you really think you can be committed to. If you have too many things, then some things you do well, and other things you don't do well."
And even in the lifestyle area that you choose to prioritize, be realistic. For example, Yang says, "Some patients will come in and say, 'I will lose 20 pounds in three months.' And I will say, 'If you can do that, fantastic. But what is a goal that is more achievable?' It might be 5 pounds or 10 pounds." It's more important, he says, to "move the needle" consistently in an area of health or lifestyle than to achieve any single goal.
Here are some examples of modest goals you could set to improve your health:
When setting and evaluating your goals, focus on mindfulness and accountability, Van Herle says. "Recognize what your limits are, and reflect on what you've been doing," she urges. That might mean changing a goal when you've been struggling with it, such as going from a daily to weekly workout target to give yourself more flexibility.
There's more than one way to hold yourself accountable in sticking to your goals. "Sometimes it's having a buddy there, sometimes it's coming back to the doctor and saying, 'I've got my fitness tracker, and I've been walking this number of steps a day,'" Van Herle suggests.
4. Prioritize SleepHealthy sleep is among the AHA's list of important health behaviors and factors (along with eating better, being more active, quitting tobacco, managing your weight, controlling cholesterol, managing blood sugar, and managing blood pressure). "Adequate sleep promotes healing, improves brain function and reduces the risk for chronic diseases," the AHA states.
In a study published in the Journal of the American Heart Association, irregular sleep patterns was linked to cardiovascular disease.
In addition to making sure you're following basic health sleep habits described by the AHA, like getting seven to nine hours daily and making sure your bedroom is dark and free of distractions from electronic devices, consider talking to your doctor about getting screened for sleep apnea, a sleep disorder that causes your breathing to become shallow or stop completely during sleep. "Sleep apnea is clearly associated with an increased risk of a number of cardiovascular diseases over time," says Shalen, and treating it may be the single most important thing someone with the condition can do for their heart health.
5. Stay on Top of MedicationsIf you're already taking medications to reduce your risk for heart disease — such as drugs to lower your blood pressure, reduce your cholesterol, or help prevent blood clots — then sticking with your prescribed treatments is one way to improve your heart health.
Unfortunately, many people don't take their medications as prescribed. Even for people who have already had a heart attack, "We know that the rate of adherence to medications at one year is close to only 50 percent," says Yang. "That's a major problem because if people are nonadherent to medications, that dramatically increases the risk of having another event."
Even if you feel fine, taking medications as directed can help you stay that way. To make sure you remember to take your medications, try using a pill organizer, setting daily reminders on your phone, or going old school by writing out a chart listing all your medications, as described by the Agency for Healthcare Research and Quality.
6. Aim for Relaxation and Stress ReductionTrying to relax might seem like it's the complete opposite of pursuing heart-healthy goals, but it's an essential end by itself. In fact, Van Herle notes, cardiac rehab programs — which typically focus on structured exercise for people who have had a cardiovascular event like a heart attack, or undergone a procedure like stent placement — also often include a stress management component like meditation or gentle yoga.
And even as you pursue your heart-healthy goals, remember to be kind to yourself if you don't follow through as well as you'd like to. "It's easy in the moment around the New Year" to stick with new goals or habits, Van Herle says. "But it's harder in the long term."
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