The Future is Now
Stem cells, plaque detectors, and superpowered `good cholesterol' are changing the odds against a killer
This is an electric moment for heart researchers. Decades of painstaking lab work, clinical studies, technological advances, and insights into the heart's special biology are yielding a cornucopia of important drugs and devices, even therapies in which replacement cells and parts come from the patient's own body. The pace of discovery is astonishing. If an increasingly obese and exercise-phobic nation will decide to change its ways enough to give these developments a foothold, the toll exacted by coronary artery disease and other heart conditions could plummet in a few short years. "I've never been more optimistic," says Kim Eagle, clinical director of the University of Michigan cardiovascular center.
He's not alone. At last month's meeting of the American Heart Association, planners had to add an extra session showcasing significant late-breaking clinical trials of a wide variety of therapies. "There were just too many good ones to leave out," says program chairman Raymond Gibbons, a Mayo Clinic cardiologist. And that was just a small sample of developments in this field. All over the world, basic scientists, clinicians--and thousands of patients in important clinical trials--are changing the face of cardiovascular medicine. The following rundown of some of the powerful discoveries, almost all of which have moved beyond the research laboratory to patients in need, illustrates why specialists are so hopeful--and why patients can hope, too.
BREAKTHROUGH DRUGS
No one seriously disagrees that when it comes to LDL, the bad cholesterol, lower is better. But pharmaceutical manufacturers are looking at ways to diminish heart risk that do more than push down the LDL number.
HDL boosters. Statin drugs dramatically lower LDL but barely improve HDL, the good kind. Last month came news of a synthetic form of HDL that can shrink fat-laden deposits in the coronary arteries in a mere five weeks. The drug, given intravenously, looked promising in a test of several dozen patients. Raising HDL or making it more effective is the idea behind many current drug trials, because HDL clears cholesterol out of artery walls and carries it back to the liver. In another study, an HDL-raising drug was delivered as a vaccine that stimulates the immune system to block CETP, a protein involved in cholesterol transfer.
Reblockage blockers. Most of the time after a blocked coronary artery is reopened, a metal mesh cylinder called a stent is put in place to hold it open (Page 58). The vessel frequently recloses within six months or so, however, when tissue grows into the stent. New drug-coated stents are an increasingly popular response to the problem, but they're expensive. Cilostazol, a drug prescribed for leg pain, was found in a just concluded study to sharply reduce reblockages.
REPAIRS THROUGH A TUBE
If you needed a heart operation and could have it done with (a) conventional surgery that opens up your chest or (b) through a small tube inserted into a tiny incision and pushed up to your heart, which would you choose? Small tubes and tiny cuts sound much better, of course. That's why interventional cardiology, which uses the tubes, is so hot--and heart surgeons are getting nervous.
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