CARDIOVASCULAR HEALTH

is a tremendous story of scientifi c research,

according to Dr. Michael Lauer, di- rector, Division of Cardiovascular Sciences at the National Institutes of Health. “Heart disease is the quint- essential example of the scientifi c method really working to help public health,” he says. Through research, he explains, scientists fi nd ways to treat the disease and continue to look for new treatments. Here’s an example. Dr. Donald

Lloyd-Jones, chair, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University in Illinois, notes that between 2000 and 2010, the American Heart As- sociation (AHA) focused on reducing the death rate from heart attack and stroke. “Their goal was a 25-percent reduction in

that decade, and

they achieved more than 30,” he says. “We think it’s a combina- tion of bet- ter control of risk fac- tors and better

medical care.”

Lloyd-Jones was chair of the AHA team charged with establishing new goals for the decade from 2010 to 2020. “We wanted a new construct of cardiovascular health,” he recalls, “so we did a careful, science-based review of people with good cardio- vascular health and came up with our ‘simple seven.’ ” (See “My Life Check,” facing page.) “All seven are modifi able, all action-

able,” he says. “If you can make an im- provement in just one area, it can have a profound impact. For people with ideal levels of all of the seven, it acts like the fountain of youth. They live longer, and they live healthier, with a better quality of life at older ages. We spend less money on them. They also have less cancer, depression, and other chronic conditions like arthritis.”

New research  “A major advance in aortic valve disease was the development of de- vices that can be inserted without open-heart surgery,” Lauer says. Until recently, the only eff ective treatment involved a major operation. “Now, we can remove a diseased valve and put in an FDA-approved prosthetic valve through a catheter,” he explains. “It’s

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a very impressive and complex proce- dure and is being done in reasonably high volume at dozens of specialized centers around the country.”  Another promising area, he says, relates to “biological agents.” Today, most high cholesterol is treated with statins, which can have diffi cult- to-manage side eff ects. Scientists studied people with particularly low cholesterol levels who never develop cardiovascular disease and discov- ered they have a gene variation with PCSK9 inhibitors. (The PCSK9 gene is involved in cholesterol regulation.) “Work is being done to repro- duce this PCSK9 inhibitor,” explains Lauer, “and the FDA has just ap- proved two. These are not pills but [rather] injectables taken every two weeks, and they are very expensive. Where they fi t in the clinical tool set isn’t clear just yet, but there are some large-scale trials ongoing.”  “Heart failure occurs when the heart muscle becomes diseased, dam- aged, or stiff , so it’s of great interest to learn how to regenerate or rejuvenate existing tissue,” Lauer says. “One par- ticular area of interest is stem cells, the idea being our heart started with stem cells [that] diff erentiated. If we