Top Advances in Cardiovascular Research from 2010

The American Heart Association publishes an annual list of the key findings in cardiovascular research for the year; this year’s list includes “research on reducing risks, improving medical treatment and improving lifestyle behaviors to fight the battle against heart disease and stroke.”

In a news release from the AHA, Ralph Sacco, MD, president of the AHA and chairman of the department of neurology for the Miller School of Medicine at University of Miami, said “We have come far in the past decade, reducing heart disease deaths by more than 27 percent and stroke deaths by more than 44 percent… But we know there is still much to be done in improving the lives of heart disease and stroke patients — and more importantly, in preventing these devastating diseases in the first place. Scientific research will help us lead the way.”

Here are five of the AHA’s 10 picks (in no particular order) for the most important cardiovascular research in 2010. The complete list (along with the AHA’s choices for the top 10 advances in stroke research in 2010) can be accessed here.

The Action to Control Cardiovascular Risk in Diabetes (ACCORD) Study

The AHA identified two studies from the ACCORD Study Group that may help researchers target “specific treatments that best reduce CVD risk in people with diabetes.” One study, “Effects of Intensive Blood-pressure Control in Type 2 Diabetes Mellitus,” found that “aggressive blood pressure control does not reduce CVD risk in people with type 2 diabetes at high risk for CVD.” The second study, “Effects of Combination Lipid Therapy in Type 2 Diabetes Mellitus,” found that combination therapy with a statin plus a fibrate “was no better at reducing risk than a statin alone in patients with type 2 diabetes at high risk for CVD. However, the combination lipid therapy may be successful in reducing CVD risk in those type 2 diabetes patients who had low HDL cholesterol and low triglycerides.”

New Options for Reducing Stroke Risk in Patients with Atrial Fibrillation

According to the AHA, “for the first time in more than 20 years there are viable alternatives to the primary prevention of stroke for patients with atrial fibrillation… Now, several new drugs have been found to work as well as warfarin — and are simpler for patients to take – offering an important advance in this field.” Several studies showed positive results for warfarin alternatives, including the RE-LY trial, which outlined the benefits of dabigatran in reducing stroke and bleeding in AF patients, and the ROCKET-AF trial, which found that rivaroxaban was comparable to warfarin in preventing stroke and non-CNS embolic events in AF patients.

New ICD Options for Heart Failure Patients

The AHA noted that “New studies show that adding additional resynchronization pacing to ICD therapy can lead to improved outcomes in an expanded group of heart failure patients. In addition, new types of ICDs (defibrillators without leads, for example) can offer options that reduce some of the risks associated with traditional devices.” Key studies in this area included the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) trial, and the Cardiac-Resynchronization Therapy for Mild-to-Moderate Heart Failure (RAFT) trial, which found that “among patients with NYHA class II or III heart failure, a wide QRS complex, and left ventricular systolic dysfunction, the addition of CRT to an ICD reduced rates of death and hospitalization for heart failure.”

New Procedure for Infants with Congenital Heart Disease

The AHA reported that the Pediatric Heart Network’s randomized trial of Norwood shunt types in infants with single-ventricle lesions showed that the type of shunt used makes a difference in outcomes. Better transplantation-free survival at 12 months is a possibility with this new understanding of the better shunt choice for these patients. This was the first large-scale randomized trial in congenital heart surgery, offering an approach that should provide answers to other questions in the future.”

Eliminating Racial and Ethnic Disparities in Cardiovascular Care

According to the AHA, “racial and ethnic disparities have been found in the quality of care delivered to patients with cardiovascular disease and achieving equity and addressing disparities has implications for quality, cost, risk management, and community benefit.” Findings from the Get With The Guidelines — Coronary Artery Disease Program “are the first to show that participating in a quality improvement program… can eliminate racial and ethnic disparities of care while increasing the overall use of evidence-based care for heart attack patients.”