February is American Heart Month. Local cardiologist Dr. Jason Robin answers questions about advances in cardiac care.
Q: What are some of the most interesting developments in screening and treatment for cardiac conditions?
A: Cardiovascular medicine continues to grow at an exponential rate with advances on both the preventative and therapeutic sides of the spectrum.
However, transcatheter heart valve procedures continue to steal the spotlight. With this technique we can replace or repair damaged heart valves by reaching the heart through a vessel in the leg and thus prevent the need to open up the chest.
Specifically, based on the PARTNER 1 and 2 Trials, we are now confident that transcatheter aortic valve replacement (TAVR) is a reasonable alternative to surgical aortic valve replacement (SAVR) in intermediate and high-risk patients.
Therefore, in 2017, the vast majority of patients who need aortic valve replacement are having it done with this minimally invasive technique. At North Shore, we also have expertise in replacing and repairing mitral valves with catheters as well.
Q: You hear about "personalized or precision medicine," but what role is it playing in cardiac care? Is there a genetic component that can assessed in heart health?
A: While cardiovascular medicine is behind oncology with respect to targeting "bad genes," in some patients with family histories of heart muscle disease (cardiomyopathy) or dangerous rhythm disorders of the heart (arrhythmias), we do have commercially available genetic testing to help guide management by either treating the cardiomyopathy earlier to prevent further deterioration of the heart muscle or implanting devices to help prevent dangerous arrhythmias from causing clinical problems.
Otherwise, we are still using traditional risk factors such as family history, high blood pressure, cholesterol levels, diabetes, smoking and age to determine what one's risk of having a cardiovascular event is.
We can use these variables to determine how likely one is to have a cardiovascular event not only over the next decade, but also during the course of one's life. This calculation allows us to determine how aggressively we should be treating each patient, especially with statin drugs which are well-known to significantly reduce the incidence of a heart attack.
Q: What are PCSK9 inhibitors and what do they do? Is this part of a new wave of treatment innovations?
A: A quarter-century after approval of the first statin in 1987, reduction of LDL cholesterol ("bad cholesterol") remains the best-validated treatment strategy in preventing cardiovascular disease.
Statins work by decreasing the production of bad cholesterol, while PCSK9 inhibitors increase the clearance of the bad cholesterol. PCSK9 inhibitors are injectable medications that reduce levels of bad cholesterol below levels achievable with statins.
Although self-administered injections might not appear attractive for lifelong treatment, this route of administration may be acceptable to high-risk patients unable to tolerate statins, or who need to achieve more stringent LDL-C targets.
There seems little doubt that the advent of therapeutic PCSK9 inhibition heralds a change to the future of lipid management. We still are not certain that this class of medication does indeed have the same impact on cardiovascular events as statins as there may be other factors besides lowering cholesterol that have contributed to their great success over the years.
In addition, the cost of the PCSK9 inhibitors could be prohibitive for some patients.
Q: Any general heart health advice and tips for consumers on staying healthy?
A: Here are some tips:
• See your doctor on a regular basis for basic screening.
• Don't use the internet to diagnose yourself
• Stay active, don't smoke, and try to consume a Mediterranean diet
• Do the best you can to reduce stress -- exercise, yoga, meditation are all great options.
• Dr. Jason Robin, FACC, is a cardiologist with North Shore University Health System who specializes in structural heart disease, complex cardiomyopathies, and athlete's heart. Dr. Robin is board-certified in cardiovascular disease and nuclear cardiology, and is a clinical assistant professor of medicine at the University of Chicago Pritzker School of Medicine, as well as an adjunct clinical assistant professor of medical education at the Northwestern University Feinberg School of Medicine.
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