Top 10 AHA advances for 2007

Top 10 AHA advances for 2007

December 24, 2007

Dallas, TX - The American Heart Association (AHA) has listed several new studies on genetics and stem cell research among its top 10 research advances for 2007. AHA President Dr Daniel Jones told heartwire that this work has been included, "not because it is of immediate clinical applicability but because of the promise it holds, the optimism about these lines of research."

Also highlighted is the much discussed COURAGE study [1], which found no benefit of percutaneous coronary intervention over optimal medical therapy as an initial management strategy in stable coronary disease, reported at the American College of Cardiology (ACC) meeting in March, and the HORIZONS trial, reported by heartwire at the TCT 2007 meeting, in which bivalirudin proved itself in acute MI patients undergoing primary angioplasty.

Other important inclusions are the first major trial to document that a reduced sodium intake lowers not just blood pressure but the risk of clinical cardiovascular disease outcomes [2], and a key study on the difficulty of diagnosing hypertension in children and adults [3].

Jones said the latter "is important to pay attention to, because the problem of hypertension in children and adults is increasing as the epidemic of obesity spreads across the world. This paper nicely points out that diagnosis in children is complex and that even good pediatricians have difficulty with the diagnostic criteria."

Basic research and a simple approach to CPR

Among the basic research singled out by AHA this year are two papers on genome-wide association, the first of which found consistent and replicable genetic markers for several complex diseases of adulthood, including atherosclerotic heart disease [4]. The second was a joint analysis of two genome-wide association studies of coronary artery disease—this confirmed previous work on the location of one region on chromosome 9 linked to a higher risk of MI, and identified two other novel markers associated with CAD [5].

Also highlighted is research on the generation of functional cardiomyocytes from adult mouse spermatogonial stem cells [6]. Jones told heartwire: "We don't yet have those big clinically applicable breakthroughs [in stem cell research] but we continue to have incremental new knowledge for basic science."

Perhaps as an antidote to the basic science, AHA has also included a study that Jones calls "really important research," on cardiopulmonary resuscitation (CPR) by bystanders with chest compression only (SOS-KANTO) [7].

CPR are useful, and we've had new guidelines for bystander CPR that have cut down the training time dramatically," he explained. "And now we have this new information that chest compressions alone can move things along. This is very encouraging. This is immediately applicable and can make a difference in people's lives."

Interventional cardiology

Discussing the issues raised by the COURAGE study, Jones says it "is important because it puts into perspective the utility of medical therapy. It's reassuring to know that aggressive medical therapy is an appropriate alternative in unstable angina."

However, he adds, "because COURAGE was a surprise to some people and it ruffled some feathers, I think we'll see a few studies done to try and clarify things. To see who is best suited to mechanical intervention and who is best suited for medical therapy."

Other interventional studies included in the top 10 are the RACE initiative, reported at the AHA 2007 Scientific Sessions, which established a statewide program for reperfusion of ST-segment-elevation myocardial infarction (STEMI) in North Carolina [8]. Jones said: "This study is about applying what we know in a more effective and efficient way. In both the US and EU there is a lot of work on organizing ourselves to get people into a place where they can have state-of-the-art interventions done."

Another interventional highlight is a large Canadian study that showed no excess risk with DES versus bare metal stents in the province of Ontario [9].

"The key thing about all of this interventional research is that it shows that information is evolving all the time on when it is best to use a stent versus medical therapies, and when it is best to use a DES versus a non-DES, and then we have the associated use of antiplatelet agents, which is an area of intense interest. I think we'll continue to see a lot of research activity in this area over the next few years."

Sources

1. Boden WE, O'Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007; DOI:10.1056/NEJMe070829. Available at: http://www.nejm.org.

2. Cook NR, Cutler JA, Obarzanek E, et al. Long term effects of dietary sodium reduction on cardiovascular disease outcomes: observational follow-up of trials of hypertension prevention. BMJ 2007; DOI: 10.1136/bmj.39147.604896.5.

3. Hansen ML, Gunn PW, Kaelber DC. Underdiagnosis of hypertension in children and adolescents. JAMA 2007; 298:874-879.


4. The Wellcome Trust Case Control Consortium. Genome-wide association study of 14 000 cases of seven common diseases and 3000 shared controls. Nature 2007; 447:661-678.

5. Samani NJ, Erdmann J, Hall AS, et al. Genomewide association of coronary artery disease. New Engl J Med 2007; 357:443-453.


6. Guan K, Wagner S, Unsšld B, et al. Generation of functional cardiomyocytes from adult mouse spermatogonial stem cells. Circulation Research 2007; 100:1615

7. SOS-KANTO study group. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): An observational study. Lancet 2007; 369:920-926.


8. Jollis JG, Roettig ML, Aluko AO, et al. Implementation of a statewide system for coronary reperfusion for ST-segment elevation myocardial infarction. JAMA 2007; DOI:10.1001/jama.298.20.joc70124. Available at: http://jama.ama-assn.org/cgi/content/full/298.20.joc70124.

9. Tu J V, Bowen J, Chiu M, et al. Effectiveness and safety of drug-eluting stents in Ontario. New Engl J Med 2007; 357:1393-1402.