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M. P. Ravindra Nathan
CELEBRATING THE CARDIOVASCULAR COMMUNITY: WHAT IS NEW IN THE TREATMENT OF HEART DISEASE? -- PART 2
By M. P. Ravindra Nathan, MD, FACP, FACC Director, Hernando Heart Clinic, Brooksville, FL Editor-in-Chief, AAPI Journal

Discussions regarding cholesterol lowering therapy took up an entire session during the annual Scientific Sessions of the American College of Cardiology (ACC) in Atlanta, Ga. All agreed that statin drugs (such as Zocor, Lipitor, Crestor) are still the mainstay in the treatment. The trial which captured the most attention was the Asteroid study headed by Steven Nissen of the Cleveland Clinic.

It evaluated the effect of a relatively new drug, Crestor, via an innovative technique called IVUS (Intravascular Ultrasound), which made it possible to directly visualize the actual plaque inside the coronary artery and its regression with therapy.

Among patients with established Coronary Heart Disease (CHD), aggressive reduction of cholesterol levels with Crestor 40 mg was associated with regression of plaques on IVUS at a two-year follow-up. This means that reducing cholesterol to aggressively low levels can not only halt progression of heart disease but also reverse it.

What does this mean to you? Well, this is yet another reason that you should know your cholesterol levels, especially LDL (bad cholesterol) levels and get treated with a statin drug, assuming there are no contra-indications to prevent future heart disease. In fact, the question you want to ask your doctor should be, “Why am I not on a statin?” In England, the cheapest statin drug – Lovastatin -- is now an over-the-counter medication. Also, along with all these, steps should be taken to increase your HDL, the good cholesterol and maintain a healthy diet and exercise routine.

In the evening, American Cardiologists of Indian Origin (AACIO), including several Florida cardiologists, met for their semi-annual conference. Indian cardiologists are definitely making an impact in patient care and research in USA. Almost every fifth cardiologist in USA is of Indian origin and nearly 11 percent of interventional procedures such as angioplasty and stent placements are performed by them. Prakash Deedwania, an eminent cardiologist from California, gave a talk on Heart Failure (HF). With high prevalence of CHD and diabetes Mellitus, the older Indian American population is facing a high incidence of HF too.

The convention also focused new attention on heart disease in women. Some of the provocative findings suggested that women may have a form of heart disease that is fundamentally different and harder to diagnose than men. For many women, the presenting symptoms may be shortness of breath and fatigue and not the classical angina pains. They also may have, unlike their male counterpart, smaller vessel disease, which is often difficult to detect with conventional angiograms. But the new cardiac imaging modalities such as CT angiograms or MRI scans may be able to give you the answers.

In this year’s exposition, more than 400 companies showcased the latest in cardiovascular equipments, pharmaceuticals, devices and cardiac literature. The floor was full of technology-related products like CT and MRI scanners, pacemakers, medical computer systems, etc. There also was a regular blood draw for those who wanted to know their lipid profile and blood sugar. From these, one can compute your coronary risk possibility for future.

Although there are moral and ethical concerns regarding stem cell therapy, several research abstracts dealing with stem cell studies were presented. The general consensus was that administration of stem cells directly into the heart muscle via the coronary arteries is feasible and effective in improving global cardiac function. This gives great hope for all those suffering from severe heart failure and other chronic problems.

“Cardiovascular risk pattern among general population is changing and this must be addressed,” Scott Grundy, the famous researcher from Dallas, said. While tobacco usage has diminished and treatment for high cholesterol and hypertension has improved, obesity and diabetes are steadily on the rise. There has been a 20 percent increase in diabetes in recent times and interestingly the average duration between the actual onset of diabetes and the diagnosis of the same may be 6-8 years. This means precious time is lost for instituting treatment early and preventing the much-dreaded complications in later life. This may be particularly true for Asian Indians.


On the whole, it was a great convention. For me, this is an annual pilgrimage. There is no substitute to coming here and talking to your colleagues, looking at the video images, watching live case transmissions, meeting experts on a one-on-one basis, listening to case presentations and lectures. All these help you stay connected and your patients are the ultimate beneficiaries.

The evolution in medicine is seemingly endless and the revolution in therapies has brightened the future for the ill. As I always say to my patients who suffer from inoperable heart disease or end-stage heart failure and losing hope, “Hang on for a little longer, miracle drugs and new techniques are in the pipeline and will be available pretty soon.” That gives them hope for a better tomorrow.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.




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