New Developments Could Soon Change the Nature of Cardiovascular Care

By Lynda Liu

New developments in the research world promise that our cardiovascular futures will be healthier than ever. "When you have a breakthrough in terms of understanding how a thing works and having a way to treat it, this is probably the result of twenty years of research by different people," says Richard A. Stein, M.D., American Heart Association spokesperson and a professor of medicine at the State University of New York Health Sciences Center in Brooklyn.

The Heart and the Human Genome
Without a doubt, the biggest milestone in the world of science in 2000 was the sequencing of the human genetic code. The map of our DNA could lead to doctors being better able to predict your heart disease risk and to developing therapies based on a person's genetic make-up. The next several years will involve identifying the roles and purposes of various gene sequences, says Richard A. Stein, M.D., American Heart Association spokesperson and a professor of medicine at the State University of New York Health Sciences Center in Brooklyn.

The drugs of today are targeted at fixing things that go wrong in our cardiovascular systems, says Dr. Stein. For example, angiotensin converting enzyme (ACE) inhibitors have become one of the most important classes of drugs for treating hypertension and chronic heart failure. ACE inhibitors help open up clogged vessels so that the heart has to work less. With genome sequencing, though, we'll be able to identify proteins involved in processes that go wrong and gear drugs toward them. Ultimately, we'll have medications that affect the very genes that start the disease cycle.

Conquering Plaques with Cardiac Imaging
A new form of high-resolution magnetic resonance imaging may help doctors identify potential problem areas in coronary arteries earlier. Plaques that build up in arteries can rupture and cause a heart attack. Traditional screening techniques can help doctors identify the largest plaques, but they are responsible for heart attacks only half the time. Now, researchers at Mount Sinai School of Medicine in New York have identified two characteristics for determining the likelihood of a rupture (the size of its cholesterol core and the thinness of the collagen around it) and used the new imaging technique to spot these potential trouble spots. This cardiac imaging could become a powerful tool in preventing heart attacks.

No-Pain Cholesterol Measurements
Testing blood cholesterol levels requires getting blood drawn with needles, but a skin cholesterol test might provide a new and painless way of assessing a person's heart disease risk. Cleveland Clinic Foundation researchers used a three-minute test that measures cholesterol levels in the skin by placing drops of fluid on the palm and measuring color changes with a special meter. They found that people with the highest levels of skin cholesterol also had the greatest number of diseased arteries. More studies will need to be done to corroborate the results, but the test could potentially replace or be used with blood cholesterol measurements.

Robotic Surgery
Clinical trials are underway for a revolutionary robotic surgical procedure using the DaVinci surgical system. The procedure uses two small robotic arms inserted into the chest cavity through small incisions. The surgeon controls their movement from behind a 3-D console several feet away in the operating room. This revolutionary procedure permits the surgeon to perform heart surgery without the large incisions or broken bones and severed muscles that usually accompany open-heart surgery. The procedures so far have radically shortened recovery time of patients.

Cell Transplants and Heart Renewal
The human heart stops growing around puberty and at that point, you never grow new heart cells. When someone suffers a heart attack, doctors have to worry about the number of cells they've lost. For the first time ever, recently, a person's own cells were used to replace dead heart cells. Physicians in France were able to inject cells taken from a man's thigh and grown in a culture into his heart. One month later, the ability of the man's heart to pump blood had improved and imaging showed that the new cells were alive and active. Doctors now work on preserving what's left of heart muscle after a heart attack; this therapy has the potential to allow them to repair damaged heart muscles, says Richard A. Stein, M.D., American Heart Association spokesperson and a professor of medicine at the State University of New York Health Sciences Center in Brooklyn.