The Fiscal Cliff: Lessons Gleaned from Preventive Cardiology

Cardiovascular prevention requires a team effort with the doctor at the helm but the patient a necessary, eager, and deeply involved participant. The goal of prevention is to identify risks and then diminish them before a crisis ensues. Success demands identification of potential problems followed by a collaborative effort between doctor and patient to minimize those risks. Only through both proper identification and risk reduction can heart attacks and strokes be prevented. As I reflect on what I do for a living I am struck by the similarity we are all experiencing as we walk steadily toward the fiscal cliff. And I find myself perplexed by the fact that although our elected leaders have identified the problems they have been unable to work collaboratively to correct the issues. An analogous scenario would be this. I, the physician, identify a severe cholesterol problem in a patient. I then perform a coronary CT angiogram and demonstrate multiple plaques within the patient’s arteries feeding her heart. I recommend a medication to lower her risk and show her all the copious data supporting my recommendation. She turns to me and replies, “No thank you; I think I’ll just take my chances.” I of course counter with a litany of references to literature and clinical experience. Although I understand this is the best option for her, I fail to offer “lesser” alternatives. I am intransigent. She too is adamant; refuses therapy; and six months later sustains a fatal heart attack. The heart attack could have been avoided, but to do so required the joint efforts of doctor and patient. I should have been more open to “alternative” – albeit probably less successful – possibilities, and she should have been more willing to consider my well-considered recommendation.

Now we find ourselves in an economic and political game of “chicken”. Who will flinch first? Unfortunately the stakes are unbearably high. All our futures hang in the balance. Our president, recently elected by a narrow margin in the most contentious presidential battle many of us have ever witnessed blames the Republican Congress for the standoff. The Republicans blame the President. It appears their current mode of “working together and reaching across the aisle” is at best a pipedream and at worst an impossibility. Surely the Republicans must bend. But so too should the president. He represents the entire country, even the nearly 50% who did not vote for him. He was appalled by Romney’s 47% comment yet he seems to be enacting the very principle he condemned.  And, he is our leader. The buck does stop with him. He must find the way to compromise. And if he does ultimately reach across the aisle the Republicans in turn must be willing to compromise as well. If not, we will like lemmings drop over the fiscal cliff. And we all know how that ends for the lemmings. Let’s hope Congress and our President find the way to diminish the risk that they’ve so clearly identified. Let’s hope we do not experience the unnecessary, potentially fatal, but certainly avoidable “heart attack”.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

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Innovative Heart Failure Discovery: Heart Failure’s Effects in Cells May be Reversed Via Rest

Our hearts might not be so different from our skeletal muscles after all. Researchers at the Imperial College London  have found that structural changes in heart muscle cells after heart failure can be reversed by allowing the heart to rest. Findings from a study conducted on rats published today in the European Journal of Heart Failure show that the condition’s effects on heart muscle cells are not permanent, as has conventionally been believed by scientists and physicians. The discovery could open the door to new treatment strategies and procedures.

Heart failure means the heart can no longer pump enough blood to meet your body’s needs. It is commonly the result of a heart attack; it can occur with other disorders; or it can occur as a result of simply aging. Around 750,000 people in Britain are living with heart failure and it is estimated that it affects nearly 5 million Americans. Severe heart failure carries a substantial risk of death within one year, which is worse than the prognosis associated with most cancers. Clearly we need new heart failure treatments and preventive measures.

In 2006, researchers at Imperial College led by Professor Magdi Yacoub showed that in some individuals resting the heart using an LVAD (Left Ventricular Assist Device) fitted for a limited time can help the heart muscle to recover. The LVAD is a small pump that boosts the function of the heart and reduces strain on the left ventricle, the most important pumping chamber of our heart. The new study is a major step in understanding the mechanisms for improving muscle recovery at the level of heart muscle cells.

The Imperial researchers studied whether “unloading” the demands on heart muscle cells can reverse the changes and damage that occurs during heart failure in rats.

“If you injure a muscle in your leg, you rest it and this allows it to recover,” said Dr Cesare Terracciano, from the National Heart and Lung Institute (NHLI) at Imperial, who supervised the study. “The heart can’t afford to rest – it has to keep beating continuously. LVADs reduce the load on the heart while maintaining the supply of blood to the body, and this seems to help the heart recover. We wanted to see what unloading does to heart muscle cells, to see how this works.”

Researchers transplanted a failing heart from one rat into another rat alongside that rat’s healthy heart, so that it received blood but did not have to pump. After the heart was able to rest, several changes in heart structure that impair heart contraction were reversed in the damaged heart.

“This is the first demonstration that this important form of remodelling of heart muscle cells induced by heart failure is reversible,” said Michael Ibrahim, also from the NHLI at Imperial, who conducted the research for his PhD funded by the British Heart Foundation. “If we can discover the molecular mechanisms for these changes, it might be possible to induce recovery without a serious procedure like having an LVAD implanted.”

The most profound cellular effects observed in this study concerned structures called t-tubules. These allow electrical signals to travel deep into the muscle cells so that all of the fibers contract simultaneously. T-tubules become sparse and irregular after heart failure. Unloading the heart led to the t-tubules returning to normal.

original press release via: eurekalert.org

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

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