Research on reducing risks, improving medical treatment and improving lifestyle behaviors to fight the battle against heart disease and stroke are among the key scientific findings that make up this year’s top cardiovascular and stroke research recognized by the American Heart Association/American Stroke Association.

The association has been compiling an annual list of the top 10 major advances in heart disease and stroke research since 1996. This year, for the first time, two separate lists have been compiled that highlight the top ten research advances in each respective area.

“We have come far in the past decade, reducing heart disease deaths by more than 27 percent and stroke deaths by more than 44 percent,” said Ralph Sacco, M.D., president of the AHA and chairman at the department of neurology for the Miller School of Medicine at University of Miami.

“But we know there is still much to be done in improving the lives of heart disease and stroke patients – and more importantly, in preventing these devastating diseases in the first place. Scientific research will help us lead the way. “

Top Ten Advances in Cardiovascular Research in 2010

1. Tailoring treatment for people with diabetes to reduce their risk of cardiovascular disease

More than 17 million Americans are diagnosed with diabetes, and heart disease death rates are two to four times higher for them compared to people without diabetes. New research from the ACCORD Study Group offers insight into specific treatments that can reduce their risk of cardiovascular disease (CVD). The first study found that aggressive blood pressure control does not reduce CVD risk in people with type 2 diabetes at high risk for CVD. In a second study, a combination therapy with a statin plus a fibrate was no better at reducing risk than a statin alone in patients with type 2 diabetes at high risk for CVD. However, the combination lipid therapy may be successful in reducing CVD risk in those type 2 diabetes patients who had low HDL cholesterol and low triglycerides. These results will be helpful for targeting specific treatments that best reduce CVD risk in people with diabetes.

·  The ACCORD Study Group – New England Journal of Medicine, March 14,2010; N Engl J Med 2010;362:1575-85. N Engl J Med 2010; 362:1563-74. http://www.nejm.org; Funding: National Heart, Lung, and Blood Institute and other National Institutes of Health divisions.

2. New advances for patients who aren’t candidates for conventional valve surgery

Many patients with severe aortic blockage have other medical conditions that make it risky for them to have conventional surgery to replace the blocked aortic valve. Transcatheter aortic valve implantation (TAVI) is an emerging alternative therapy to open-heart surgery in these high-risk patients. Two new studies support the evidence that TAVI can improve symptoms and outcomes – including quality of life – even over the course of several years. While there are some risks associated with TAVI, including strokes and other major cardiovascular events, the catheter-based procedure offers significant progress in this area.

·  PARTNER Trial Investigators – New England Journal of Medicine, Sept. 22, 2010; N Engl J Med; 363(17):1597-607. http://www.nejm.org; Funding: Edwards Lifesciences.

·  Ye, et al – Journal of Thoracic and Cardiovascular Surgery, May 1, 2010; J. Thorac. Cardiovasc. Surg.; 139: 1107-1113. http://jtcs.ctsnetjournals.org; Funding: Edward Lifesciences.

3. Improving the way we reverse sudden cardiac arrest

More than 300,000 people suffer out-of-hospital sudden cardiac arrest each year. Many die because the people around them didn’t know how to or were uncomfortable performing cardiopulmonary respiration (CPR). Significant studies now report that chest compression only, or ‘Hands Only CPR’ for adults by bystander lay rescuers improves survival outcome. Public awareness campaigns resulted in increased use of hands only CPR, as well as improved survival rates. While the new procedure appears successful in adults, it is important to note that using conventional chest compressions with rescue breathing is still important for children stricken with sudden cardiac arrest. In October, the American Heart Association issued updated Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science, reflecting new advances in this field.

·  Bobrow, et al – Journal of the American Medical Association, Oct. 6, 2010; JAMA;304(13):1447-54; http://www.jama.com; Funding: Support from Medtronics Foundation

·  Rea, et al – New England Journal of Medicine, July 29, 2010; N Engl J Med;363(5):423-33. http://www.nejm.org; Funding: Laerdal Foundation for Acute Medicine, Medic One Foundation.

·  Field, et al – Circulation, Oct. 18, 2010; Circulation;122[suppl 3]:S640 –S656.

4. More options for reducing stroke risk in atrial fibrillation
For the first time in more than 20 years there are viable alternatives to the primary prevention of stroke for patients with atrial fibrillation (AF). AF is a major risk factor for stroke and affects more than 2 million people over the age of 65. Warfarin (Coumadin) has long been the standard anti-clotting drug used to reduce the risk of stroke for these patients. But it carries its own complications from bleeding, and managing the dose requires regular blood tests, making it difficult to manage for both patients and doctors. Now, several new drugs have been found to work as well as warfarin – and are simpler for patients to take – offering an important advance in this field. In October 2010, following further positive findings from the RE-LY trial, the U.S. Food and Drug Administration approved dabigatran for stroke prevention in AF patients. The ROCKET-AF trial presented at the American Heart Association’s Scientific Sessions 2010. Rivaroxiban, apixiban, edoxaban and other oral anticoagulants are being or have been studied in AF and may show future promise.

4. More options for reducing stroke risk in atrial fibrillation
For the first time in more than 20 years there are viable alternatives to the primary prevention of stroke for patients with atrial fibrillation (AF). AF is a major risk factor for stroke and affects more than 2 million people over the age of 65. Warfarin (Coumadin) has long been the standard anti-clotting drug used to reduce the risk of stroke for these patients. But it carries its own complications from bleeding, and managing the dose requires regular blood tests, making it difficult to manage for both patients and doctors. Now, several new drugs have been found to work as well as warfarin – and are simpler for patients to take – offering an important advance in this field. In October 2010, following further positive findings from the RE-LY trial, the U.S. Food and Drug Administration approved dabigatran for stroke prevention in AF patients. The ROCKET-AF trial presented at the American Heart Association’s Scientific Sessions 2010. Rivaroxiban, apixiban, edoxaban and other oral anticoagulants are being or have been studied in AF and may show future promise.

·  RE-LY - Lancet, Sept. 18, 2010; Lancet. 2010 Sep 18;376(9745):975-83; http://www.thelancet.com. Funding: Boehringer Ingelheim.

·  ROCKET-AF – American Heart Association Scientific Sessions 2010, Abstract 21839. Funding: Johnson & Johnson, Bayer HealthCare.

·  AVERROES – European Society of Cardiology Congress 2010. Funding: Bristol-Myers Squibb Company, Pfizer.

5. Adjusting pacing therapies can improve outcomes for heart failure patients

Many heart failure patients experience abnormal heart rhythms, known as arrhythmia. There are a number of devices available to treat arrhythmia, including implantable cardioverter difibrillators (ICDs) which can shock the heart beat back into a normal rhythm. New studies show that adding additional resynchronization pacing to ICD therapy can lead to improved outcomes in an expanded group of heart failure patients. In addition, new types of ICDs (defibrillators without leads, for example) can offer options that reduce some of the risks associated with traditional devices.

·  MADIT-CRT Trial Investigators – New England Journal of Medicine, Sept. 1, 2009; N Engl J Med;361(14) 1329-1338. http://www.nejm.org; Funding: Boston Scientific.

·  RAFT Investigators – American Heart Association Scientific Sessions 2010, Abstract 21768; New England Journal of Medicine, Nov. 14, 2010. 10.1056/nejmoa1009540; http://www.nejm.org; Funding: Canadian Institutes of Health Research; Medtronic of Canada.

·  Bardy, et al – New England Journal of Medicine, May 12, 2010; N Engl J Med;363:36-44; http://www.nejm.org; Funding: Cameron Health.