There have been a number of major developments in the field of cardiology in 2019. Here is my list of the top 10 new findings that might affect your life:
Generic blood pressure drugs remain a big problem. When the generic drug for hypertension called valsartan was recalled more than a year ago because of cancer-causing impurities found in medication produced in China and India, it was supposed to be a temporary shortage. Since then, other related medications called losartan and irbesartan have also been recalled. The market has been plagued by shortages, often forcing people to switch their medications every couple of months. Although this is not unsafe to do, I worry that some patients will become frustrated and stop their medication entirely, which is not safe to do.
The Apple Watch can detect dangerous irregular heartbeats. Wearable technology has become big business. Perhaps no player is bigger than Apple, as the watch has added an algorithm that can sense an arrhythmia called atrial fibrillation. In a study in the New England Journal of Medicine funded by Apple and published in November, it has been shown to accurately and sensitively detect atrial fibrillation in a screened population of more than 400,000 people. Of note, in a prior, much smaller study, a company called Kardia did the same thing with an app for the Apple Watch. It no longer offers the app, as Apple has incorporated the technology. Sometimes being bigger has its advantages.
Eating eggs might not be so bad for you, but they still affect cholesterol. In a study published in March in the Journal of the American Medical Association, researchers found an association between dietary cholesterol, eating eggs, and heart disease, but not as strong as expected. The conclusion: An occasional egg will not hurt you.
Aspirin does not always help the heart and may hurt by causing increased bleeding. Another large trial in 2019 has again shown that taking an aspirin every day to prevent a heart problem in a person with no cardiac problems may cause more harm than good by increasing your risk of bleeding. This is not true if you have a history of heart attack, bypass surgery, a coronary stent, or stroke. In addition, if you have symptoms suggestive of a heart attack or stroke, it is important to take an aspirin immediately.
Fish oil is helpful if you have coronary artery disease and high triglycerides. The REDUCE-IT trial showed a 30% relative risk reduction in ischemic events when taking icosapent ethyl (also known as the trade name Vascepa). This is impressive, but the brand of fish oil studied is quite expensive and not always covered by insurance.
Bypass and coronary stents are not always necessary if you have a coronary blockage. A finding released at the November heart meetings in Philadelphia showed that coronary artery blockages, when treated with aggressive medication and lifestyle change for people with stable angina, did just as well as if they had bypass surgery or stents.
The Impossible Burger is not much healthier than red meat. There is just as much saturated fat and calories, and more salt and carbs, in the Impossible Burger as in lean red meat. A traditional veggie burger is a healthier option, with less fat and salt. However, the Impossible Burger may be an environmentally better choice, consuming fewer resources to produce than red meat.
TAVR (transcatheter aortic valve replacement) is now available for people who have aortic stenosis but are younger and at lower risk than those first eligible for TAVR. Expanded use of the minimally invasive operation means fewer people will need open-heart surgery to get a new heart valve. It may seem obvious that open-heart surgery is best avoided, but until now, the long-term safety has been questioned.
A new use for a diabetes drug: Helping the heart. While studying a drug used to treat diabetes, scientists noticed that it also helped treat congestive heart failure. Empagliflozin (Jardiance), a member of a class called SGLT2 inhibitors, was then studied in a group of people with heart problems and no diabetes, and it really helped.
Take your blood pressure medications at night. I have always suggested that patients take their blood pressure medications first thing in the morning. This has been the doctrine for years, as we know that people are more active in the early part of the day. It seemed that you would get the most bang for the buck by taking meds early. But a recent study suggests that evening use of blood pressure medications is optimal. Proven through an ambulatory blood pressure monitor, more sensitive than home or office-based checks, this finding is a simple and effective way to better control blood pressure without more medication. The one exception is if you are taking a diuretic, which increases urination. This is still best taken in the morning so you are not up all night.
David Becker is a frequent Inquirer contributor and a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. He has been in practice for 25 years.