• As 2016 winds down, it is a good time to look back on some of the biggest developments in cardiology this year. Here is my list of the top 10 heart-related stories.
  • 10. Precision medicine is moving into cardiology.  This year saw advances in the development of a "genetic score" that can help predict the occurrence of heart disease.  Scientists have found more than 50 genetic markers, each of which suggests higher risk.   By looking at the number of these markers in your blood or saliva sample, you can know if you have a high risk of having a heart attack.  These tests will soon be commercially available
  • 9. High costs keep demand for new drugs low. Entresto, the first new medication in years to really help patients with severe heart failure, has not caught on with cardiologists.  The expense and lack of coverage by many insurance plans is probably the main reason.  The other two predicted big sellers (Repatha and Praluent, both used to lower cholesterol) also are very expensive, and have not yet been the great successes many had expected.
  • 8. An important heart drug goes generic. You will not see any more television commercials for Crestor, with happy people dancing down the street because their cholesterol numbers have improved.  It is now generic, and pharmacies can sell it for as little as a $5 co-pay.
  • 7. Stroke-preventing Watchman device has taken off.  Implanted in the heart to prevent strokes in people with atrial fibrillation who cannot take blood thinners, Watchman was approved by the FDA in 2015. Since that time, more than 4,000 people have had it installed, and its future seems bright.
  • 6. Scans may predict if coronary blockages could become lethal. Using a new technique in CAT scanning, doctors can calculate something called a fractional flow reserve (FFR) to see if any blockages found are severe enough to lead to a heart attack.  This is a noninvasive test that doesn't require a heart catheterization.
  • 5. More evidence for the power of lifestyle changes.  An important study showed that in people with a genetic tendency to heart disease, four factors (not smoking, regular physical activity, avoiding obesity, and a healthy diet) were associated with a whopping 46 percent decreased risk of having a heart attack.
  • 4. The jury is still out on bioabsorbable stents. These devices, which essentially melt away a few months after being put in a coronary artery, are becoming popular, but they have not yet been shown to be superior to regular stents,
  • 3. Hybrid cardiac surgery is hot.  Newer techniques that combine open heart surgery and coronary stents are getting more common, and it's hoped that this will improve outcomes for patients such as diabetics, for whom bypass surgery may be better than stenting alone.
  • 2. Breast cancer screening is also picking up heart disease. A study looked at using digital mammograms to look for calcification of the mammary arteries, finding that this could be an early predictor of undetected coronary disease.
  • 1. And 2016's top cardiology story is ..... TAVR, or transaortic valvular replacement, allows surgeons to give patients a new aortic heart valve without the risk of a traditional open-heart procedure. Because it's not clear whether TAVR is as good as open-heart, it's now only approved for patients deemed too sick for major  surgery. But look for its use to keep on booming in the years to come.

 
David Becker, M.D., is a board-certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa., and has been in practice for 25 years.


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