Medicine changes so fast that doctors are hard-pressed to stay on top of the latest developments. That’s why they attend national medical meetings. At these meetings, they learn the latest information in their specialty.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
The annual meeting of the American Heart Association (AHA) is one of the largest in the world. From the thousands of presentations at AHA 2014, Steven Nissen, MD, Chairman of Cardiovascular Medicine at Cleveland Clinic, picked four that he feels are most likely to influence the way doctors prevent and treat heart disease.
1. Rock-bottom LDL levels safely lower risk after a heart attack
Low levels of “bad” LDL cholesterol are known to reduce the likelihood of having a heart attack. That’s why people at risk for heart attack are advised to keep their LDL level around 70 mg/dL—a feat that usually takes a statin to achieve. Whether going lower would produce additional benefit, or even be safe, has been unknown.
In a study presented at AHA 2014, researchers gave a different cholesterol-lowering drug, ezetimibe (Zetia), plus simvastatin (Zocor) to patients who had suffered a heart attack. The drug combination pushed LDL levels as low as 53 mg/dL, while those taking simvastatin alone achieved levels of 69-70 mg/dL. As LDL levels fell, so did the risk of heart attack and stroke, and the patients suffered no unusual events.
“This trial really shows that for very high risk patients, exceedingly low LDL levels produce meaningful benefits,” says Dr. Nissen.
2. Extending dual antiplatelet therapy after stenting has both risks and benefits
After receiving a stent, patients must take clopidogrel or a similar drug plus aspirin for 12 months. This regimen, called dual antiplatelet therapy, is designed to reduce the likelihood that a clot will develop inside the stent, causing a heart attack, or elsewhere in the arteries, potentially causing a stroke.
The results of a trial presented at AHA 2014 found that extending dual antiplatelet therapy to 30 months did, indeed, reduce the rate of these undesirable events, but also increased the rate of moderate or severe internal bleeding. In addition, in-stent clots and heart attacks rose within three months after clopidogrel or similar drug was discontinued.
“The optimal duration of dual antiplatelet therapy remains unknown,” says Dr. Nissen.
3. Aspirin fails to prevent a first heart attack or stroke
After a heart attack, taking low-dose aspirin every day can help prevent another heart attack. But if you have never had a heart attack, the risks of daily aspirin outweigh the benefits, even if you have hypertension, diabetes or high cholesterol.
In a study presented at AHA 2014, daily low-dose aspirin significantly reduced the rate of heart attack and transient ischemic attack (a “pre-stroke” or “mini-stroke”). However, the risk of bleeding canceled out any benefit.
Recently, a survey of U.S. cardiology clinics showed that 10 percent of patients were being given aspirin to prevent a first heart attack.
“For some years, we have recommended that patients not take aspirin for primary prevention of heart disease. This study furthers supports our conviction that patients should take aspirin only if they already have heart disease,” says Dr. Nissen.
4. Stenting asymptomatic diabetic patients does not save lives
Diabetes is a major risk factor for cardiovascular disease, so stenting high-risk diabetic patients—even when their risk factors are under control—should reduce the risk of death, heart attack and stroke. But a study presented at AHA 2014 found this assumption is flawed.
The study used coronary CT angiography (CTA) to identify coronary artery disease in asymptomatic patients with diabetes, so that stenting could be performed. When compared with those whose blood sugar, blood pressure and cholesterol were controlled with medication, stenting made no difference in the rate of heart attack, stroke, hospitalization for cardiovascular causes or death.
“The negative results of this study reinforce that CTA does not provide an outcomes advantage in asymptomatic patients, even those at high-risk,” says Dr. Nissen.