Every year, billions of dollars are spent studying ways to prevent and treat coronary artery disease (CAD), valve disease and other heart diseases caused by atherosclerosis.
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Yet heart disease remains the leading killer of men and women in the United States. With so much time and money invested in research, why haven’t we found a way to cure this common problem?
It’s a topic Steven Nissen, MD, Chairman of Cardiovascular Medicine at Cleveland Clinic and one of the most respected heart disease researchers in the world, is happy to discuss.
Q: What’s preventing heart disease from being cured?
A: When heart muscle is damaged by heart attack, it cannot regrow. There is some evidence that we may be able to delay or even prevent a heart attack by aggressively treating high blood pressure and high cholesterol. However, once a heart attack occurs and heart muscle dies, we can’t regenerate those cells.
Along the same lines, once a heart valve becomes stiff and calcified, there is no way to restore the valve’s flexibility. It must be repaired or replaced.
Q: How treatable is heart disease?
A: Although we can’t cure heart disease, we can make it better. Most forms of heart disease are very treatable today.
There is some evidence that normalizing high blood pressure and lowering cholesterol to very low levels will partially reverse plaques in the coronary arteries. They won’t go away completely, but they shrink enough to make a difference.
We can open vessels so patients don’t die from CAD. We can repair or replace diseased valves. When damage to the heart muscle causes the heart to fail, we can offer a mechanical assist device to help the heart pump more strongly or do a heart transplant.
These measures don’t cure the disease, but they do allow patients to recover and live long, functional lives.
Q: What progress have we made in preventing heart disease?
A: Some of the most exciting advances have been made in disease prevention.
We have learned a lot about the risk factors for CAD and can recommend lifestyle changes and medications to lower risk. We have excellent medications that can prevent CAD in people with diabetes, high blood pressure and high cholesterol.
Q: Do you think it will ever be possible to cure CAD?
A: Studies on stem cell therapy to regenerate heart muscle are promising, but they are not ready for prime time. New drugs are taking us to ever-lower levels of LDL cholesterol, but the ability to erase plaques is still a long way off.
I think we will likely become better at preventing CAD before we find a cure for it. This is very important, because the best CAD is the CAD you never develop.
This Q&A originally appeared in Cleveland Clinic Heart Advisor.