Cardiologists are sometimes accused of giving too much treatment. Low-risk patients are handed armfuls of daily medication, risking side effects, while surgeons insert stents or ‘replumb’ blood vessels at the drop of a hat, despite less-than-clear benefits. Or so say the critics.
But if new research unveiled at the American Heart Association annual conference in Chicago this year is anything to go by, the order of the day is a less-is-more approach that’s focused not just on trying to make people live longer, but feel healthier too.
For the one million British heart failure patients, there was more evidence that new drug treatments are effective – but there was also much excitement at proof that something as simple as iron supplementation, albeit via IV infusion once every six months, not only prevents deaths but improves symptoms and boosts wellbeing.
There was major research into the beneficial effects of trendy mindfulness meditation on blood pressure – hard scientific proof that gentle lifestyle tweaks have a significant physical impact on heart health.
Cardiologists are sometimes accused of giving too much treatment. Low-risk patients are handed armfuls of daily medication, risking side effects, while surgeons insert stents or ‘replumb’ blood vessels at the drop of a hat, despite less-than-clear benefits. Or so say the critics
For the one million British heart failure patients, there was more evidence that new drug treatments are effective – but there was also much excitement at proof that something as simple as iron supplementation, albeit via IV infusion once every six months, not only prevents deaths but improves symptoms and boosts wellbeing
There was even a bizarre-sounding Chinese medicine containing crushed cockroaches and scorpions that might provide protection to heart attack patients.
Many of the advances involved treatments that are already approved, and inexpensive, meaning that patients won’t face an agonising wait for the regulatory green light.
That’s not to say it was all good news about complementary and alternative therapies: a large study into popular heart health supplements, of the kind millions of Britons take regularly, found they did little but cause stomach upsets and other problems.
As for surgery, a series of trials seems increasingly to show that stents – wire tubes commonly inserted into arteries to prevent blockages – might not be necessary for many.
And many game-changing discoveries have been made by doctors working in the NHS.
‘It’s phenomenal that the UK is leading the way, not just in treating patients but in improving outcomes for people with heart problems across the world,’ said Divaka Perera, Professor of Cardiology at King’s College London, adding that the new findings showed ‘a continual drive in cardiology, not just to look at how many years extra life we can give, but also in making quality of life better’.
Here, with the help of some leading medical minds, we outline the most vital news that emerged last week and explain what it means for British patients.
Success from Chinese tablets full of insects
As strange as it sounds, a traditional Chinese medication made from crushed herbs and insects might be effective in preventing heart attacks.
Tongxinluo capsules, which contain a cocktail of powdered scorpions, cockroaches, centipedes, leeches and cicadas, alongside more familiar ingredients such as ginseng, are widely used in China to treat heart problems. Previous research had suggested the preparation might work by relaxing blood vessels and improving circulation.
It has been found in smaller trials to reduce angina, but the new study, using more than 4,000 volunteers, is one of the largest to examine its effects. Patients in hospital after suffering a severe heart attack were given either standard treatment – including stents and conventional drugs – with Tongxinluo capsules, which they had to take three times a day for a year, or standard treatment and a dummy pill.
Tongxinluo capsules, which contain a cocktail of powdered scorpions, cockroaches, centipedes, leeches and cicadas, alongside more familiar ingredients such as ginseng, are widely used in China to treat heart problems
Dr Kenneth Mahaffey, Professor of Cardiovascular Medicine at Stanford University, called the results ‘interesting’. He added that further analyses would be needed before drawing any conclusions – in particular, how much impact the standard medication had
The results, reported at the conference, raised eyebrows, not simply due to the unusual ingredients, but because it turns out the medication was dramatically effective. A third fewer patients in the Tongxinluo group needed further surgery, died from heart attacks or had other heart problems in the first month. No significant side effects were reported.
Dr Kenneth Mahaffey, Professor of Cardiovascular Medicine at Stanford University, called the results ‘interesting’. He added that further analyses would be needed before drawing any conclusions – in particular, how much impact the standard medication had.
‘For now, these results will likely support the use of this Chinese medicine in [severe heart attack] patients in China,’ he concluded.
So should we all rush out and get our local Chinese doctor to prescribe Tongxinluo? Perhaps not quite yet. Albert Ferro, Professor of Cardiovascular Clinical Pharmacology at King’s College London, commented: ‘We don’t know what the active [ingredient] is.
‘It’s a mixture of herbs and insects, and what is it, in all of that, that’s doing the good stuff? We do want to know more about [whether] this is a real effect.’
Boosting iron levels to keep hospital at bay
A megadose of iron once every six months keeps heart failure patients out of hospital and may even boost survival rates.
The doctors behind the British Heart Foundation-backed trial recommend all those with the condition are given the treatment – a one-hour infusion of iron, via an intravenous drip – to improve quality of life.
Iron is a vital mineral, best known for its role in the production of haemoglobin, a protein in red blood cells that allows them to transport oxygen. Normally a balanced diet provides enough – it’s found in meat, poultry and dark green leafy vegetables such as spinach – but about half of heart failure patients are deficient.
Unlike a heart attack, which happens when the blood supply to the heart is blocks, leading to part of the muscle dying, heart failure is an incurable, long-term condition in which the heart can no longer pump effectively. There are roughly one million UK sufferers, and one in five adults are expected to develop the condition, which is primarily caused by blocked arteries reducing blood flow to the heart.
The doctors behind the British Heart Foundation-backed trial recommend all those with the condition are given the treatment – a one-hour infusion of iron, via an intravenous drip – to improve quality of life
Due to stress on the body caused by the disease, the liver produces a protein that blocks iron from being absorbed by digestive system, leading to deficiency.
‘Because of this, it’s difficult to correct with normal iron tablets,’ said Professor Paul Kalra, the cardiologist who led the study at Portsmouth Hospitals NHS Trust.
Iron deficiency worsens heart failure symptoms, including severe fatigue and breathlessness, and puts patients at higher risk of hospitalisation. But in the trial of 1,137 heart failure patients, which was carried out at clinics across the UK, half were given an IV drip containing a 2,000mg medical-grade iron preparation, and the other half were given a placebo drip.
They were given a dose at the start of the experiment and scheduled for follow-up appointments every four months.
The treatment with iron reduced the risk of hospitalisation and death by 20 per cent. Patients reported feeling better, and there were no serious side effects.
More research is needed to see if the group given iron will live longer than expected, but experts said they were hopeful.
‘Relatively few patients needed a top-up dose at four months, so we’d expect to give this treatment once every six months at most,’ said Prof Kalra.
‘I hope to see it become a standard part of care from here on.’
Don’t bother with useless supplements
Two-thirds of UK adults take a dietary supplement, and one in five does so to promote heart health. But just how much do they help?
When it comes to lowering cholesterol, the answer is nothing – and in the case of some supplements, they could even make problems worse.
Researchers gave volunteers one of six heart health supplements commonly found on the high street, including garlic, fish oils, cinnamon, turmeric, plant sterols and red rice yeast.
Others were given either a statin – drugs proven to lower cholesterol and prevent heart attacks and strokes – or a placebo.
After 28 days, those taking the statin had seen an average 38 per cent reduction in LDL cholesterol, the type linked to damage inside blood vessels.
The supplements, however, worked no better than the placebo – and in the case of garlic supplements, actually increased LDL cholesterol levels.
Plant sterols, which are regularly added to margarines and yogurt drinks sold in supermarkets, were found to lower levels of HDL cholesterol, the type often called ‘good’ cholesterol as it protects heart health.
Plant sterols, which are regularly added to margarines and yogurt drinks sold in supermarkets, were found to lower levels of HDL cholesterol, the type often called ‘good’ cholesterol as it protects heart health
People often avoid statins due to worries about side effects, with muscle aches being one of the most reported. However, in this trial, none of the statin group suffered these problems, while those taking garlic, turmeric, sterols and red rice yeast all did.
Cleveland-based cardiologist Dr Luke Laffin, who led the study, said: ‘Patients often put more faith in these heart health supplements, which can be picked up in supermarkets, than they do proven medication. This is a big problem.’
Dr Kalra welcomed the research, which he said would help him give patients advice on supplements.
‘They aren’t as regulated as medication, so a product might say it lowers cholesterol, but we don’t really know what that means.
‘These things aren’t cheap – and as this shows, people are paying a lot for something that not only isn’t going to help, but may harm.’
Mindfulness to tackle high blood pressure
Mindfulness has become a health buzzword in recent years.
The meditation-like techniques – which involve sitting still and focusing the mind on bodily sensations or the immediate environment – have been shown in some studies to help patients stop worrying.
This in turn can be effective in tackling stress, anxiety and other mental health problems. Now it seems that there could be a benefit for people suffering with high blood pressure too.
The news will be significant for the one in three British adults who suffer the condition – a major risk factor for heart attacks and strokes.
In a trial, more than 100 patients with high blood pressure – about two-thirds of whom were on blood pressure medication – were offered an eight-week mindfulness course. Two-hour classes were held once a week and involved standard mindfulness meditation as well as ‘mindful exercise’ and ‘mindful eating’, which involve concentrating on the sensations experienced during those activities.
Another 100 patients with high blood pressure not given mindfulness classes were also tracked.
After six months, the group attending the sessions had brought down their blood pressure by five points – translating to a ten per cent reduction in heart attack risk.
The meditation-like techniques – which involve sitting still and focusing the mind on bodily sensations or the immediate environment – have been shown in some studies to help patients stop worrying
Many of those on tablets decreased the amount they were taking, and the benefit remained. They were more active, reported less stress and their diet had gravitated towards including more heart-healthy food.
But Brown University epidemiologist Professor Eric Loucks believes that mindfulness itself has a specific effect on the nervous system: ‘Research that shows mindfulness has an effect on the brain, lessening activity in areas linked to stress, and connecting other areas that allow us to be less reactive to stresses.’
Although patients today can’t access the specific programme used in the trial, Prof Loucks recommends investing in a home blood pressure monitor and ‘just give mindfulness a go – an app, or a class, whatever feels good. Try it out. We can all do these experiments on ourselves.’
One drawback the researchers admitted to was most of the trial volunteers were from a quite narrow demographic – white and university-educated, so more likely to be in a higher income bracket and more open to the ideas of mindfulness.
Glasgow-based obesity and heart health expert Professor Naveed Sattar believes the research proves how important lifestyle changes are for tackling high blood pressure. ‘You don’t have to overhaul everything, just focus on making small tweaks,’ he says.
‘Swap your latte with sugar for a cup of tea with milk, aim to get your 10,000 steps in every day, have two fingers of KitKat, not four, and a salad with your meal so you’re less likely to snack. All these things will help control weight and blood pressure, and are easy to achieve.’
I had only two years to live, but gene editing has given me hope
One of the first heart-failure patients to benefit from a pioneering gene-editing drug said the treatment had given him hope when he was faced with a bleak prognosis.
Married father-of-three Chidi Egbochue, 57, had suffered gradually worsening health until he was diagnosed with the condition in February and told he could have as little as two years to live.
The City lawyer, who lives in Uckfield, East Sussex, with wife Samantha, 46, and their daughters Amarachi, six, and Nkechi, eight, and son Chinedu, 11, had worse news to come – his illness had been caused by a genetic disease called hereditary ATTR amyloidosis, meaning that it was likely he had passed it on to at least one of his children.
However, having been put on a trial for the medication NTLA-2001, which corrects the faulty DNA that causes the problem with a single dose, Chidi now feels ‘optimistic’.
The experimental drug is based on Nobel Prize-winning genetic-engineering technology known as CRISPR, which allows sections of faulty DNA inside cells to be manipulated.
Chidi Egbochue, 57, had suffered gradually worsening health until he was diagnosed with the condition in February and told he could have as little as two years to live.
Early-stage trial results, reported exclusively last week in The Mail on Sunday, showed that the treatment is highly effective in halting the illness in its tracks.
‘The strong likelihood is that there will be no further damage to my heart,’ Chidi said. ‘And there is a possibility, over time, that the existing damage will be reversed. I hope, in the future, if one of my children develop the condition, it will be simple to cure.’
Hereditary ATTR amyloidosis causes the liver to produce defective proteins that form clumps in the cardiac muscle, leading to heart failure. Unlike a heart attack, which happens when the blood supply to the heart is suddenly blocked, heart failure is a chronic condition in which the heart can no longer pump effectively because the muscle has become weakened. Symptoms include crushing fatigue and extreme breathlessness.
There are roughly one million sufferers in the UK, with one in five adults expected to develop the condition. It is primarily caused by blocked arteries reducing blood flow to the heart, but up to one in 20 cases are believed to be caused by ATTR amyloidosis.
So far 12 patients, including Chidi, have been treated in the trial, which is being carried out by NHS cardiologists at The Royal Free Hospital in North London.
Although some patients are born with the genetic fault that causes ATTR amyloidosis, other people develop the mutation spontaneously as adults, meaning it can happen to anyone.
Professor Julian Gillmore, who runs the University College London Centre For Amyloidosis, said: ‘If this trial continues to be successful, the treatment may permit patients who are diagnosed early in the course of the disease to lead completely normal lives without the need for ongoing therapy.’