As 2023 comes to a close, cardiologists are reflecting on some of the advancements and breakthroughs in their field over the past 12 months.
Heart disease is a pressing issue in the United States. The American Heart Association reports that more than 130 million adults (about 45.1% of the population) will develop some form of cardiovascular disease by 2035, which will lead to $1.1 trillion in projected total costs.
This reality means researchers and clinicians are invested nationwide in developing better interventions and treatments to address the rising prevalence of heart disease among Americans.
To put in perspective how serious this is, heart disease stands as the leading cause of death regardless of gender and spans most racial and ethnic groups in the United States, according to the Centers for Disease Control and Prevention (CDC).
Heart disease kills one person for every 33-second interval nationwide.
Healthline spoke with several experts who weighed in on the major breakthroughs and innovations of the past year as well as promising developments on the horizon in 2024.
Dr. Joseph C. Wu, Ph.D., FAHA, American Heart Association president and director, Stanford Cardiovascular Institute and Simon H. Stertzer Professor of Medicine & Radiology at Stanford School of Medicine, said that glucose-lowering drugs have been a game changer for people with type 2 diabetes, helping them to reduce cardiovascular events and improve their heart health.
Research is now suggesting these same drugs may also improve heart health in people with obesity who aren’t also living with diabetes.
“In one trial of semaglutide, a medication shown to lower the risk of heart problems in people with diabetes and approved for long-term weight management, people with heart failure with preserved ejection fraction and obesity fared better on the drug than on placebo,” Wu said.
What is preserved ejection fraction?
Wu explained that this happens “when the heart muscle becomes thick and stiff and can’t pump out enough blood to meet the body’s needs.”
“The semaglutide group had greater reductions in heart failure-related symptoms, greater improvements in the ability to exercise and greater weight loss,” he added.
Wu also singled out a late-breaking trial of the GLP-1 (glucagon-like peptide 1) receptor agonist drug that was presented at the American Heart Association’s Scientific Sessions 2023.
In that trial, researchers looked into whether semaglutide benefitted people who are living with overweight or obesity who did not have diabetes, but who had cardiovascular disease.
The findings show that the drug was “superior to placebo in reducing cardiovascular-related death, nonfatal heart attacks, and nonfatal strokes,” Wu told Healthline.
Dr. Steven Nissen, a cardiologist at Cleveland Clinic, pointed to a different type 2 diabetes medication that he said is also a “blockbuster” — tirzepatide.
He cited findings released this year that showed the cardiovascular benefits of the dual-acting GIP and GLP-1 agonist, which was originally made available solely for diabetes under brand name Mounjaro, and was recently approved for weight loss and the treatment of obesity under the name Zepbound.
“We’ve had these drugs, but we didn’t really know whether they’d have a favorable effect on cardiovascular outcomes on people who are being treated for obesity,” he said.
The research conducted on this drug had a “very robust result,” Nissen stressed.
It was shown to have a 20% reduction in body weight for people who were overweight, while showing clear, “promising hard endpoints” of lower risk of cardiovascular death, stroke, myocardial infraction, or heart attack.
“That’s a big reduction, it’s a turning point in the battle against obesity,” he added.
Dr. Karol Watson, PhD, an attending cardiologist and a Professor of Medicine/Cardiology at the David Geffen School of Medicine at UCLA, said all of the big 2023 developments in cardiovascular health center on preventive measures for lipid and hypertension management.
Watson, who is also the director of the UCLA Women’s Cardiovascular Health Center, the UCLA-Barbra Streisand Women’s Heart Health Program, the co-director of the UCLA Program in Preventive Cardiology, and director of the UCLA Fellowship Program in Cardiovascular Diseases, told Healthline that the big goal is “trying to figure out how to get people to take their medications in the least invasive way possible.”
Watson said that, traditionally, you had daily pills people would take or injectables they would have to receive every two weeks. Today, there are more options.
“Now, there is data on the injectables people can do every every six months. Now, there are longer gaps [between injections]. The whole idea is one and done and doing something people will find easier for them. And, it works,” Watson explained. “The problem is, these things are not going to be cheap.”
The findings of the drug zilebesiran, which showed the potential to lower pressure with an injection every six months, were presented at the American Heart Association’s Scientific Sessions 2023.
Watson added that this kind of injectable “makes it easy for people to get the medication they need.” She reiterated a big problem persists.
“These [medications] are easy, you have one injection every six months,” she said, “but they are not cheap. That is the problem.”
Wu pointed back to the 2023 Scientific Statement from the American Heart Association, which offers a summary of cardiovascular-kidney-metabolic (CKM) syndrome. He said this is “an interconnection between obesity, chronic kidney disease, diabetes, and cardiovascular disease, which is linked to premature death and disability.”
He said concretely pointing out this relationship is one of the big cardiovascular headlines of the year.
“The statement summarizes what is known about CKM syndrome and how to prevent and manage it. It highlights a new way to calculate risk of the syndrome, as well as gaps in knowledge and needed research,” Wu added. “An accompanying Presidential Advisory helps define CKM syndrome and offers guidance on the prevention and treatment of the syndrome across different clinical and community settings.”
Wu pointed to research on endovascular thrombectomy, a minimally invasive surgical procedure used to remove a stroke-causing blood clot from an artery in the brain, as another one of 2023’s big stories.
This procedure restores blood flow and prevents further brain damage and disability. It’s the standard form of treatment for either small or medium-sized strokes.
“Until now, it wasn’t clear if endovascular thrombectomy would also benefit people with larger, more severe strokes, which account for up to one-fourth of all strokes.
In a study of people with severe strokes from China and in another trial of people in North America, Europe, Australia, and New Zealand, researchers found endovascular thrombectomy within 24 hours of a stroke was superior to standard medical care,” Wu said.
This research showed that these individuals who received this treatment showed signs of experiencing fewer disabilities and “were more functionally independent during the three months after treatment.”
He pointed to a third study of those treated for severe stroke in Europe and Canada who showed similar outcomes.
“Those who underwent endovascular thrombectomy were more functionally independent than those who had standard medical treatment, alone. This study also showed that thrombectomy patients were less likely to die,” Wu added.
What do these experts see in the year to come? All three cited innovations in gene editing.
Watson said “we are starting to see the era of gene editing.”
She pointed to research out of New Zealand that shows, for the first time, gene editing technology can reduce low-density lipoprotein (LDL).
“What we’ve seen in this small proof of principle study, what we’ve seen in these first 10 patients, is that [we saw] durable LDL reduction, but of the 10 patients, two of them had very serious adverse events — one died and one had a heart attack, so the questions of safety will always persist,” she added.
Watson and Wu said that, even more promising, is the FDA approval of a cure for sickle cell disease that harnessed the same CRISPR gene-editing technology. The approval of Casgevy is a major breakthrough — the first medicine that utilizes CRISPR to receive U.S. approval, according to NBC News.
Nissen pointed to the number of drugs in development for treating lipoprotein (a), or Lp(a), as a development to keep front and center for the coming year. He said “this is a condition, which is a heart disease risk factor in 20 percent of the population that has never been treatable.”
Now, what is known as RNAi, or RNA interference, is being utilized to reduce Lp(a). Nissen said he and his team have published several articles on these new therapies, and one of them involves a clinical trial for a drug called pelacarsen, which he is chairing.
This study has enrolled 8,300 patients and “is now well along toward completion,” he said.
“If successful, it will be the first time ever that we can treat this disorder, everyone is waiting for the results of the trial,” he said.
Additionally, beyond these innovations, Wu said he’s excited about the FDA Modernization Act 2.0, which opens the door for moving beyond mandatory animal testing and toward a new era of using stem cells, organoids, artificial intelligence and machine learning, and in computer models for drug discovery.
Top Heart Disease Treatment and Prevention Advancements in 2023 Read More »
As a new school year begins, parents can help to slow the spread of seasonal illnesses and avoid unnecessary absences. This article covers the role of healthy hygiene habits, vaccination, spotting the symptoms of common illnesses, and how to make informed decisions on whether a sick student is well enough to attend school or college.
When one thinks of the most wide-reaching, deadly health issues facing the world today, cancer has to be right up there at the top of the list.
The wide range of diseases encompassed by the disease affect people of all walks of life in all corners of the globe.
In the United States alone, recent figures show there were an estimated 1.9 million new diagnosed cases of cancer in 2022 along with 609,360 cancer deaths.
Zooming out for a more global perspective, cancer stands as the second most common cause of death worldwide, accounting for almost 10 million deaths in 2018, the World Health Organization (WHO) reports. That was nearly one in every six deaths.
The World Cancer Research Fund International states that there were 18 million cancer cases globally in 2020. About 9.5 million were reported in men while 8.5 million were seen in women.
Given these statistics, where are we today in the push to develop new treatments?
The research now out there is offering us a more comprehensive understanding of how cancers are affecting millions of people around the world.
Healthline spoke with some experts to contextualize the big breakthroughs in oncology research and treatment over the past year as well as predictions of what we should be looking in the year ahead.
Experts say that mRNA technology has yielded exciting results
Throughout this year, news was made regarding various clinical trials for potential cancer therapies that were developed by way of mRNA technology, which was used to develop the COVID-19 vaccines.
MRNA refers to a kind of nucleic acid, which essentially communicates ways the body can produce needed proteins. When mRNA is injected into the body via a vaccine, for instance, it communicates with the body’s cells to trigger an immune response to the kinds of abnormal proteins created by a cancer, according to the National Cancer Institute.
A range of trials are testing whether the success seen with COVID-19 can work with cancers.
A team from Memorial Sloan Kettering Cancer Center in New York funded by the National Institutes of Health (NIH) has been developing an mRNA vaccine for pancreatic cancer.
In this small study, customized vaccines were engineered successfully for 18 of the 19 participants.
Throughout the study, 16 remained at a healthy threshold to receive some of the vaccine doses and half of them saw the vaccine trigger T cells needed to target their pancreatic cancer.
The results were encouraging, but a mixed bag — after a year-and-a-half post-treatment period, those who had a strong T cell response did not show signs of the cancer returning. The other half who didn’t respond to the vaccines with T cell activation saw their cancer return within an average of one year, reports NIH Research Matters.
Dr. Janice Mehnert, a melanoma expert and medical director of NYU Perlmutter Cancer Center’s Clinical Trials Office in New York, told Healthline that the Moderna mRNA vaccine program is currently “a super exciting space to watch.”
The drug manufacturer has been engaging in promising mRNA vaccine clinical trials in non-small cell lung cancer, for which it’s partnering with Merck on a phase III trial, as well as two vaccine trials for melanoma.
In July, the companies announced a phase III trial of a combination therapy that consists of mRNA-4157 plus pembrolizumab, brand name Keytruda, for people who are at high risk and who’ve received surgery. The goal is to enroll 1,089 people at melanoma stages IIb to IV, with final trial results expected in 2029.
Earlier in the year, the two companies reported results from a phase 2b trial of mRNA-4157 and pembrolizumab in a 157-participant trial. It revealed a 44% decrease in risk of post-surgical melanoma recurrence or death, compared to the risk with pembrolizumab used on its own. This combination therapy has earned breakthrough designation from the U.S. Food and Drug Administration (FDA).
Mehnert said that these developments combine “two of the most exciting breakthroughs in medicine — mRNA vaccine technology and immunotherapy in a personalized tumor informed approach.”
There was also news about antibody drug conjugates (ADCs)
“Antibody drug conjugates are a major space to watch with huge breakthroughs in breast and bladder cancer as well as lung and stomach cancer,” Mehnert said.
What are they?
Antibody drug conjugates (ADCs) are basically a way to directly target cancer cells without causing the toxic damage of chemotherapy. They consist of monoclonal antibodies attached to the drug itself by way of a linking chemical that can directly hit the cancer cells in question.
The journal Frontiers in Immunology reports that ADCs have proven successful in preclinical and clinical trials, and some have even been approved by the FDA to treat some types of cancer. It’s a growing field and 2023 saw it continue to be high on everyone’s radars.
Given how the disease presents itself so differently between individuals and the many forms it takes, cancer is one of the more complex health issues that frustrates clinicians and patients alike.
Samuel Godfrey, PhD, a research information lead at Cancer Research UK, said that is changing partially due to the work of TRACERx, a project that aims to deliver “the most detailed understanding of cancer evolution ever.”
“We learned how cancer’s capacity for rapid change is inexhaustible, which helps explain why this disease is such a challenge to beat. TRACERx has showed that it is actually possible to spot patterns and predict cancer’s behavior, even among such high levels of complexity. Realistically we could one day predict how a cancer progresses and perhaps even intervene before it becomes a problem,” Godfrey told Healthline.
Mehnert added that the advent of novel bispecific T cell engagers marks another big 2023 cancer development.
These are artificial antibodies that essentially aim a person’s T cells to their intended cancer cell target.
“They can redirect the entire repertoire of T cells against tumor, independent of T-cell receptor specificity,” according to the BMJ Journal for ImmunoTherapy of Cancer.
Godfrey also pointed to clinical trials such FOxTROT from the University of Birmingham in the United Kingdom and INTERLACE out of University College London as showing great promise in “markedly improved cancer survival.”
“What I find exciting about these trials is that the breakthroughs weren’t about new, expensive medicines but rather using well-established, cheaper drugs,” he said. “In short, with treatment, it might be all about timing.”
Many of the advancements and breakthroughs these experts cited are currently in trials, some of them might be years away from making a direct, concrete impact in cancer care.
Some of them are already changing the game.
It’s a wide range, just in the same way cancers themselves affect people around the globe in such broad and varied ways.
When asked what he sees on the horizon, Godfrey said that now is a time of “much optimism and excitement in the science community.”
“As we look forward to 2024, I am particularly excited about seeing many small but vital steps toward better prevention, diagnosis and treatment,” he added. “I think there will be further innovation in the use of our own immune systems to tackle cancer. We’ll see more improvements to technology that can detect the earliest signs of cancer. And AI [artificial intelligence] will continue to allow our scientists to do more, taking on some of the toughest cancer challenges such as predicting who is most at risk of the disease.”
“There is still a long way to go, but it is very inspiring to see how we are steadily moving toward a future where cancer won’t be a major problem,” Godfrey said.
Oncology/Cancer: 2023 Advancements and Breakthroughs Read More »
As 2024 approaches and you think about goals related to wellness, it’s a good time to prioritize your heart health.
Screenings are the best way to evaluate your heart, said Dr. Christopher Tanayan, sports cardiologist at Manhattan Eye, Ear and Throat Hospital.
“Particularly for those who are [over] 35 years old and have strong family history of heart disease,” he told Healthline.
However, heart screening may be different for different subgroups of the population.
“For instance, heart screening of competitive athletes may involve tests like an ECG and echo with a different set of criteria whereas someone who is generally healthy getting into their midlife years may just need bloodwork,” said Tanayan.
Not sure which screenings make the most sense for you? Experts break down the top seven.
Your primary care doctor, internist or general practitioner will gather a medical history, which includes your family history of medical conditions and your lifestyle practices, such as diet, exercise, and substance use.
“This is probably the most basic but most cost-effective screening tool we have because it’s (a) cheap (b) easy to perform (c) non-invasive, no blood draws and (d) provides so much insight to clinicians on what’s the next best step,” said Tanayan.
For instance, if you smoke, Dr. Roger Blumenthal, spokesperson for the AHA and director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, said your doctor will prioritize guidance on helping you quit.
“We try to use nicotine replacement therapy like patches or gum or medications like bupropion and varenicline. Also, behavior modification plays a key role,” he said.
By measuring your waist circumference and body mass index (BMI), your doctor can gauge if you have overweight or obesity, which increases your risk for heart disease, stroke, atrial fibrillation, congestive heart failure, and more.
“BMI [is a] non-invasive measurement during an office visit,” said Tanayan. “Losing weight significantly impacts blood pressure control, sleep apnea, insulin resistance, ability to exercise.”
High blood pressure increases the risk of heart disease and stroke. Because high blood pressure often doesn’t have any symptoms, many people don’t know they have it until they are monitored for it.
The American Heart Association (AHA) states that people whose blood pressure is below 120/80 mm Hg, should get it checked at least once every two years, starting at age 20. Those who have blood pressure higher than that should talk to their doctor about having it checked more often. Your doctor can check your blood pressure or you can check it at home.
Lifestyle changes and medication can help control blood pressure.
This blood test is taken to measure total cholesterol, which includes LDL (bad) cholesterol and HDL (good) cholesterol.
“Everybody should have their cholesterols checked at least once a year after a certain age. Normal LDL or bad cholesterol would be less than 100 and the same with triglycerides, which are the blood fats,” said Blumenthal.
The test is also important for detecting genetic abnormalities in cholesterol metabolism and the results provide target threshold numbers for treatment, said Tanayan. Lifestyle changes and medication are used to treat high cholesterol.
This test is taken every four to six years, starting at age 20 or more often for people at an increased risk for heart disease or stroke.
High blood sugar levels increase your risk of developing insulin resistance, prediabetes and type 2 diabetes, which can all lead to heart disease and stroke, if they are not treated. Specifically, high blood sugar can damage blood vessels and nerves that control the functioning of your heart.
One way to screen for type 2 diabetes is by measuring hemoglobin A1c levels (A1c %) in your blood. Diabetes is determined with an A1c level of 6.5% or higher.
Blumenthal said the AHA just released a new risk calculator called PREVENT that estimates the 10- and 30-year risk of total cardiovascular disease for people aged 30 years and older. The calculator estimates the risk of heart attack, stroke and, for the first time, heart failure. In the past, physicians would calculate risk for heart attack and stroke only.
“Congestive heart failure is many times more common than the risk of a heart attack or stroke,” said Blumenthal.
The AHA states that the calculator was created based on health information from more than 6 million adults, including people from diverse racial and ethnic, socioeconomic and geographic backgrounds.
For some people who are at least 35 years old and have at least two risk factors for heart disease, their doctor might recommend a coronary artery calcium (CAC) test, which determines how much plaque is in your heart arteries. This involves a CT scan of the heart that takes images of the arteries that supply blood to the heart muscle. The test helps a doctor determine a person’s risk of heart disease.
“[It’s] really for people who are on the fence about whether or not to add a medication, generally for cholesterol but sometimes for blood pressure control,” said Blumenthal.
The test is appropriate for the following people, according to the AHA.
To keep your heart healthy, the AHA recommends the following eight health behaviors and factors, which are the key measures for improving and maintaining cardiovascular health.
Having good cardiovascular health helps lower the risk for heart disease, stroke and other major health problems, said Blumenthal.
7 Preventative Heart Screenings You Should Prioritize in 2024 Read More »
The new year often brings about new health goals, and one goal everyone should consider adding to their list is scheduling screenings for cancer.
“The advantage of regular cancer screening is that cancers that are small and without any symptoms can be found early, when treatment is more successful,” Robert Smith, PhD, senior vice president of cancer screening for the American Cancer Society, told Healthline. “Cancer screening works best when it is done regularly according to the guidelines.”
He said to think of cancer screening as part of your preventive health plan, meaning you should always be current for the cancer screening that is recommended for your gender and age group.
As the medical field continues to understand the importance of screening in regards to improving health, impacting survival, and reducing the number of people who develop late-stage cancer, it will be able to help more people obtain screening earlier, which may impact curative potential of many diseases, said Dr. Ajaz M. Khan chair in the department of medical oncology at City of Hope Atlanta, Chicago and Phoenix.
As certain cancers like breast, colon and lung continue to increase, screening becomes more and more critical, he added.
“More importantly, they establish criteria and guidelines that can help determine patients that are at higher risk based upon their age, gender, family, and social history. Early detection of cancers may also help improve survival and offer curative options for treatment,” Khan told Healthline.
Health experts say that the top five cancer screenings that should be on your radar in the new year include the following:
A mammogram takes an X-ray picture of the breast, so doctors can analyze the breast for early signs of breast cancer. Getting regular mammograms allows doctors to compare changes in breasts over time, and allows them to find breast cancer early, sometimes up to three years before the cancer can be felt.
The American Cancer Society (ACS) recommends the following guidelines for women at average risk for breast cancer, meaning they don’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as in a BRCA gene), and have not had chest radiation therapy before the age of 30.
“[In] patients with higher risk, which is dependent upon familial or individual risk, screening may also include [ultrasound and] MRI evaluations,” said Khan.
The following two tests can help detect cervical cancer early or prevent it. Your doctor can do both tests in the office by collecting cells and mucus from the cervix and the area around it. The sample is then sent to a lab for testing.
“Cervical cancer screening usually begins after the age of 18 and women can obtain a Pap smear evaluation along with testing for HPV DNA in order to assess for higher risk of development of cervical cancer,” said Khan.
Depending on your age, your doctor will determine how often you need these tests.
The U.S. Preventive Services Task Force (USPSTF) recommends that both men and women age 45 to 75 be screened for colorectal cancer. Those older than 75 and those at increased risk for colorectal cancer should talk to their doctor regarding screening.
While there are several screening tests that can detect polyps or colorectal cancer, such as flexible sigmoidoscopy and stool tests, colonoscopy is often used for preventive screening.
During a colonoscopy, a doctor checks the rectum and colon for polyps or cancer by using a flexible, lighted tube. If polyps and cancer are found, the doctor can sometimes remove them during the procedure.
If everything looks normal, your doctor will recommend getting another colonoscopy in 10 years, “but the interval of screening will be dependent upon both individual and familial risk,” said Khan.
A prostate-specific antigen (PSA) blood test detects PSA, which is a protein made by cells in the prostate gland (both normal cells and cancer cells).
The higher the PSA levels, the higher the chance of having prostate cancer. Doctors vary on when they believe a man needs further testing with some using a PSA cutoff point of 4 ng/mL or higher and others recommending more testing when levels are 2.5 or 3, according to the ACS.
Doctors should talk to men about prostate screening at the following ages, according to guidelines from the ACS:
The USPSTF recommends that people who match the below criteria get lung cancer screening once a year:
A low-dose computed tomography (LDCT) scan is the only recommended screening test for lung cancer. The scan is done quickly and involves an X-ray machine taking images of your lungs.
Typically, your primary care or family doctor will refer you for screening.
“Mammography for breast cancer screening, and low-dose CT for lung cancer screening are performed in an imaging center; colonoscopy for colorectal cancer screening is performed in a hospital or outpatient setting, or stool testing is performed at home, and PSA testing can be done in the clinic,” said Smith.
If you’re interested in learning more about screening, reach out to the ACS to understand options for cancer screening and timing of screening, and to find providers who may be offering screening in your area.
Top 5 Cancer Screenings That Should be on Your Radar in 2024 Read More »
