What's New in Heart Attack Prevention?
In the field of medicine, disease prevention is just as important as disease treatment. For example, it’s estimated a heart attack occurs every 40 seconds in the United States, and millions more Americans are at high risk of having one. And if you’ve already had one heart attack, your risk of another is greatly increased. But with advances in heart attack prevention, researchers are hopeful statistics like these can be improved. Here are some discoveries worth noting.
High blood pressure has long been linked to the development of heart disease and the risk of heart attack. In 2017, new guidelines were released defining high blood pressure as anything above 130/80, versus the previous 140/90. Lowering the limits of what constitutes high blood pressure means a much larger number of Americans will fall into this category, especially those under age 45.
Why is this significant? With lower limits for high blood pressure, treatment can be initiated earlier, whether through lifestyle changes, medication, or both. By treating high blood pressure at an earlier stage, the goal is to lower the risk of heart disease and prevent serious events, like heart attacks.
High levels of cholesterol in your blood, namely low-density lipoprotein (LDL) cholesterol, can cause fatty deposits to build up in your blood vessels and increase the risk of heart attack. rugs known as statins, like atorvastatin (Lipitor) and rosuvastatin (Crestor), have been instrumental in lowering cholesterol levels and improving heart disease. However, some people have persistently high cholesterol even after taking a statin or can’t tolerate the side effects. In these cases, a type of medication called a PCSK9 inhibitor can help.
Given as an injection every 2 or 4 weeks, the PCSK9 inhibitors evolocumab (Repatha) and alirocumab (Praluent) lower LDL levels by making it easier for your liver to remove cholesterol from your blood. According to studies, these medications can also improve cardiovascular outcomes, including the risk of heart attack and stroke, and may even lower the risk of death.
There is a significant overlap in patients who have type 2 diabetes and heart disease. Now, some medications used to treat type 2 diabetes–canagliflozin (Invokana) and liraglutide (Victoza)–have been found to also lower the risk of heart attack. Another diabetes medication, empagliflozin (Jardiance), has been shown to decrease heart-related deaths as the result of cardiac events like heart attack and stroke.
The way these medications work to lower complications from heart disease is not entirely known, but with such promising results, research remains underway to study other diabetes medications for the same effect. Recent clinical trials suggest that in the near future, more diabetes medications will receive approval from the Food and Drug Administration (FDA) for their cardiovascular benefits.
Many other methods of preventing heart attacks are being studied as well, and some look quite promising, including:
Addressing the role of triglycerides: Just like high cholesterol, high levels of triglycerides in your blood may contribute to heart attack risk. In addition to doing things like eating a healthier diet, some people may benefit from taking medications to lower their triglyceride levels. Early results of a recent study show that a triglyceride-lowering medication, icosapent ethyl (Vascepa) also led to a reduction in heart attacks and other cardiac events. The full study has not yet been released, but it may lead to more research in this area.
Addressing the role of inflammation: Researchers have suspected that inflammation, the body’s natural response to injury or infection, may play a role in the development of heart disease. Anti-inflammatory medications like canakinumab (Ilaris) have been studied to see if by decreasing inflammation within the body, they could also help prevent heart attacks. The FDA has not yet approved anti-inflammatory medications for this use, but the door has been opened to a potential new form of treatment.
Using precision medicine to identify heart attack risks: A growing field of medicine, called precision medicine, looks at things like your genetics to determine treatments that would work best for you. For example, researchers are learning how to analyze certain genetic changes that may help predict who is at high risk of having a heart attack or developing other heart-related complications. Identifying these individuals allows more aggressive preventative treatments to be implemented before a heart attack occurs.
Even as we continue to discover new treatments to prevent heart attacks, it’s important to remember that many of the “old school” prevention strategies remain the same: stop smoking, maintain a healthy weight, eat well, and exercise regularly. Be sure to see your doctor as scheduled, and if you are at high risk for a heart attack, talk to your doctor about which methods of heart attack prevention would be most beneficial for you.