After peaking in the mid-1960s, deaths from heart disease have dropped 60%, one of the great accomplishments of modern medicine. And yet it remains the No. 1 killer for both men and women, and data suggest that historic decline could be reversing itself, especially in the years after the pandemic.
That makes the latest innovations in treating cardiovascular conditions like high blood pressure, atrial fibrillation (A-fib), and aortic valve stenosis so critical for the 30 million Americans who are diagnosed with heart disease each year.
“How we treat cardiovascular disease will have a significant impact on your longevity and your health,” says M. Akram Kawsara, MD, cardiologist on the medical staff at Methodist Dallas Medical Center. “These technologies are evolving very rapidly.”
Dr. Kawsara discussed how such innovations are paving the way for the future of heart care with a group from Methodist Generations, an education and enrichment program for older adults.
Monitoring your blood pressure regularly is the first step to keeping it within healthy limits.
1. RENAL DENERVATION
It’s no wonder so many people suffer from high blood pressure when you consider there are so many factors that put people at risk. Here are a few of the risk factors for hypertension that we can control:
- Tobacco use
- Diet high in sodium and fat
- Physical inactivity
- Being overweight or obese
- Chronic stress
Other factors may not be under our control, including age, family history, and even ethnicity. But the first step is simply monitoring your blood pressure to know when it becomes a problem.
“A lot of people with hypertension are not aware of it because they don’t feel it,” Dr. Kawsara says. “They can go years and be unaware of it. That’s what makes it a silent killer.”
Aside from lifestyle changes, medication is the most common intervention, and most patients respond well to the many diuretics and beta-blockers on the market. But patients with “resistant hypertension” may benefit from a relatively new intervention known as renal denervation.
“The nerves around the kidney give feedback to the brain and contribute to hypertension,” Dr. Kawsara says. “We can use a catheter through an artery in a leg to burn those nerves with ultrasound or radiofrequency energy.”
This minimally invasive procedure ablates the nerves while not damaging the kidney or the surrounding arteries that supply blood to the organ. Afterward, patients can benefit from a drop in blood pressure between 5 and 15 points, Dr. Kawsara says.
“The data show if you lower your blood pressure by 10 points, you decrease your cardiovascular risk by 20%,” he says.
An implant placed with a catheter can close off the pocket where blood pools in AFib patients.
2. WATCHMAN FOR AFIB
AFib is a type of cardiac arrhythmia, one of several abnormal heart rhythms that are named by the chambers of the heart in which they occur (atria or ventricles) and by what effect (too slow, too fast, irregular) they have on the heart’s rhythm.
“By the time we reach our 70s, one out of every four people will have atrial fibrillation,” Dr. Kawsara says. “With some more sensitive patients, every time they have an irregular heartbeat they may feel it. Other patients may go years not knowing they have AFib.”
Caused by abnormal electrical signals in the heart, AFib interferes with the muscle’s ability to pump blood normally. Sometimes this causes blood to pool in a pocket of the heart known as the left atrial appendage (LAA), potentially creating a blood clot that could travel to the brain and cause a stroke.
From prevention to advanced procedures, trust your heart to the innovative, personalized care that Methodist provides. Visit MethodistHealthSystem.org
Like hypertension, medication tends to be the first line of defense in treating AFib. That often means beta-blockers to slow the heart rate and blood thinners to prevent blood clots. But for patients at high risk for bleeding, blood thinners might not be an option. That’s where innovative implants to close off the LAA can help.
“Years ago, a surgeon might remove that appendage with open-heart surgery,” Dr. Kawsara says. “Now we can do it with a minimally invasive procedure to seal off that pocket of the heart with an implant that looks like a strawberry.”
One such implant, a WATCHMAN device, is placed using a catheter in a procedure that lasts 30 to 45 minutes. The patient goes home the same day, Dr. Kawsara says, and the benefits last a lifetime.
“This procedure does the job of the blood thinner, decreasing the risk of a stroke by half,” he says. “The difference is immediate, and you’re done with blood thinners for the rest of your life.”
Minimally invasive procedures like TAVR sometimes make open-heart surgery unnecessary.
3. TAVR FOR AORTIC STENOSIS
Aortic stenosis is the most common disease of the heart valves, affecting about 5% of people age 65 and older, according to the Centers for Disease Control and Prevention.
The aortic valve has three flaps, called leaflets, that open and close to allow blood to flow into the heart with each beat. With age, those flaps stiffen or become calcified, preventing the valve from opening or closing completely and causing pressure to rise in the heart.
“Calcium could build up in this valve for years, and patients don’t feel it,” Dr. Kawsara says. “But when they start having symptoms, they can go off a cliff and their condition can worsen very quickly.”
Those symptoms include shortness of breath, fatigue, and chest pain. In extreme cases, it can lead to heart failure and sudden cardiac death, Dr. Kawsara says.
With age, the aortic valve can stiffen, preventing it from opening and closing completely.
Unlike hypertension and AFib, there’s no medication to treat stenosis. The calcified valve must be replaced, and in the past, that required open-heart surgery. Now it can be done with a minimally invasive procedure known as transcatheter aortic valve replacement, or TAVR.
“When we have a blockage in the arteries, we can open it up with a tiny device called a stent that we place with a catheter,” Dr. Kawsara says. “In the 1990s, a Danish doctor asked why can’t we do the same thing with a big stent to open the aortic valve.”
During a TAVR procedure, an interventional cardiologist uses a catheter to place an artificial valve inside the old one, pushing the calcified leaflets aside and restoring healthy blood flow to the heart.
“The procedure takes between 45 minutes to an hour,” Dr. Kawsara says, “and we expect patients to be up and walking on the same day and home in less than 24 hours.”
Unlike WATCHMEN and renal denervation, TAVR has been around since the turn of the 21st century, but like those innovations, new advances are making treatments for heart disease more effective every day.
“The devices are getting smaller, the procedures are becoming less invasive, and recovery is quicker,” Dr. Kawsara says. “All that adds up to better outcomes for our patients.”
Connect With Methodist