A New Dawn in Heart Disease Treatment
Whether intentional or circumstantial, we have fallen into a time hierarchy for curing and treating the three big killer illnesses in America — heart disease, cancer and Alzheimer’s disease.
With immunotherapy showing sudden and extraordinary promise for curing cancer, we are on the verge of wiping out or treating cancer as a chronic but manageable set of diseases within a decade. That’s truly astounding.
But at the same time, we are entering a lull in similar progress against heart disease.
For heart medicine, there are good drugs for hypertension and cholesterol and good surgeries for some conditions. All of these undoubtedly prolong life.
But heart diseases (and especially if you include stroke in the calculations, which I do, because strokes are vascular events and subject to similar causes) are by far the most prominent killers in this country, and it seems as if we should have made far more progress against them by now.
We understand almost all heart disease and have for decades. So where are the advanced medicines?
There are more than 21,000 trials for heart disease underway, yet only nine drugs were approved for heart disease last year and only two in 2014.
None of these drugs were a breakthrough. Four of them were for cholesterol and high blood pressure — for which there are already many options.
Like cancer, heart disease comes in many different forms. Drug companies tend to focus on developing drugs like statins and blood pressure medications because they can be used as mass treatments that will bring in massive revenues.
For all our success in cardiology — and there is much to be proud of — prevention and surgery remain our best tools. Devices like defibrillators, pacemakers and stents are effective at keeping people alive longer but do not treat the underlying disease.
Of course, the best way to prevent heart disease from happening is to exercise every day, eat carefully and refrain from smoking…
But none of those tricks works very well for people born with the wrong genes, and those people represent a lot of heart disease. As with cancer, their disease often develops from mutations within.
Also like cancer, heart disease should not be seen as a single disease but as a complicated group of subdiseases that must be tackled one at a time and thoroughly understood before they can be treated effectively.
Heart disease may not be dissimilar. The significant role of genetics in heart disorders is only beginning to be appreciated.
But there is a new dawn on the horizon. And it’s called precision medicine.
The idea of precision medicine is a little hard to grasp, but it got a lot of attention when President Obama launched a national initiative at it and funded it with $215 million in the 2016 budget.
The concept behind precision medicine is to develop therapies that pinpoint an individual’s problem, rather than developing medicines and therapies designed for the masses.
Take heart disease: why do some people react well to specific statins and others don’t? We actually don’t know the answer to that question. But if we understood the role of cholesterol in our bodies, and how individual genetics change that role, it could revolutionize one field of heart disease.
The ultimate precision medicine approach would involve the individual taking his or her health history, decoding his or her genome for possible mutations, understanding his or her past and present environment as well as lifestyle and then making a custom drug for that person alone.
The approach promises to cure many people of diseases –and to prevent many that are inherited.
Cancer is the first to undergo a revolution thanks to precision medicine. We no longer give almost all breast cancer patients the same chemotherapy, as we once did. Patients undergo testing to establish their specific genetics. Then we decode the genetics of the individual’s cancer, which has its own characteristics, and then the patient is given a specific therapy that is most likely to work for their version of the cancer.
The same concept has yet to be applied to America’s No. 1 killer — but we’re getting there.
As drug companies continue to lay the groundwork for precision medicine in areas like cancer, it’s only a matter of time before we approach and treat heart disease using the same method.
The cure could be right around the corner…
To your health and wealth,
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