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Heart Care: How Far We Have Come

Written by  OurHealth

The evolution of the subspecialty of cardiology is widely considered being responsible for the greatest prolongation of life in industrialized nations. Advancements in science and technology coupled with the expertise of medical experts in the field have contributed to a significant decrease in heart disease and heart-related conditions.

Although heart disease continues to be a leading killer, the death rate by age and impact to population per capita during the 21st century is markedly less than during the 20th century. To learn more, OurHealth turned to cardiologists in Southwest Virginia for their expert opinion on how far we’ve come in the field of heart care.

Q: How far has drug therapy come over the last decade in preventing heart failure and high cholesterol?
A: The first statin was FDA approved in the United States in 1987, and the latest generation -- potent statins -- have been approved for more than a decade. Over the years, we have refined our criteria for eligible patients with several iterations of guidelines and have shown that statins have benefits in patients without marked elevation in cholesterol, but with other markers of risk, such as inflammation. We have raised questions about the usefulness of other types of lipid lowering therapies, for example niacin, when the patient is on an optimal statin and the LDL-cholesterol is at target.

What is a statin?

A class of drugs that help reduce levels of fats, including triglycerides and cholesterol, in the blood. By lowering these levels of fats, they help prevent heart attacks and stroke.

Source: American Heart Association

The latest breakthrough is the approval of two agents in a completely novel class: the PCSK9 inhibitors. These drugs inhibit the action of an enzyme that breaks down the LDL receptor. Both of the FDA-approved drugs are remarkably potent in reducing LDL cholesterol and offer a novel approach to patients whose cholesterol is not adequately controlled by statin therapy or who are intolerant to statins.
The best way to prevent heart failure is to reduce risk factors for coronary artery disease such as,
•    smoking
•    diabetes
•    high cholesterol
•    and blood pressure.
Reducing blood pressure is especially important as this risk factor can produce heart failure by increasing the risks for heart attacks or by leading to thickening of the heart (ventricular hypertrophy).

The traditional threshold for defining hypertension has been a blood pressure greater than 40/90 but a recent study suggested that the threshold should be significantly lower. If these findings are incorporated into the next guidelines, there will be more patients who are labeled "hypertensive" and more medication therapy will be required to meet targets.

For the patient who already has heart failure, two new medications were recently approved. The first is a combination of an old medication with a new class of medication that inhibits the degradation of an enzyme that breaks down certain peptides that are protective in heart failure. The second is a novel drug that slows the heart rate by acting on the intrinsic pacemaker of the heart. This drug can be used for patients who cannot tolerate beta blockers or who do not achieve the desired effect.

Sane David 2


David Sane, MD
Chief of Cardiology
Carilion Clinic
Roanoke | 540.982.8204


Q: How has an increased awareness in preventive care affected Cardiology? What is Preventive Cardiology?
A: Preventive cardiology focuses on preventing or better managing risk factors that increase the risk of cardiac disease. An increased awareness of preventive care has helped patients to better prevent or manage risk factors such as,
•    diabetes
•    high cholesterol
•    tobacco abuse
•    high blood pressure
•    and obesity.

Through education and routine yearly physical exams patients can significantly reduce the risk of cardiac disease. Increased education for smoking cessation, management of obesity and increased exercise for a healthy lifestyle have also moved in the direction of decreasing risk of cardiac disease.

By having patients obtain yearly physicals and educating patients on healthy lifestyle choices and risk factor reduction we as a community can reduce the overall number of patients that develop cardiac disease. Continued development of improved procedures, medications, and treatment that reduce risks of cardiac disease will further reduce development and progression of cardiac disease for better long term patient outcomes. Patients and practitioners are encouraged to embrace Preventive Cardiology methods for better outcomes in the future.

Bowles matthew-2


Matthew Bowles, PA-C

LewisGale Physicians
Salem | 540.772.3430


Q: How does Carilion Clinic’s hybrid operating room affect cardiovascular care in Southwest Virginia? (PHOTO)
A: The hybrid operating room at Carilion Roanoke Memorial Hospital offers the functional capacity of a cardiac catheterization laboratory and a fully functional operating room. The hybrid operating room gives us an environment where we can perform endovascular procedures, but have the ability to switch to an operative approach if needed. It offers a full suite of the radiographic imaging technology in a surgical environment, which means we can perform more complex procedures on site. For patients, this means we don’t need to refer them to hospitals that may be a few hours away. We are regularly performing procedures such as pacemaker lead extractions, Transcatheter Aortic valve replacement (TAVR) and complex aortic endograft and vascular surgical procedures.
Ball Timothy 2


Timothy Ball, MD, PhD
Carilion Clinic
Roanoke | 540.982.8204

What is a hybrid operating room?

A specially designed operating space that allows a variety of different specialists, including cardiac surgeons, interventional cardiologists, vascular surgeons and interventional radiologists to work together at one time, performing minimally invasive procedures on patients. This means that patients who might have otherwise required open heart surgery can now be effectively treated with a far less invasive catheterization procedure.

Source: Carilion Clinic

Q: How has recent gender specific research affected heart disease detection in women?
A: The most important thing that has been learned from research on cardiac disease in women is that women are not simply "little men".  We experience symptoms of heart disease differently and it is a well-known fact that a woman is more likely to die of her first heart attack than a man.  The important thing that we need to take from this is that we need to listen to our bodies. If you don't feel well, you need to see a doctor. If you suddenly feel terrible and are experiencing:
•    shortness of breath
•    chest pain or pressure
•    nausea with arm, neck or upper back pain
•    or a combination of these symptoms and it doesn't resolve within a few minutes you need to call 9-1-1 and get checked out.

Rutherford 2



Molly Rutherford, MD
Jefferson Surgical Clinic
Roanoke | 540.283.6000

Q: What is sensor-technology in cardiovascular care and how is it changing the way doctors interact with their patients?
A: Broadly speaking, a medical sensor is any device that transduces physiological information into an electric or optical signal. Sensors are used to measure heart rate, blood pressure, oxygen saturation, rhythm disturbances, and other important parameters. The coupling of sensor technology with wireless transmission is now allowing transmission of important data from the patient to the physician from remote sites--such as the patient's home--without direct patient contact.
For example, most pacemakers and defibrillators transmit to a receiver that allows remote patient monitoring of heart rhythm issues. The pulmonary artery pressure of patients with heart failure can be followed by a sensor placed in the pulmonary artery. The data can be transmitted from the patient's home, allowing the physician to detect important trends that correlate with fluid retention. That information will allow them to make adjustments that reduce patient symptoms without requiring hospitalization or even an outpatient visit.
In the near future, data analysts may monitor physiological parameters from multiple patients, reporting the data to a physician who then makes clinical decisions.
Though direct patient contact will remain essential, the ability to remotely monitor physiological parameters may decrease the frequency of office visits and, more importantly, of hospitalizations.  

Sane David 2


David Sane, MD
Chief of Cardiology
Carilion Clinic
Roanoke | 540.982.8204


Q: How is bio-monitoring impacting heart failure and high cholesterol?
A: Over the last decade numerous advances have been made with respect to medical therapy and monitoring to treat patients with heart failure. The addition of bio-markers and biosensors have improved our ability to better predict when a patient may be in declining health or a worsening fluid balance. With that information, we initiate more aggressive medical therapy sooner potentially preventing a full blown exacerbation of heart failure.

What is a Biomarker?

A characteristic that is measured and evaluated as an indicator of normal biologic processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Typically describes substances detectable in blood, urine, or other bodily fluids.

Source: American College of Cardiology

If I peer ahead a few years, I believe the greatest advances to be made will be related to bio-monitoring. The amount of information we can get from personal bio-monitoring is immense, and access to that real-time data will allow us to make great strides in cardiac care.  I believe the goal should be to improve preventative therapies and deliver aggressive risk factor reduction sooner, preventing long-term problems.

Ball Timothy 2


Timothy Ball, MD, PhD
Carilion Clinic
Roanoke | 540.982.8204