Heart Matters

Start with one part diuretic. Add one part ACE inhibitor, and sprinkle in one part beta blocker. Then add a dose of statins, and top it off with a portion of antiplatelets. Here we have the proposed recipe for a singular pill that some experts believe will eventually help us stick a fork in heart disease. Yet there are pharmacologic concerns and certainly clinical trials to pass before this drug comes to a practice near you. That said, it's fair to wonder: how close are we? Dr. Salim Yusuf, professor of medicine and the director of the Population Health Research Institute at McMaster University in Hamilton, Ontario, Canada, is the lead author of one of the most recent polypill clinical trials, presented at the American College of Cardiology's 2009 Scientific Sessions. Dr. Yusuf joins host Dr. Janet Wright to give us an update on the global effort to create a polypill that will improve compliance, increase convenience and reduce cost.

Research tells us that more than 80 percent of American women have used hormonal contraception during their lives. Though evidence suggests hormonal contraception could offer anti-atheromatous effects, the verdict is far from in. Further, we have a lot to learn about the long-term risks for thrombosis, arrythmogenesis, vasomotion and beyond. As we study the potential links between contraceptive hormone use and cardiovascular disease, where should our priorities lie? Host Dr. Janet Wright poses this question as part of a fascinating conversation with Dr. Noel Bairey Merz, director of the Women's Heart Center and the Preventive and Rehabilitative Cardiac Center, and the Women's Guild Endowed Chair in Women's Health at Cedars-Sinai Medical Center in Los Angeles, and a professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles.

Does elective percutaneous coronary intervention (PCI) make sense for patients with stable coronary artery disease (CAD), or are some better off with optimal medical therapy? The answer may depend on our ability to document ischemia in these patients, but it also leads us to another question: are we doing enough, through stress testing or other means, to substantiate the need for PCI? Dr. Rita Redberg, professor of clinical medicine in the division of cardiology at the University of California, San Francisco, School of Medicine, talks with Dr. Janet Wright about the work-up and evaluation of patients with stable CAD.

It is increasingly recognized that symptoms of heart disease are different for men and women. But it appears we are often slower to recognize heart disease in women, resulting in important distinctions in early treatment and outcomes. What are these differences, and how can we, as providers, help narrow this gender gap? Host Dr. Janet Wright welcomes Dr. Rita Redberg, professor of clinical medicine at the University of California, San Francisco, School of Medicine (UCSF), and director of women's cardiovascular services at the UCSF National Center for Excellence in Women's Health, for an important conversation about where can we do a better job of encouraging women to be aware of cardiac concerns specific to women? Dr. Redberg also shares her approach to evaluating female patients with symptoms that are suggestive but not definitive.

We're seeing some progress in cardiac imaging toward this lofty goal, thanks, in part, to a system that combines online technology with science-based selection criteria. The system will help us track patterns of care, provide insights into variations in care across the country and ensure that patients get the test that brings the most value to their care. Host Dr. Janet Wright probes the areas where we can further develop our goals for providing the most appropriate care with Dr. Robert Hendel, clinical cardiologist at Midwest Heart Specialists, based in suburbs west of Chicago, and professor of medicine at Rush University Medical College in Chicago. Dr. Hendel also explores trends in the appropriate ordering of tests within a practice versus those referring to that same practice.

It takes a substantial measure of time, money and manpower to bring a new drug from the bench to the marketplace. One key aspect of this sequence is the drug approval process, overseen by the Food and Drug Administration (FDA). Host Dr. Jack Lewin welcomes Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, former commissioner of the FDA and administrator of the Centers for Medicare and Medicaid Services, to discuss a range of issues within the FDA's approval process: from essential boosts in funding, to more transparency about conflicts of interest, to the imperative need for comprehensive, real-time surveillance of long-term drug outcomes, how can the agency devote more attention to each of these areas of concern?

The next year promises to be an important one in health policy, in cardiology and in many other areas of medicine, as we set our sights on significant transformations across our health care system. What improvements can you anticipate that will enrich your practice environment and enhance the care you provide to your patients? Host Dr. Jack Lewin welcomes Dr. Alfred Bove, the newly installed president of the American College of Cardiology (ACC), for a look ahead at key points of emphasis during the coming year, from more rigorous quality measurements, to patient empowerment and value of care, to the broader issue of health care reform and the ACC's role in furthering the priorities of cardiologists and care providers across the entire health care spectrum.

For patients undergoing major non-cardiac surgery, perioperative management often focuses on recognition and treatment of cardiac risk factors and disease. Dr. Don Poldermans, professor of medicine and head of perioperative cardiac care at Erasmus Medical Center in Rotterdam, the Netherlands, joins host Dr. Doug Weaver to explain how medical treatment and testing should factor into pre-operative preparations. How should you proceed with patients who you suspect possesses some risk, but displays no risk factors? Does aspirin complicate our approach to certain surgeries for certain patients?

Long-term anticoagulation is often viewed as inconvenient and somewhat risky, even for patients with atrial fibrillation who are at elevated risk for stroke. Are these factors overshadowing the evidence that demonstrates the effectiveness of anticoagulant therapy in preventing stroke? Dr. John Cairns, professor of medicine in the division of cardiology at the University of British Columbia in Canada, talks with host Dr. Doug Weaver about stroke prevention for patients with atrial fibrillation. Is it safe to stop anticoagulant therapy in this population, and if so, when should this decision be considered?

The performance of percutaneous coronary intervention (PCI) without a surgical backup has long produced controversy. In recent years, off-site PCI has become more common, and clinical evidence demonstrates comparable outcomes for on-site and off-site procedures. How does this shift allow us to serve a broader patient population? Will guidelines change to reflect some of these new findings? For a look at these questions and more, Dr. Spencer King, president of Saint Joseph's Heart and Vascular Institute in Atlanta, professor of medicine emeritus at Emory University School of Medicine, and a past president of the American College of Cardiology, joins host Dr. Doug Weaver.