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    View of the Future From Cardiac Experts at the ACC Annual Meeting

    Though science has come a long way in understanding the nature of coronary artery disease, there are still many questions and much to learn.

    That was the message of James Willerson, M.D., a cardiologist at the University of Texas Medical School in Houston. His remarks were made during the 49th annual meeting of the American College of Cardiology in Anaheim, Calif.

    "We've made great strides in the last century," Willerson said. "We've developed the ability to visualize the heart and the arteries - invasively and non-invasively - and to understand the cause of myocardial infarction (heart attack), but there is much to be done."

    Willerson outlined what physicians and research scientists still have to learn and made some predictions about what he thinks cardiologists will accomplish in the future.

    "We still can't accurately predict myocardial infarctions or strokes," he said, "and we can't predict how rapidly heart disease will progress. We can't correct the severe reduction of HDL (the "good" type of cholesterol) or prevent restenosis (re-blockage of a vessel after opening it with a stent or balloon)."

    Other shortcomings of cardiovascular medicine are doctors' inability to prevent the progression of early coronary artery disease and peripheral vascular disease, and the inability to identify the role of microorganisms in heart disease.

    Willerson then offered his opinion on where research will concentrate its efforts in the near future.

    "The focus will be on plaque," he said. "That will be our next hurdle."

    Willerson spoke briefly about current research focusing on measuring the temperature of plaque and using this method to predict vessel and heart problems. With this knowledge, doctors will be able to eliminate problems caused by plaque before they occur.

    Willerson also predicted that, within 15 years, physicians will be able to tightly control cholesterol; raise HDL; use gene therapy to delay the aging of vessels; and prevent organ damage due to decreased circulation in diabetics.

    Another cardiologist, Martin B. Leon of Lenox Hill Hospital in New York City, added that cardiologists have yet to realize the full potential of drugs and their use with procedures such as angioplasty. He also said that it is imperative to understand the contributions of the non-clinical sciences such as biochemistry, applied biophysics and molecular biology.

    "The emerging role of cardiologists is the coordination of the overall vascular treatment plan," Leon said. "The ultimate winners will be the out-of-box thinkers."

    Editorial comment: There are two important things to consider from this study. First, there may be an association between bacterial infection and the development of plaques. There is now an impressive body of literature supporting such a possibility. Antibiotics may serve as protective agents against plaque rupture but this remains to be proven in
    a large-scale prospective study.

    The second possibility is that flu increases stress on a person who has heart disease and thereby increases heart attack risk. Influenza may not cause plaque rupture but may induce heart attacks, because the heart rate is increased during fever. And increases in heart rate place heavier demands on the heart. Doctors and patients with heart disease should consider vaccinations against pneumonia and influenza yearly. Furthermore, fever should be lowered in people with heart disease (especially the elderly) because it induces chest pain and heart attacks.



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