The severe heart disease of old age, characterized by aortic valve narrowing (aortic stenosis) combined with cardiac amyloidosis, has long been associated with a high risk of death. For years, treatment has focused on replacing the narrowed heart valve, while often leaving the amyloid deposits in the heart muscle untreated. A groundbreaking international study led by MedUni Vienna and University College London has now demonstrated that combining heart valve replacement with specific drug therapy can significantly prolong life for patients with this condition.

Led by Christian Nitsche (Department of Medicine II, Clinical Division of Cardiology, MedUni Vienna) and Thomas Treibel (Department of Cardiovascular Imaging, University College London), the research team analyzed data from 226 patients with aortic stenosis and concomitant cardiac amyloidosis from ten countries. Their study revealed that both aortic valve replacement and treatment with the drug tafamidis for amyloidosis were associated with a lower risk of death.

Most impressively, the survival benefit was highest in patients who received both forms of treatment. “Our results show that patients with both conditions who received valve replacement and specific amyloidosis therapy had similar long-term survival rates to people with aortic stenosis without amyloidosis,” emphasized study leader Christian Nitsche.

The targeted therapy can slow the progression of amyloidosis, while valve replacement treats the mechanical stress caused by the narrowed heart valve. The research suggests that around ten percent of patients with aortic stenosis also have amyloidosis, but this is often not diagnosed in everyday clinical practice.

“Our findings also suggest that patients with severe aortic valve stenosis should be screened for amyloidosis so that we can offer them targeted life-prolonging treatment options,” Christian Nitsche emphasized.

This study offers new hope for patients with severe heart disease and highlights the importance of combining therapy to improve outcomes. By targeting both the mechanical stress caused by aortic stenosis and the debilitating effects of cardiac amyloidosis, doctors can now provide their patients with more effective life-prolonging treatment options.

Starting statin therapy as soon as possible can dramatically reduce the risk of heart attack and stroke for patients with diabetes, according to a new study published in the Journal of the American Heart Association. Despite clinicians’ recommendations, nearly one-fifth of diabetic patients choose to delay taking statins, which is a proven and effective way to lower cholesterol levels.

Researchers from Mass General Brigham conducted an analysis of electronic health records of 7,239 patients with diabetes who started statin therapy over a nearly 20-year period. The study found that those who delayed statin therapy for more than a year were significantly more likely to experience heart attacks or strokes compared to those who started taking the medication right away.

The median age of the patients in the study was 55, and about half of them were women. The researchers used artificial intelligence methods to gather data from the electronic health records and found that nearly one-fifth (17.7%) of the patients declined statin therapy when it was first recommended by their clinicians. However, they later accepted the therapy after a median of 1.5 years.

The study’s findings are clear: starting statin therapy on time can save lives. For diabetic patients who delayed taking the medication, the rate of heart attacks or strokes was 8.5%, compared to just 6.4% for those who started taking statins immediately.

Clinicians should use this information to guide shared decision-making conversations with their patients, said senior author Alexander Turchin, MD, MS. “Time is of the essence for your heart and brain health,” he added.

The researchers’ findings are timely, given that heart attacks and strokes remain the leading causes of complications and mortality for patients with diabetes. Statin therapy has been proven to reduce risk by preventing plaque buildup in blood vessels, which can lead to delivery problems for the heart and brain.

The study’s authors emphasize the importance of early intervention and encourage diabetic patients to discuss their individual risks and treatment options with their clinicians. By starting statin therapy on time, patients with diabetes can significantly reduce their risk of heart attack and stroke, and improve their overall health and well-being.

The PREVENT risk calculator has been shown to accurately estimate 10-year cardiovascular disease (CVD) risk and identify individuals with plaque buildup in their heart’s arteries, according to new research published in the Journal of the American Heart Association. The study found that combining the PREVENT score with a coronary calcium score further improved risk prediction, matching patients with the highest risk of heart attack to those who actually experienced one during the follow-up period.

The PREVENT calculator, released by the American Heart Association in 2023, estimates CVD risk based on age, blood pressure, cholesterol levels, body mass index, Type 2 diabetes status, social determinants of health, smoking, and kidney function. This tool can help tailor care and determine who may benefit from treatment to prevent a heart attack.

Another important factor in screening heart health is coronary computed tomography angiography (CCTA), a non-invasive imaging test that visualizes plaque buildup in the heart’s arteries. The CCTA provides a coronary artery calcium (CAC) score, which helps inform decisions about heart disease prevention and treatment.

The researchers analyzed electronic health records for nearly 7,000 adults who had undergone CCTA screening at NYU Langone Health between 2010 and 2024. They found that the PREVENT score accurately matched the level of calcium buildup according to the CAC score. The study also used the PREVENT risk assessment and coronary artery calcium scores, separately and in combination, to predict future heart attack risk and assess the accuracy of each with the participants who had a heart attack during the follow-up period.

Study co-author Sadiya Khan emphasized that the CAC score can help classify risk for heart disease by analyzing calcium buildup. The study’s findings are important in shaping future guidelines on the use of the PREVENT calculator and CCTA, particularly for patients uncertain about starting lipid-lowering therapy or intensifying it.

The study had several limitations, including a single institution as the data source and a predominantly white participant population, which may not be generalizable to other groups. The analysis only included people who had undergone coronary calcium screening, and electronic health records were the sole source of data. Additionally, the follow-up time was relatively short at 1.2 years, and the presence of non-calcified plaque in the heart’s arteries was not assessed.

Despite these limitations, the study demonstrates that the PREVENT risk calculator is accurate in identifying individuals with subclinical risk for CVD, meaning blocked arteries before symptoms develop. This research contributes to shaping future guidelines on the use of the PREVENT calculator and CCTA.