Life is back to normality now having involved a lot of travel over the last few weeks. The European Society of Cardiology meeting last week has provided so much content it will keep me going for a few weeks at least. Now I’ve had time to organise my thoughts, I think breaking the conference down into key topics and take-aways for you is the right approach. Of course some of this content will be more relevant to you or your family than others, but I hope to tease out information that will at the very least be interesting, and may even improve your health.
One of the highlights of any conference for me is meeting old friends and colleagues. This time was particularly noteworthy as I met a guy who I went to school with! I last saw him after our A-levels in 1996 (which is rather frightening), but we instantly recognised each other. He married an Australian and now works in Sydney. I also met a good friend and colleague who I did my research with, who now works in Perth. Hearing about the Australian system was both interesting and a bit depressing. Although they have their own challenges, their health service seems to function rather better than our own.
Indeed, only this morning in the news I read Lord Darzi’s report on the state of the NHS. It was commissioned after the election, and lays bare what a difficult time this is. Please do look it up. The most sobering aspect of the report for me was on children. Prescriptions for ADHD medication for children up 10% in the past year. 1 in 3 children from deprived backgrounds obese by age 11. Life-threatening and life-limiting conditions among children up 40% over the last 20 years. What chance do we have of addressing chronic disease in adults if we are failing our children like this? We have to look at education and lifestyle modification for all, but particularly disadvantaged families if we are to reverse this trend. I really hope the NHS and education sectors see the investment that will be needed to start to address this.
Now, to your own education! I’m going to start with a trial that was presented and simultaneously reported in the New England Journal of Medicine (arguably the foremost medical journal in the world). The trial, Helios B, used a novel drug for a condition called cardiac amyloidosis. You might wonder why such a niche trial got so much attention, and I think there are a few reasons.
Firstly, we are increasingly realising that cardiac amyloid is much commoner than previously thought. If you put the topic into Google, you will see ‘this rare disease….’ whereas contemporary studies show that up to 20% of patients with slightly thick hearts of a number of causes (for example valve disease, high blood pressure and so on) do in fact have amyloid. Not so rare then, it just depends how hard you look, and what test you do.
The second reason is the drug itself. Amyloid is a protein made in the liver which gets misfolded and ‘stuck’ in various places, for example the heart, bowels, carpel tunnel ligaments. Historically treatments have been limited, and mainly work by trying to stabilise the misfolding process to stop the protein getting stuck. This new drug works on something called RNA, and actually stops the genetic process by which the liver produces amyloid protein in the first place.
Tested against a placebo, the drug reduced death, cardiovascular events, and improved quality of life. I’ve actually got a few patients in this trial, so have witnessed it first hand which is pretty incredible.
Although we have the trial results, the drug will now need to work its way through the regulatory and guideline processes before we can access it. Until then, we should fairly soon be able to access the former drug, which in itself is super-exciting as there has never been anything in this space that makes a real difference. We also need to focus on improving access to diagnosis, as without that first step, we are stuck. This really is cutting edge heart science.
For something a bit more common and simple, check out this week’s research video where I discuss the very latest update in guidelines on blood pressure. Just released for 2024, I’ll give you the key messages that everyone should know.