Valentin Fuster, MD: Renal denervation, cardiac education focus of symposium

New applications for renal denervation and educational interventions for children about dietary behavior and physical activity will be among the biggest issues in cardiology in 2014, Valentin Fuster, MD, PhD, MACC, told Cardiology Today.

Those are among the topics being discussed this weekend at the American College of Cardiology’s 46th New York Cardiovascular Symposium directed by Fuster, who is director of Mount Sinai Heart and physician-in-chief of Mount Sinai Hospital, as well as the 2014 editor-in-chief of the Journal of the American College of Cardiology.

Valentin Fuster

Although renal denervation has shown positive results for lowering BP, it has potential for other applications as well, Fuster said.

“The sympathetic system, which is what we really address [with renal denervation], has many roles in many diseases,” he said. “Up until now, we only found a niche in high BP by cutting the nerves of the kidney, but maybe these nerves can also play a role in disorders in some other places, such as rhythm disturbances of the heart, and maybe we might cure them.”

A presentation by Vivek Reddy, MD, of Mount Sinai Hospital, will explore renal denervation therapy for arrhythmias and for autonomic nervous system dysfunction, Fuster said.

CVD epidemic requires health promotion

Promoting health, especially in children, also will be crucial in 2014, Fuster said.

“There’s an epidemic of CVD, and we have to move from disease to health,” he said. “Promoting health is the next step.”

Fuster said he will discuss three strategies at the symposium. One is an intensive educational program about nutrition and physical activity for children aged 3 to 5 years. Fuster and colleagues organized 1,218 children in groups of three to five and educated them about the body.

“The whole concept here is dual,” he said. “One, can we prevent problems at a young age that are then transferred into adulthood, like obesity? And most important, we have learned that our behavior as adults has a lot to do with what we learned in our environment when we were between ages 3 years and 5 years. What we’re trying to do is teach them at that age that health is important, thinking that their behavior as adults will be much better than ours.”

Fuster and colleagues recently published 36-month data from the program, which showed that the educational intervention maintained a beneficial trend toward a healthy lifestyle in children and their parents.

The researchers found a significant increase in mean knowledge, attitude and habit scores at 36 months compared with baseline: 87.94 vs. 76.15 (P<.001) in knowledge score; 86.39 vs. 57.03 (P<.001) in attitude score; and 66.29 vs. 48.72 (P<.001) in habits score. There was a similar increase in knowledge (73.45 vs. 70.01; P<.001) and attitude (78.08 vs. 74.65; P<.001) scores in parents. The proportion of eutrophic children increased from 62.1% at baseline to 75% at 36 months (P<.0001).

The second strategy was employed in Kenya, which has a high rate of hypertension because food is typically preserved with salt. Fuster and colleagues taught people to use automated technology to take BP readings of their neighbors and document them. “It’s a clear example of how you can achieve success in a poor area [through] technology … that is not very expensive,” he said. “Adults do not change, but we certainly have a few things we can do, and one of them is to teach people to help other people.”

That also is the principle behind the third strategy, employed in Spain, Fuster said. In that project, 100 people were divided into groups of 10, and each group became a support group in which members helped each other overcome cardiac risk factors, “like an Alcoholics Anonymous kind of approach,” he said. “In terms of high BP, smoking, lack of exercise and obesity, they have achieved a tremendous result of modifying their risk factors significantly. In 95% of those people, at least one of those four risk factors vanished; it was completely corrected by using other people to help them.”

Mechanisms of disease identified

The symposium also focuses on some of the biggest advances of 2013 in cardiology. One, Fuster said, is reclassifying heart-muscle diseases unrelated to blood supply based on their mechanisms, and then using imaging to better identify those mechanisms.

“This is important because, up until now, we all have been managing muscle disease of the heart by giving drugs that make the heart have to work a little better, but not because they address the mechanism by which the heart is in bad shape.”

Other significant advances, he said, include gene therapy to bolster molecules that have been downgraded, leading to improved contraction; and proliferation of progenitor cells in vitro, with subsequent injection back into the heart to cover fibrotic areas. – by Erik Swain

For more information:

Céspedes J. Am J Med. 2013;126:1122-1126.

Disclosure: Fuster reports no relevant financial disclosures.