BMC Medicine at ESC Congress 2018

BMC Medicine attended ESC Congress 2018, the largest medical congress in Europe. It gathers over 30,000 active participants and this year took place in Munich. Here we look at some of the highlights from the meeting.

Lipid lowering therapy beyond LDL cholesterol

Brian Ference from the Chinese Precision Medicine Initiative presented a talk on the benefit of reducing plasma lipoprotein(a) (Lp[a]) in patients. Lp(a) is associated with cardiovascular disorders, and genome-wide association studies (GWAS) show the strongest correlation.

Lp(a) is an important cause of coronary heart disease (CHD), however we are not sure how much the values need to be lowered to reduce risk.

In a mendelian randomization study, authored by Stephen Burgess and colleagues, the clinical benefit of lowering Lp(a) is likely to be proportional to the absolute reduction in Lp(a) concentration. The results indicate that a reduction of approximately 100 mg/dL may be needed to deliver a clinically meaningful reduction in CHD risk.

People with very high Lp(a) levels are likely to derive the most significant benefit, and lowering Lp(a) is likely to reduce the risk of other vascular outcomes.

High density lipoprotein and cholesterol

High density lipoproteins (HDL) have long been seen as the “good cholesterol.” Ulrich Laufs, from the University of Leipzig, argued that might not always be the case, and our knowledge of HDL is still evolving.

HDL molecules are complex and not static and, generally, low HDL values are associated with cardiovascular issues.

In a 2017 literature review, results indicate that HDL-C (HDL Cholesterol) levels correlate with cardiovascular risk only in healthy individuals, and the calculation of the ratio of LDL-C to HDL-C is not useful for everyone. Lifestyle interventions that increase HDL levels are positive, however HDL-C is not currently a valid target for drug therapy.

In conclusion, the concept of HDL function is of high scientific interest, but currently without clinical consequences.

Cardio-oncology and its opportunities

Cardio-oncology deals with the cardiovascular side effects of cancer therapy. Unfortunately, cancer patients are at risk of developing heart conditions, which can lead to morbidity and mortality. Nicola Maurea of the Istituto Nazionale Tumori ‘Fondazione Pascale’, indicated that venous thromboembolism is the second most common cause of death in cancer, after cancer itself.

In a recent article, Chang and colleagues argue that cardiologists need to work closely with cancer specialists to prevent and treat cancer therapy-induced cardiovascular disorders. In their study, they provide indications on how to tackle the issues of cardiomyopathy and ischemia, to manage cardiovascular complications.

In his conclusive remarks, Prof. Maurea urged physicians that cardiovascular side effects should not cause them to abandon highly effective cancer treatments.

Heart failure in women

Mary Walsh from St. Vincent Heart Center presented the issue of heart failure (HF) in women patients. Heart failure affects millions of people worldwide, and its prevalence is rising. In her talk, Dr. Walsh indicated that the prevalence of HF in women older than 80 is above 10%, higher than men.

Heart failure with preserved ejection fraction (HFpEF) is currently understudied, and women in particular have not been sufficiently represented in HF trials, with about one in four studies including women patients.

HF is more prevalent in men, however data on women is scattered, and trials have not been consistent so far. Additionally, diabetes and hypertension in women are the key factors to address HF in women. This calls for greater inclusion of women in HF studies, to better understand and treat the condition.

For more on the latest cardiology research, browse our list of BMC cardiology journals: BMC Cardiovascular Disorders, Cardio-Oncology, Cardiovascular Diabetology, Cardiovascular Ultrasound, Journal of Cardiothoracic Surgery, Journal of Cardiovascular Magnetic Resonance, and Journal of Congenital Cardiology.

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