(Circulation. 2002;105:e9065.)
© 2002 American Heart Association, Inc.
Cardiovascular News
Circulation Newswriter
Bush Names Science Advisors
President Bush named his Council of Advisors on Science and Technology in the waning days of 2001. The panel, to be chaired by John H. Marburger III, director of the Office of Science Technology Policy, and E. Floyd Kvamme, a partner in Kleiner, Perkins, Caufield & Byers, sports a host of new members from the computer field, including Carol Bartz, board chairman, president, and CEO of Autodesk, Inc; Michael S. Dell, chairman and CEO of Dell Computer Corporation; Gordon E. Moore, chairman emeritus of Intel Corporation; Robert J. Herbold, executive vice president of Microsoft Corporation; and George Scalise, president of the Semiconductor Industry Association.
Other new members include Bernadine Healy, MD, a former director of the National Institutes of Health, nationally recognized cardiologist, and embattled former leader of the American Red Cross, who was forced to resign from the Red Cross; Charles M. Vest, president of the Massachusetts Institute of Technology; and G. Wayne Clough, president of the Georgia Institute of Technology. A full membership list can be found at http://www.ostp.gov/PCAST/membership2.html.
Canadian Research Budget Grows, but Flat Healthcare Funds Draw Protests
The Canadian government announced that it plans to spend 8% more on health and research in fiscal year 2002, which equates to $7.4 billion Canadian or $4.7 billion in US dollars. Canadians are planning a renaissance in research in the coming years.
However, various provinces blasted the national budget because it promised no new funds for healthcare spending, according to the December 11, 2001, issue of the Toronto Star. Mike Harris, premier of Ontario, said as many as eight provinces will face a deficit this year. If the provinces have to make up for the federal deficit, "it’s going to squeeze all the other funding [in those regions]," Harris told the Star.
"While they’ve increased spending by billions of dollars, there’s no new money for healthcare services, there’s no new money for health care for Canadians, and this is Canadians’ top priority," Manitoba Premier Gary Doer told the Star. Quebec Premier Bernard Landry called the federal budget’s lack of increase for health care "a national scandal."
The budget includes (in Canadian dollars) $560 million for the Natural Sciences and Engineering Research Council, $536 million for the National Research Council, and $560 million for the Canadian Institutes of Health Research. Other programs, such as a plan to build a high-capacity, broadband network to link research institutions and universities and a one-time grant to help universities meet their overhead costs, also go into the $7.4 billion amount, according to the journal Nature in its December 20/27, 2001, issue (Nature. 2001;414:821). Funds are also available to support high-tech ventures such as nanotechnology, the journal reported.
By contrast, an effort to double federal spending on the National Institutes of Health in the United States within 5 years is nearly halfway to the goal. The President’s proposed budget for the National Institutes of Health in 2002 exceeds $23 billion.
American Heart Association Names Top 10 Research Advances of 2001
The drug-eluting stent, which is designed to prevent reblockage of coronary arteries in patients who have undergone percutaneous transluminal angioplasty with a stent, ranked first among the top 10 research advances named by the American Heart Association (AHA) for 2001. Although stents were instituted to prevent reblockage, between 15% and 30% of patients who receive stents experience renewed stenosis. In several clinical trials, however, stents coated with a drug that prevents the overgrowth of cells significantly reduced restenosis. In the pivotal RAndomized study with the sirolimus-coated Bx VELocity balloon-expandable stent in the treatment of patients with de novo native coronary artery lesions (RAVEL) reported at the European Society of Cardiology, September 1–5, 2001, in Stockholm, Sweden, none of the patients who received the drug-coated stent experienced restenosis in the 7 months after the procedure, whereas 26% of those who received uncoated stents did.
Several other studies are underway to test the value of coated stents. In November 2001 at the AHA’s Scientific Session in Anaheim, Calif, the EvaLUation of pacliTaxel-Eluting Stent (ELUTES) trial found that patients who received stents with the highest dosage of the cancer drug paclitaxel had the lowest restenosis rate—3.1%. By comparison, those who received uncoated stents had a restenosis rate of 20.6%.
Ranking second among the advances cited by the AHA was the implantable left ventricular assist device, which has been shown to improve quality and length of life in patients who received them when compared with those who received the best available medical treatment and monitoring. The results of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) study were published in the New England Journal of Medicine (N Engl J Med. 2001;345:1435–1443) and reported at the AHA 2001 Scientific Sessions.
In third place was the AbioCor totally implantable heart, which was first implanted at the University of Louisville, Ky, in 59-year-old Robert Tools on July 2, 2001. Mr Tools lived 151 days with the heart and died from severe abdominal bleeding. Other patients have received the heart in the months after Mr Tools’ surgery.
In fourth place was the potential of tissue engineering to grow heart valves, blood vessels, and muscles; fifth, gene therapy’s potential to reduce angina; sixth, the effect of cholesterol-lowering drugs on the health of high-risk populations; seventh, the potential of genetic predictors of cardiovascular disease; eighth, cell transplants for stroke recovery; ninth, studies of the effects of nature and nurture on incidence of type 2 diabetes; and tenth, new research of the detrimental effect of passive smoking on arteries.
The organization’s 2002 Heart and Stroke Statistical Update showed that 958 775 people died of cardiovascular disease in 1999 compared to 549 838 from cancer, 97 860 from accidents, 44 536 from Alzheimer’s, and 14 802 from HIV/AIDS. In the 20 years from 1979 to 1999, the number of cardiac catheterizations increased 355%, with an estimated 1.36 million performed in 1999.
Heart Cells May Undergo Division
Between 7% and 10% of cells in the donor organs of men who had received transplants of women’s hearts seem to demonstrate that primitive cells from the recipient may migrate to the grafted heart, according to Piero Anversa, MD, and colleagues from New York Medical College in Valhalla, NY, and the Department of Pathology at the Unversity of Udine in Italy (N Engl J Med. 2002;346:5–15).
In an accompanying editorial, Robert S. Schwartz, MD, and Gregory D. Curfman, MD, noted that questions about the findings remain but also "raise the hope that, counter to traditional beliefs, the heart can repair itself. If it can, we will have opportunities to enhance the process that regenerates damaged myocardium." The possibility is more than a dream, they note, because "methods of moving marrow stem cells into the circulation are already in clinical practice. Such approaches to therapy, which were previously only pipe dreams, are now realistic goals that may soon be within reach" (N Engl J Med. 2002;346:2–4).
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