The new statins? Millions of us already take pills that reduce cholesterol and cut our heart attack risk. Now experts say we should be on a drug to target another potential killer in the blood…

Eight million Britons take statins to cut their cholesterol levels and protect them from a heart attack or stroke, and nine million are on drugs to reduce blood pressure.

Could many soon be offered more medications to further reduce their risks?

That was the suggestion last week at the American College of Cardiology conference in Atlanta, Georgia.

Over the past decade, heart researchers have been focused on tackling a type of cholesterol called LDL – low-density lipoprotein – the form most closely linked with heart disease. Statins were the first and most successful treatment to tackle this fatty substance in the blood. And in recent years a number of other drugs have been developed to do the same thing.

But now there’s a new target of concern – another kind of fat that is found in the blood, called triglyceride.

Our triglyceride level features on every cholesterol test. However, until recently, it has been largely ignored, mainly because it was believed it was harmless, if not beneficial, as triglyceride is used by the body for energy.

But more recent research shows an excessive amount in the blood can block arteries and trigger life-threatening complications such as heart attacks and strokes. Raised triglycerides can also cause pancreatitis – a life-threatening complication where the pancreas, a gland in the abdomen, becomes inflamed.

Surprisingly, about a fifth of UK adults have worryingly high triglyceride levels. The problem is most common among over-60s – although many people are unaware they are at risk.

In most cases, a raised level is triggered by obesity and a lack of exercise, as well as other health conditions such as diabetes and kidney disease. These patients tend to also have high levels of LDL.

However, roughly a tenth of adults have genetic abnormalities that mean their triglycerides are elevated, despite having a relatively healthy lifestyle and low LDL levels.

And there are two new drugs, unveiled last week, aimed at tackling the problem.

One, a jab called plozasiran, was able to reduce triglycerides in patients with extremely high levels by three-quarters in six months. The treatment is given via an injection once every three months, and the findings were described by the lead researcher, Professor Daniel Gaudet, a cardiologist at the University of Montreal, as ‘extraordinary’.

The other medicine, olezarsen, was given to patients with moderately raised triglycerides. Given as a once-a-month injection for nearly a year, it reduced triglyceride levels by about half – back to a safe amount.

Both treatments block the body from creating a protein called apoC3, which helps the liver turn carbohydrates into triglycerides.

Experts say more research is needed to conclude how many deaths and hospitalisations plozasiran and olezarsen will help prevent, but they expect them to make a big difference.

‘We’ve known for many years that high triglycerides are linked to cardiovascular disease, but in the past there weren’t any specific treatments,’ says Professor Derek Connolly, consultant cardiologist at Sandwell and West Birmingham Hospitals NHS Trust.

‘Statins and fish oil have some effect, but not much. These new drugs will be phenomenally useful, especially because they will protect patients against pancreatitis, which can be a really serious condition.’

The good news didn’t end there, with other announcements at the conference that are set to improve the heart health of patients across the UK. Read on to find out more…

Keyhole is safest for valve replacement

NHS chiefs were urged last night to offer thousands of patients with worn out heart valves a keyhole operation, after research proved it was more effective than open heart surgery.

More than 300,000 people in the UK suffer from aortic valve stenosis – when one of the crucial valves narrows and reduces blood flow, causing chest pain, fatigue and increasing the risk of heart failure. The majority of patients have to undergo open heart surgery to have the valve changed. While often effective, it’s a major procedure with a long recovery.

There is, now, a less invasive alternative called transcatheter aortic valve implantation (TAVI). It involves threading an artificial valve into the heart via a catheter inserted into a vein in the groin.

While speedier than open heart surgery, TAVI is more expensive – each procedure costs around £10,000 – so has been rationed for only the patients who need it the most. But experts hope this will change, thanks to the findings.

The German trial, which involved about 1,400 patients, found they are significantly less likely to die or fall severely ill than those with open heart surgery. Currently, only around 7,000 TAVIs take place on the NHS every year – reserved for elderly patients deemed unlikely to survive surgery. Last year, the NHS pledged to increase this number by 1,500, but doctors say a much larger expansion is needed.

‘There is no question that TAVI is a much less invasive procedure, which causes fewer injuries,’ says Dr Daniel Blackman, a cardiologist at Leeds Teaching Hospitals NHS Trust. ‘But these are really striking results which bring home the benefits. Patients, regardless of their age, would much rather have a TAVI any day of the week, and the NHS should allow more of them to get one.’

Angina implant that slows blood flow

Patients with severe angina chest pains could soon be offered a pioneering British-developed implant that can ease pain and improve quality of life.

Around two million people in the UK suffer from the condition, which is caused by reduced blood flow to the heart muscles.

The majority of patients get medicines to combat the debilitating symptoms, and each year about 35,000 of the worst affected undergo surgery to get a stent – a small mesh tube that holds the artery open to allow more blood to flow into the heart. But studies show that, for as many as four in ten patients, this op is ineffective.

Now researchers have created an alternative procedure which – counterintuitively – involves blocking a small vein in the heart. Called a coronary sinus reducer, the 1in implant slows down the flow of blood.

This increases the amount of oxygen that the muscles of the heart can absorb – reducing angina symptoms.

The heart requires a constant supply of oxygen absorbed through the blood. When this is reduced, the organ becomes deprived of oxygen, triggering angina. The pain usually comes on in brief episodes, often caused by exercise or stress.

It is a serious condition, and sufferers are more at risk of a heart attack or stroke as the blood vessels are narrowed.

People who are overweight, smoke or drink excessive amounts of alcohol are more likely to develop angina.

It is usually treated with drugs such as calcium channel blockers or beta blockers, though the effectiveness can be limited. Many sufferers will eventually develop unstable angina, where the episodes become more frequent and happen at random.

More than 150,000 people are hospitalised in the UK every year with the unstable condition.

In the new study, which involved 51 patients with severe angina who had not responded to conventional treatments, half were given a coronary sinus reducer.

The mesh hourglass-shaped device is fitted into the coronary sinus vein – which is where blood accumulates after it has been pumped around the heart.

It is designed to make the vein smaller, reducing the amount of blood which can pass through it. This pressure pushes blood back up into the heart, giving the muscles more time to take in oxygen.

The participants were asked to complete a daily survey where they reported how often they experienced an angina episode – and those who received the coronary sinus reducer experienced 40 per cent fewer attacks.

‘We were quite shocked by how well the device worked,’ says Dr Rasha Al-Lamee, a consultant cardiologist at Imperial College Healthcare NHS Trust.

‘After ten weeks, patients noticed a significant difference and it really improved their quality of life. These are people who suffer up to ten angina episodes a day, so this is a big deal for them.I expect that our findings mean that patients who have failed to respond to other options will be able to receive the device on the NHS soon.’

NHS vindicated over heart pump rollout

There was also good news for patients left severely unwell following a heart attack, after a study found that a controversial heart pump already offered on the NHS saves lives.

The device is a thin tube fitted inside the organ, and contains a motor which helps pumps blood from one side to the other.

It is designed to help patients who develop cardiogenic shock – a deadly heart attack complication which occurs when the organ becomes too weak to pump enough blood to meet needs.

The condition occurs in around one in ten heart attacks.

In 2016 the NHS made the decision to approve the rollout of the £15,000 Impella – which is surgically implanted after a heart attack – before studies showed it was effective. Since then, it has been linked to 49 deaths in the US and, last month, the country’s Food and Drug Administration warned there was a risk it could puncture the wall of the heart.

But a new study, presented in Atlanta last week, found that Impella patients were 13 per cent less likely to die within six months of a heart attack compared with those who did not undergo the procedure.

However, Danish researchers say the trial, which involved 360 participants from the UK, Denmark and Germany, did find that Impella patients were more likely to experience complications such as internal bleeding.

None of the trial participant experienced a heart puncture.

‘This is the first time in a very long time that we have a positive study for managing cardiogenic shock,’ says Professor Jacob Moller, cardiologist at the Odense University Hospital in Denmark and study author.

‘I think this will be a routine device that will be used in these desperately ill patients.’

Questions over beta blockers 

A landmark study has raised serious doubts about the use of beta blockers to tackle a number of common heart conditions.

Last week the Mail was first to report findings that the common treatment does not benefit half of patients recovering from a heart attack.

The tablets slow the pulse and lower blood pressure, and have been offered to the majority of patients recovering from a heart attack since the 1960s. However, side effects include fatigue, nausea and erectile dysfunction. And for about 50 per cent of patients, taking beta blockers does not reduce the risk of another attack, according to the data.

Now experts argue that doctors should reconsider prescribing beta blockers to patients with other heart problems they are commonly offered for, such as angina chest pain and atrial fibrillation – a problem with the heart’s rhythm.

In recent years, a number of new and more effective drugs, included medicines called calcium channel blockers, which also lower blood pressure, have been rolled out on the NHS.

Patients who have not had a heart attack and take beta blockers as a way to control high blood pressure alone should keep taking them.

However Professor Tim Chico, consultant cardiologist at the University of Sheffield, said: ‘When doctors first began offering these drugs, they were one of the only things available for heart patients. However, there has been enormous progress.’

Experts say patients should talk to their doctor if they do not wish to keep taking beta blockers.