Cancer? No, thankfully, it’s just elevated cholesterol.

Cardiovascular disease — America’s leading cause of death — faces an unexpected challenge, as per heart health authorities. It’s not alarming enough.

“You receive a cancer diagnosis, and everyone reacts. They shift heaven and earth. Families rally. Individuals mobilize,” stated Ami Bhatt, chief innovation officer at the American College of Cardiology. “You mention ‘heart disease’ and individuals don’t respond similarly.”

The mindset of most patients, if not all, is that they will eventually attend to it. They intend to modify their nutrition after the festivities, and they will begin that fitness regimen once the weather is more favorable. This perspective needs revision.

Such was the warning from Bhatt and other heart disease prevention specialists and surgeons who convened on February 26 at the Harvard T.H. Chan School of Public Health to deliver a crucial message.

They emphasized that the persistent status of cardiovascular disease as the leading mortality cause in the nation, despite years of advancements, indicates that substantial efforts are still required. Significant progress has been made in areas such as minimally invasive and transplant surgeries, while future prospects envision an increased integration of artificial intelligence that harnesses extensive medical knowledge in real time to offer patients more tailored care.

However, in terms of prevention, the mere potential of a disease diagnosis often evokes a nonchalant reaction from patients, leaving those who address this issue regularly perplexed.

“This scenario occurs for me weekly in the clinic when I’m seeing patients,” mentioned Joseph Woo, chair of Stanford Medical School’s Department of Cardiothoracic Surgery and associate director of Stanford’s Cardiovascular Institute. “I attempt to remind them that cardiovascular disease claims more American lives each year than all types of cancers combined, and if they were informed about having a cancer diagnosis, no matter how slow it might progress, they would want it addressed immediately.”

Jorge Plutzky, director of preventive cardiology at Brigham and Women’s Hospital, noted that the issue might arise from a lack of awareness that cardiovascular harm is not simply due to aging, but accumulates over many years. He advised patients not to postpone treatment until necessary but instead to “be aware of their metrics” — LDL or “bad” cholesterol, blood pressure, weight, and sleep quality — from a young age.

He recounted dialogues with patients who are doubtful about cholesterol-reducing medications and contrasting them with a recent discussion with a 28-year-old cardiology fellow who opted to start statins, as his LDL cholesterol, while not excessive, was not in the ideal range.

“That illustrates much of our challenge because what does that cardiology fellow at Brigham understand that the average patient doesn’t?” expressed Plutzky, an associate professor of medicine at Harvard Medical School. “Bridging that divide is essential for effectively conveying what the concern is and why intervention is necessary. Physicians aren’t prescribing a statin early on because they perceive it as detrimental. They initiate early because they foresee advantages.”

The recent event, “Understanding heart disease: Advances in risk assessment, diagnosis and treatment,” also highlighted Tommaso Danesi, the section chief of valve surgery and director of the Endoscopic Valvular Program at Brigham and Women’s Hospital. The session, part of the Dr. Lawrence H. and Roberta Cohn Forum, was led by Melody Mendez, an anchor and journalist at NBC10 Boston, and hosted by the Chan School’s Leadership Studio.

Panelists explored numerous advancements in cardiovascular disease management. Notably, there is a revolutionary heart transplant method that employs a machine to maintain the donor heart’s function while in transit to the implantation site, as opposed to pausing it and keeping it on ice during transport. The transplant is finalized with the heart still active, enhancing patient recovery time.

Endoscopic

Medical procedures have made remarkable advancements, particularly in heart valve replacements, now performed through a mere three-inch incision, permitting patients to return home after four days. Physical capabilities revert to their normal state within only two to three weeks, as noted by Danesi, in contrast to the two to three months typically required after conventional open-heart surgeries, which necessitate the complete opening of the chest cavity.

Innovations have also emerged in unconventional sectors, according to Bhatt. Wearable fitness trackers, while often viewed as a manifestation of excessive “consumerism,” can alternatively be considered empowering tools for patients to take control of their health by monitoring some of their health metrics, marking a positive trend in fields such as cardiovascular health.

In the same vein, Bhatt highlighted that the swiftly increasing utilization of the latest generation of weight-loss drugs by individuals lacking a clinical diagnosis has been criticized as mere vanity. However, it is equally true that these medications—and the weight loss they facilitate—have been linked to enhanced health outcomes.

“Our population is becoming healthier,” Bhatt remarked. “You do not need to be a fully developed diabetic with heart failure or at risk to reap benefits from GLP-1.”

Emerging medications, methods, and technologies characterize the recent past and forthcoming phases of cardiovascular health, yet age-old challenges remain, Plutzky noted. Patients regularly neglect screenings that could detect issues early and, even when medications are prescribed, many discontinue use due to life’s demands: relocation, prescriptions expiring without renewal, or difficulties communicating with healthcare providers.

One solution proposed by Plutzky involves employing “navigators” to enhance the care and attention provided by physicians during intervals between appointments. These navigators proactively engage with patients, offering follow-up care after surgeries like stent placements that keep blood vessels open or assist when patients face rising LDL cholesterol or blood pressure levels.

“It is quite astonishing, the degree of undertreatment we uncover, even within an exemplary system like ours,” Plutzky stated. “We can promptly indicate, ‘Alright, that prescription is now ready for you. Here’s the reasoning for why it’s essential, and let’s ensure you rejoin the treatment regimen.’”

Plutzky remarked that this strategy relieves overburdened physicians from managing prescription refills—a tedious yet crucial aspect of patient care—provides supportive contact to patients in the interim months between check-ups, and as a community-focused initiative, reduces barriers to access.

“This strategy has proven to be extremely efficient in guiding individuals toward appropriate treatment,” Plutzky asserted. “It does not depend on education, wealth, or other factors. It simply acknowledges that this individual’s LDL levels are alarmingly high, they ought to be in treatment, and we can initiate that in a relatively straightforward and effective manner.”