Heart Failure Awareness – why should we care?
February is Heart Awareness Month. In this Insight, Karin Kleinhans of LSP discusses how heart failure, one of the leading causes of death worldwide, is a global problem that demands urgent attention.
Heart Failure Awareness – why should we care?
Despite significant improvements in cardiovascular mortality over the past several decades, cardiovascular diseases, including Myocardial Infarcts, Angina Pectoris, Arrythmia and Heart Failure, remain the leading cause of death both in the United States and across the rest of the world. Heart disease and stroke will result in an estimated 24 million deaths/year worldwide by 2030 and will continue to be the dominant cause of death among the most prevalent chronic diseases [1].
More people die due to diseases affecting the heart than of cancer. While a cancer patient has a ~67% chance of living 5 or more years after diagnosis, a patient with heart failure has only a ~48% chance. Still, we are more scared about cancer than about heart disease. Why is that?
Heart disease – only for the gluttonous, the poor obese or wealthy?
During my medical studies I was interning at a medical facility treating heart disease patients after initial diagnosis. Working so closely with affected patients, hearing their stories, made me realize that heart disease is impacting not just the elderly, but everyone, and we have no way of treating patients effectively. I met a young child with a congenital heart defect. She was not yet in middle school but had already undergone major heart surgery. She was not allowed to do sports, to run or play due to the risk of overwhelming her heart. How can we help patients with heart disease caused by developmental defects or genetic mutations?
On another occasion, I met a mother of four – an avid marathon runner who felt physically well and had come in for a routine health check. The check-up revealed that she was suffering from myocarditis, an inflammation of the heart muscle, that alters the contractions of the heart permanently. We had to inform her that she could not run or do sports anymore, that she could not be exposed to any kind of stress and would need constant monitoring. What we could not tell her, and her family, was that we have any therapies available today to improve her condition.
I remember also meeting a very nice elderly gentleman who watched his weight, ate healthily, and was looking forward to his life as a pensioner. When he retired, unfortunately he got into arguments with his wife over issues they thought were long buried in their decades of marriage. The stress of suddenly not working anymore and constantly fighting at home led to a heart attack and eventually heart failure. What can we tell our parents and grandparents to alleviate their suffering?
An unhealthy diet and lifestyle are the widely known leading risk factors for developing heart disease, and whilst we have documented the potential correlation quite well, it is only predicting risk and does not paint the whole picture. The clinical reality looks way more diverse than what statistical models suggest. Combined with age-induced heart failure of our ever-older global population, more and more individuals do and will suffer from heart disease.
An estimated 64.3 million people are living with heart failure worldwide. In developed countries, the prevalence of known heart failure is generally estimated at 1% to 2% of the general adult population [2]. In the US, 50% of patients will die within five years of diagnosis [3], and it is becoming noticeably more prevalent with an aging population [4].
Now with COVID-19 ravaging our world we see more and more patients with COVID-19 induced heart disease. Young children with heart failure after a seemingly mild COVID-19 case, and athletic middle-aged individuals learning how to cope with a failing heart are becoming more common place. The long-term consequences of elevated biomarkers of cardiac injury in COVID-19 patients is not known, however the general expectation is that heart disease will be even more prominent than ever before.
A symbol for life and love, the heart doesn’t get the attention it deserves
Innovation is fuelled by scientists’ research and industry funding, enabling early discoveries to enter clinical development and reach the patient as approved therapies. Funding for breakthrough research is directly correlated to public awareness, patient advocacy directing public grants, charity funds and interest in fostering new therapies. On the other hand, institutional investors fund companies with innovative compounds that have a clear path through the clinic to market approval.
Awareness and care are directly linked to funding and financing. Cancer research saw an unprecedented boom in the last 20 years by non-profit organizations, research centres, government funding and institutional investors pouring billions into cancer research, therapeutic development, and company creation. These immense efforts put into new cancer therapies enabled the approval of about 10 new cancer drugs – per year! At the same time, our molecular understanding of cancer biology and disease progression and monitoring has improved immensely with the availability of novel analytical techniques. We can analyze much better novel therapeutic modalities, understand how they work, and select patients that respond exquisitely well to those new therapies. The result is a standardized clinical development plan which harbors much less risk of failure than 20 years ago.
In heart disease we have not seen the same level of care or awareness nor funding. The regulatory authorities have approved about 1 new drug per year for heart disease patients and in some years, they have not approved a single one due to lack of development. Looking at the funding side of heart disease therapy development, a similar trend is observed. Despite heart disease being the number one cause of death in the world, only a handful of charities and patient organizations support innovative research. Company creation around novel heart therapies is scarce as well, with few biotechs attracting institutional financing to develop novel therapies. If we look at the risks of developing novel therapies through the clinic, we see a disproportionately higher hurdle for therapies in heart disease as compared to cancer. Also, we still face intrinsic problems in acquiring data from inside the heart due to technical limitations, lack of longitudinal phenotypic and genotypic studies, and identification of subgroups of patients with shared molecular characteristics. On the other hand, we have the same novel analytical techniques at hand and could develop much smarter ways to reach clinical development if we could only put more care, awareness and funding into our work.
Where should we begin? Start by caring for your and your family’s heart and raise awareness that heart disease is affecting everybody – even the apparently young and healthy! New therapies are desperately needed to improve our health so that we can enjoy life from the very bottom of our hearts.
At LSP our mission is nurturing innovation to its full potential, with the aim to develop products and technologies that have a positive impact on society, and help inventors achieve their goals.
New FDA guidelines to accelerate drug development in heart disease are positive signs. We are hopeful for further innovation in the space. Companies like Myokardia (recently acquired by Bristol Myers Squibb (BMS)), and our portofolio companies Cardior Pharmaceuticals, XyloCor, Cardiac Dimensions and Endotronix are developing new therapies and devices which could potentially have a huge impact on the lives of people living with heart failure.
[1] http://dx.doi.org/10.1016/j.jacc.2015.03.016
[2] GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990‐2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392: 1789– 1858.
[3] Mozaffarian D, et al. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation. 2016;133(4):e38-360.
[4] Savarese G, et al. Global Public Health Burden of Heart Failure. Card Fail Rev. 2017;3(1):7-11.
