Heart diseases belong to one of the most common causes of death worldwide. World Heart Day on the 29th of September aims to draw attention to this and raise awareness about heart health. What are the most common heart diseases?
Many people have auricular fibrillation, a cardiac arrhythmia that is associated with thrombo-embolisms and strokes. This can occur in isolation or be the result of another disease. Patients who have lived with high blood pressure for a long time are at an increased risk. Heart failure or a defective heart valve can also lead to atrial fibrillation. Heart failure is also something that we frequently encounter, which occurs when the heart no longer pumps correctly. The third disease that we often see is coronary heart disease, which involves the calcification of the coronary arteries.
Interdisciplinary research both in the clinical environment and in fundamental research is helping us to better understand many aspects of these well-known diseases.

Where do we stand when it comes to the treatment of heart diseases?
A lot has been done in recent years when it comes to drug treatments. We now have several new, highly effective substances for blood thinning. These slow down blood clotting and are important for patients with atrial fibrillation because they ensure that blood clots are less likely to form. This can prevent strokes and heart attacks.

Does the topic of prevention play a role in research?
A lot is being researched when it comes to prevention. Here, there is a strong focus by doctors on lowering LDL cholesterol levels. A high level of these fat molecules increases the risk of cardiovascular disease. We aim for a level below 55 milligrams per decilitre of blood in patients who have already had a heart attack.

A new method for this is siRNA therapies. These ¡®small interfering RNA¡¯ can, via a special cell mechanism, turn off specific signals in the cells and inhibit cholesterol formation. For patients, this therapy is very convenient: the drug is injected into abdominal fat twice yearly and they do not need to remember to take tablets every day.

What other aspects of heart health are being researched in Augsburg?
A very broad range of research is being conducted at the Faculty of Medicine, from molecular to clinical and epidemiological research.

A topic that interests us at the Chair of Internal Medicine is the interaction of platelets and leukocytes, i.e., blood platelets and white blood cells. This is about environmental influences and the extent to which they cause blood clots.
Together with the Augsburg University Hospital, we run a heart attack register in Augsburg, which has collected data from heart attack patients for the last forty years. In a project with the Chair of Epidemiology, we are analysing this wealth of data and with the help of Artificial Intelligence developing a projection model.

Are there any flagship projects?
One of our flagship projects is ALERT-IST, which is funded by the Federal Joint Committee¡¯s (G-BA) Innovation Fund to the tune of €1.8 million for three years. Together with Elke Hertig, professor for regional climate change and health, and Christian Hinske, professor for data management and clinical decision support, we are developing a model that predicts the need for intensive medical support as a consequence of environmental influences and weather phenomena. Hospitals of the future will have to be more flexible and adaptable to extreme heat and cold in order to continue to fulfil their care mandate.

We are also planning a study in which we equip patients who have had a stroke based on unknown causes with a Smart Device that can record an EKG two times a day for half a year in order to find out whether atrial fibrillation caused the stroke.

How have treatment methods developed in recent times?
What has developed enormously is the technology with which we can help heart patients. A narrowed blood vessel is increasingly opened without the insertion of a stent. Instead of inserting a wire mesh, the narrowed area is widened with a balloon that is coated with a drug. This is absorbed directly by the vessel wall and can prevent the vessel from re-narrowing. This method is a trend that is constantly being improved. We have also conducted clinical research in this area. The Faculty of Medicine at the University of Augsburg is the third largest university-based heart attack provider nationally, and we therefore treat a lot of patients.
Another method that is constantly being improved is the catheter-based treatment of aortic valve stenosis, which is the narrowing of one of the four heart valves and one of the most common valve defects. Here, both the instruments as well as the access points to the heart are becoming smaller, so that patients can be treated more gently.

A completely new medical device will soon be available for the treatment of mitral valve insufficiency. If the mitral value is leaky, the blood flows back in the direction of the lungs and the heart has to work harder to pump an additional volume of blood. These patients often experience a pronounced shortness of blood. Until now, this leakage was treated with clips that were attached to the valve via a catheter. Now, replacement valves are available, which are also attached via a catheter.
There are also new techniques for the treatment of cardiac arrhythmias. In general, these usually involve the removal of heart tissue in order to prevent misdirected electrical impulses causing the heart out to go out of rhythm. Previously, electricity was used for this purpose; however, freezing has been the standard for several years. Pulsed field ablation is now the newest method, which uses high or low temperatures with electrical impulses, which is gentler on the tissue.

However, prior to treatment is diagnosis. Here, imaging techniques are making rapid progress. Narrowing of the blood vessels is now commonly examined with a very fine catheter that produces an ultrasound image. A relative new procedure is optical coherence tomography (OCT), which provides very precise information about changes in the coronary arteries. With OCT, it is possible to make a very good assessment of how dangerous the deposits on the blood vessels are. Following the insertion of a stent, we can also control how well it is positioned and how the implant develops.

What can people do to maintain good heart health?
Above all else, a heart-healthy lifestyle means getting lots of exercise. It does not have to include a marathon; rather, a light, continuous workout of between three and four times a week: cycling, swimming, Nordic walking are all very beneficial, as well as some strength training.
Naturally, healthy nutrition is also important: lots of vegetables and Mediterranean food, olive oils, nuts are also good. Eating little meat is also recommended, and if you do eat it, then poultry is the best. It is recommended to eat fish at least once a week. Drinking enough is essential ¨C unless you have a cardiac insufficiency ¨C and avoiding the heat in extreme summers.

It is important to see a GP regularly in the second half of your life in order to be make sure your blood pressure is well controlled and that you don¡¯t develop diabetes. It is also recommended to keep check on your cholesterol levels and not to smoke.
What¡¯s more, Smart Watches that monitor the pulse can now also quite reliably detect atrial fibrillation. If they do, you should not delay in visiting the doctor! ??

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