Targeting Root of Disease: Russian Cardiologist on Prospects of Fight Against Ischemic Heart Disease

The Medical Research and Educational Center of Lomonosov Moscow State University is currently working on a unique project aimed at curing ischemic heart disease rather than simply managing it, Russian cardiologist Simon Matskeplishvili explained. He described the project as a "nature-like" approach called therapeutic angiogenesis.

This treatment method focuses on actively promoting the growth of new blood vessels, known as collateral vessels, to compensate for the lack of blood flow caused by narrowed or blocked coronary arteries. He believes this approach has the potential to eliminate myocardial ischemia, representing a major breakthrough in the treatment of ischemic heart disease.

"It is extremely important that our treatment is safe, non-invasive, and well tolerated, and its effectiveness, I hope, will be proven in the study that we are currently conducting. The entire course of treatment takes no more than three weeks, and, as preliminary results have shown, patients' stenocardia goes away and they return to normal life," said Simon Matskeplishvili.

The cardiologist emphasized that serious cardiovascular diseases, such as ischemic heart disease and life-threatening arrhythmias, often remain asymptomatic until a critical point. He explained that these diseases, which can be either genetic or acquired, can go unnoticed by the patient, with the first manifestation often being a major heart attack or even sudden cardiac death. This silent nature underscores the importance of early detection and prevention, as these conditions can lead to disability, death, or significant medical expenses.

"When discussing ischemic disease, the process of atherosclerosis of the coronary arteries, a common underlying cause of ischemia, can begin almost immediately after birth and remain asymptomatic for decades, sometimes even until 80-90 years of age. However, in some individuals, it can manifest as early as 35-40 years old," stated the specialist.

Dr. Matskeplishvili explained that the first step in assessing a patient's risk of developing coronary heart disease is to identify any existing risk factors. These include high blood pressure, smoking, diabetes, and high cholesterol, especially "bad" cholesterol, or low-density lipoproteins. He emphasized that some risk factors, such as lifestyle choices, can be modified, while others, such as age, gender, and genetic predisposition, cannot be changed, although there are attempts to intervene in these areas as well.

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Speaking about new factors provoking heart disease development, the doctor emphasized the following:

"Noise, air pollution, poor lighting, and other adverse environmental factors certainly have a negative impact. But one of the most serious risk factors that we have recently begun to pay attention to is sleep disturbance. […] In addition, there is another well-known risk factor – insufficient physical activity. We live in an obesity pandemic," said Matskeplishvili.

While traditional methods like stress testing, contrast CT, and ECG play a crucial role in diagnosing coronary artery disease, the limitations of coronary angiography and the often ineffective nature of stents and bypass surgery highlight the need for alternative approaches.

"Coronary angiography is the most questionable, inaccurate test for diagnosing coronary heart disease, since it can only display the lumen of the coronary arteries, while the pathological process occurs in their walls, which are not visible during coronary angiography," Matskeplishvili stated.

Current treatments focus primarily on managing symptoms, such as reducing oxygen demand or improving blood flow, rather than addressing the underlying causes of the imbalance between the heart's oxygen demand and supply.

However, new research is exploring promising alternative treatments, such as the aforementioned therapeutic angiogenesis, which focuses on stimulating the growth of new blood vessels to compensate for inadequate blood supply.

This shift in focus from treating symptoms to treating the underlying causes of coronary artery disease offers hope for more effective, long-term solutions for patients.

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"The research we're working on is an international endeavor. We're just at the very beginning of this journey, but if successful, it could represent a monumental breakthrough for medicine worldwide," Matskeplishvili stressed.

Debunking Cardiovascular Myths

During the interview, Matskeplishvili debunked some myths in cardiology. One common misconception was that cholesterol-lowering drugs such as statins cause Alzheimer's disease, osteoporosis, or diabetes.

"These are perhaps the most mythologized drugs, although in fact they protect against the most severe complications of atherosclerosis and prolong people's lives. There are a huge number of adherents of statin therapy, as well as its ardent opponents, and among them there are many doctors," stated the cardiologist.

Another dangerous myth, long debunked but still persistent, is the notion of "working" blood pressure.

"Today we have absolutely clear indicators of normal blood pressure […] Normal pressure is 120 to 80 or even lower. Blood pressure indicators, of course, also depend on age and concomitant diseases, but when a person says that his working systolic pressure is 145 or 150, this is already arterial hypertension, which must be treated," said Matskeplishvili.

According to the expert, people with such "borderline" blood pressure readings are at greater risk because a person with a blood pressure of 180 "will certainly feel unwell and will not hesitate to see a doctor," but blood pressure at 140–150 often remains a hidden problem and can lead to ischemic heart disease, heart failure, and other cardiovascular diseases.