Research to find new drugs losing steam

On World Heart Day today, vice-chairman and managing director of Asian Heart Institute in the city, Dr Ramakanta Panda, speaks on the need for advanced cardiac medicines and ways to keep your heart healthy.

Advances in cardiac medicines are trailing as compared to cancer. Since 2012, 17 new drugs for cancer have been approved by the US Food and Drug Administration  as compared to just three medicines for heart disease.

This, despite the fact that cardiovascular diseases remain the number one killer globally and doctors fear a renewed epidemic of heart problems in 20 to 30 years as a new generation of overweight and obese youth reach middle-age.

Besides, the problem of non-communicable diseases, sedentary lifestyle and generational decline in physical activities persists that needs both disclipline and scientific attention.
Acute heart failure is also a rising problem among the ageing global population. Many patients have clogged arteries despite taking cholesterol-lowering statins, while heart failure -- when the heart fails to pump blood adequately -- remains a deadly disease that has seen little progress in treatment in the past 40 years. While hundreds of millions of dollars have been allocated for development of miracle molecules, it remains doubtful whether the money earmarked for cardiovascular research is spent well, especially after recent high-profile setbacks.

For example, a drug used to treat HIV+ patients was found to be effective in increasing HDL to about 80. HDL is the good cholesterol. The higher it is, better the health. However, this drug proved to have many side effects and had to be banned in 2011-12. Intense research is on to develop a medical formulation to reverse HDL breakdown.

This actually brings us to the reality that the focus in cardiology has shifted from cure to prevention. New studies say that plant-based nutrition is most important to prevent cardiovascular diseases. Researchers are also focussing on age-old ideas like rigorous exercise and avoiding processed foods while trying to popularise the new findings.

Some of the most important findings of recent researches include:
1. Asians who eat cruciferous and leafy vegetables like cauliflower, cabbage, cress, bok choy and broccoli have lower incidences of heart diseases.

2. The Japanese have healthier hearts due to higher intake of seaweed, seafood, green tea, soy foods and lower intake of animal products and sweets.

3. The Japanese also eat less fat, more carbohydrates and possibly fewer calories overall. American men get about 33% of their calories from fat and 47% of their calories from carbohydrates.

4. The Maasai tribe of Africa consumes acacia nilotica (babul) soup. The Maasai tribe also consume soup laced with bitter bark and roots containing cholesterol-lowering saponins. Urban Maasais, who do not have access to these plants, tend to develop heart disease.

5. A population of cross-bred families in southern France in 1975 and in Cape Peninsula in 1993 were detected to have high level of the mutated good cholestrol, HDL. After two decades of intense research, an enzyme called CETP (cholesterol ester transferase protein) was confirmed to be absent in these people. It was found that it is the CETP that breaks down HDL.

6. Doctors believe that one research area that might deliver fresh impetus is the emerging class of experimental cholesterol-lowering drugs known as PCSK9 inhibitors. These man-made antibodies -- that can be injected in the body -- offer a new way to fight atherosclerosis or the build-up of artery-clogging fatty deposits. However, they are in the mid-stage of experimentation and need to be put through late-stage tests.

Another problem for drug makers is that previously profitable drugs are now available as cheap generics, reducing drug companies’ revenue from the sector. Cardiovascular drugs still need more research, often with uncertain returns.