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Among the latest trends and research in heart disease and stroke management and prevention:

• Several studies have confirmed that Transcatheter aortic valve replacement is safe and effective for patients with severe narrowing of the aorta. Even patients in their 80s or 90s could possibly benefit. Researchers have found that this minimally invasive procedure had a 95 percent success rate; at one-year follow-up, the mortality rate was 17.5 percent and stroke rate was 3.5 percent.
• There is a disconnect between how clinicians and patients view heart failure, according to a study from the Univeristy of Colorado published recently in JACC: Heart Failure. Researchers found that physicians identified most patients with advanced heart failure as being at high risk for transplant, left ventricular assist device, or death, while few patients felt the same urgency or concern. Researchers also discovered that while three-quarters of patients would consider a Left Ventricular Assist Device (LVAD), a pump surgically implanted just below the heart to assist with cardiac circulation,  63 percent said they would decline other, simpler life-sustaining therapies. The results, the authors say, point to a need for better patient-physician communication about options to address advanced heart failure.
• Post-menopausal women who have been using vaginal estrogen therapy do not have a higher risk of cardiovascular disease and cancer than women who haven’t used any estrogen, according to a recent study of data from the Women's Health Initiative Observational Study published in Menopause.

Among women with intact uteri, the risks of stroke, invasive breast cancer, colorectal cancer, endometrial cancer, and pulmonary embolism/deep vein thrombosis were not significantly different between those using estrogen therapy and non-users.

However, the risks of coronary heart disease, fracture, and premature death were lower in users than non-users. Other studies have shown that women taking oral estrogen therapy (pills) may have an increased risk of blood clots, stroke, and possibly breast cancer.

• A recent study from the Cedars-Sinai Heart Institute published in European Heart Journal suggests that cardiac stem cell infusions could someday help reverse the heart’s aging process and may be useful in treating heart failure.
• Not only is smoking bad for the heart, but a recent study published in Age & Ageing suggests that smoking also increases the risk of developing frailty, which is considered to be a precursor to disability and is associated with increased vulnerability to adverse health outcomes, cognitive decline, and poor quality of life. The good news is that researchers could find no correlation between frailty and a past history of smoking; only current smokers appear to be at risk.
• Research continues to document the benefits of physical activity on the heart. A recent study by the University of São Paulo in Brazil published recently in the journal Autophagy, determined that aerobic exercise actually protects the “sick” heart. Researchers suggest that individuals who already are active should continue their exercise routines and that sedentary people can benefit from becoming more active—even it just involves walks up and down the hall.
• A new Michigan State University study on 240 emergency room visitors identified the significant role cholesterol plays during a heart attack. The researchers found that a vast majority of heart attack patients had excessive amounts of crystallized structures referred to as “cholesterol crystals,” a material that contributes to hardened arteries. This suggests the benefits of a healthy diet at any age. The article was published in the American Journal of Cardiology.
• A recent study from the Imperial College London and the University of Cambridge published in the European Heart Journal suggests that carrying extra weight could raise a patient’s risk of heart attack by more than a quarter, even if that individual is otherwise healthy.

Researchers determined that being overweight or obese increases a person’s risk of heart disease generally by up to 28 percent, compared with those with a healthy weight, even if they have normal blood pressure, blood sugar, and cholesterol.

• According to a study involving more than 11,000 patients, sitting up or lying flat after a stroke makes no difference to recovery. This is contrary to some studies that have suggested lying flat may improve recovery by increasing blood flow to the brain’s main arteries. The authors suggest that head position doesn’t matter as much as quality nursing care. The study was conducted by the George Institute for Global Health and published in the New England Journal of Medicine.
• The rate of ischemic stroke among older baby boomers, those born between 1945 and 1954, has come down in the past 20 years, according to one study from the Cardiovascular Institute of New Jersey at Rutgers Robert Wood Johnson Medical School (published in the Journal of the American Heart Association).

However, during that same time period, stroke rates have more than doubled in GenXers, those individuals born between 1965 and 1974. The lowered rates for older people is attributed to the advancement of medicine, while the higher stroke rate for younger individuals is likely due to higher levels of obesity and diabetes.

• In people aged 75 and older, long-term daily aspirin use is associated with a higher risk of disabling or fatal bleeding, according to a recent study from the University of Oxford, United Kingdom, published in The Lancet. Although short-term aspirin use after stroke or heart attack has been shown to have benefits, the authors suggest that patients over 75 who take aspirin on a daily basis should be prescribed a proton-pump inhibitor to reduce the bleeding risk.