One Health out into Practice: Veterinary and human cardiologists discuss cardiovascular disease in pets
‘Making tomorrow happen today’ was the theme of the human-veterinary cross-talk symposium organised by Ceva on 19th February 2016. Over 100 veterinary and medical experts from Europe, the USA and Australia met to hear the latest developments and research findings in cardiology, nephrology and hypertension in cats, dogs and humans. The event took place in Paris, at the Museum of Natural History.
The Symposium was chaired by Professor Clarke Atkins (North Carolina State University, USA) and Professor Faiez Zannad (Clinical Investigation Centre, Nancy, France), both renowned specialists and involved in the writing of international guidelines for the treatment of heart failure in dogs and humans respectively. Seven internationally recognised specialists in cardiovascular disease shared their knowledge and expertise.
‘Dogs in stage B2 of heart failure are a very heterogeneous group,’ recalled Dr Michele Borgarelli (Virginia Tech, USA), speaking on the pre-clinical stage of mitral valve disease. ‘Some of these dogs would benefit from early treatment. Certain multicentre clinical studies, such as the DELAY study, might help identify the impact and role of such treatment.’ However identifying which B2 patients would benefit from treatment can be a challenge.
Dr Nuala Summerfield (Switzerland/UK) and Professor Mark Oyama (University of Pennsylvania, USA) addressed the hot topic of rational use of diuretics and diuretic resistance. ‘Signs of heart failure are not always caused by volume overload. So if diuretics are an essential part of first-line therapy, the aim should always be to use them with the lowest effective dose in order to minimise their adverse effects on renal function,’ Dr Summerfield emphasised.
Professor Oyama presented several strategies to overcome diuretic resistance which is associated with an increased risk of morbidity and mortality. These included ruling out owner non-compliance, using multiple diuretics, optimising their dosage, switching to other loop diuretics or to different routes of administration.
A thought-provoking session on mineralocorticoid receptors was then led by two specialists in the subject area; Dr Marisa Ames (USA) and Professor Frédéric Jaisser (Inserm, France). Dr Ames focused on aldosterone breakthrough in canine patients. ABT occurs when the renin-angiotensin-aldosterone system cannot be blocked efficiently by angiotensin-converting-enzyme inhibitors alone. ABT is common in dogs with heart disease treated with ACEi, according to Dr Ames, who found that it occurred in up to 40% of the canine cardiac patients she studied. Her study concluded that these patients might benefit from mineralocorticoid receptor antagonists, which block the detrimental effect of excess aldosterone.
Feline patients were also considered during the symposium. Professor Jonathan Elliott (Royal Veterinary College London, UK), who leads different research projects on feline hypertension, shared his findings on the management of the hypertensive cat and the importance of early detection and management. ‘The correlation between age, chronic kidney disease and increased blood pressure in cats is now clearly established,’ he confirmed. Regarding treatment, he commented: ‘We have a very good drug for hypertensive cats: amlodipine.’
Finally, Dr Adrian Boswood (Royal Veterinary College London, UK) talked about the risks of the inappropriate use of diagnostic tests. An increasing number of tests are becoming available and vets, who must choose them wisely. He emphasised, ‘When choosing a diagnostic test, first ask yourself, will the outcome affect your diagnosis, prognosis or therapy? If not, this test is probably inappropriate for the patient.’
Each session was followed by a lively exchange between experts of the veterinary and human fields, and discussions continued during the social get-together.