One Health Out Into Practice: Veterinary And Human Cardiologists Discuss Cardiovascular Disease In Pets
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‘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 (MMVD). ‘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 (ABT) in canine patients. ABT occurs when the renin-angiotensin-aldosterone system cannot be blocked efficiently by angiotensin-converting-enzyme inhibitors (ACEi) 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 (MRAs), which block the detrimental effect of excess aldosterone.
Mineralocorticoid receptors are also particularly topical at the moment in human nephrology, as shown by Professor Jaisser, a renal physiology specialist. ‘MRAs have a broad expression, well beyond the classical targets. Studies have shown they have a beneficial effect in renal disease and hypertension,’ he explained. These promising findings reinforce the interest of MRA in veterinary medicine.
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.
It was the third symposium of its kind, with earlier occassions held in 2009 and 2011 in Bordeaux. With these Cross-Talk Symposia, Ceva has created unique events, facilitating exchange between colleagues from veterinary and human fields and putting the benefits of a One Health approach into practice. ‘This symposium is really one of its kind,’ commented Professor Atkins. ‘It brings together an interesting mix of physicians and veterinarians, cardiologists and nephrologists, from academia as well as private practice.’
‘This cross-talk format between human and veterinary medicine is absolutely unique,’ added Professor Zannad. ‘We learn so much from each other.’
By including topics on nephrology and blood pressure, this third occasion had a wider audience and a broader scientific programme than previous occasions.
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