Commentary

Cardiology Today’s ‘top news’ of the past decade and a look ahead

Carl J. Pepine

by Carl J. Pepine, MD, MACC

This was an odd decade — uneven and erratic for the biggest killer and contributor to poor quality of life in the United States, CVD; yet, celebratory and euphoric in other areas of medicine.

No question that there was plenty to write about in Cardiology Today, on Healio and beyond. More recently, the decades have been filled with increasing numbers of randomized clinical trials to gather evidence to support or modify our practice patterns. These data could be considered “our national championships.” There, the decade clearly did not disappoint.

We saw major breakthroughs in patient management — for example, with transcatheter aortic valve replacement, the development of PCSK9 inhibitors and remote monitoring by wearable technologies — in landmark clinical trials such as FREEDOM, CANTOS, SPRINT and ISCHEMIA; the emergence of new CV subspecialties including but not limited to cardio-oncology, cardioimmunology, cardio-gynecology and maternal-fetal medicine; increased “de-prescribing” of long-standing therapies such as aspirin and digoxin; renewed interest in old drugs like colchicine; unforgettable personalities; and some other moments that you’d surely like to forget (fill in your own blanks).

There were moments where we were delighted, like when the CANTOS trial proved the inflammation hypothesis, but also times when goosebumps felt like they were going to take over your whole body, like when the PARTNER TAVR results were first presented, and other moments that alternated between feelings of morose and anger.

The past decade was dominated by atherosclerotic CVD, primarily ischemic heart disease and stroke, because in the United States for most decades during the past century, ASCVD has continued to cause the most deaths and disabilities and consume a tremendous amount of health care resources.

What about the next decade?

What 2020 and beyond holds for the field of cardiology is anyone’s guess right now. But, I think we can certainly anticipate updates in the following.

Much more use of artificial intelligence and wearables to capture not only activity, heart rate and heart rhythm, but also BP, oxygen saturation, temperature, sleep pattern and more. More importantly, information gleaned from AI and tech will influence patient outcomes, and provider care. I anticipate that new small molecules will enter the field while regenerative CV medicine greatly expands. We are a decade away from cardiac recellularization to restore contractile function, but I foresee continued progress in noncontractile benefits with selected cell-based approaches including allogeneic cells and secretome products, such as exosomes, growth factors, microRNAs, etc. Look for expanded use of extracellular matrix and scaffolds. With the success of TAVR, nonsurgical approaches to other valves should, and likely will, continue. I also anticipate cardiac preservation will improve markedly, expanding the availability of transplantable hearts. The next decade of CV medicine is bright, indeed.

A look back

Each year, the Cardiology Today Editorial Board is asked to vote on the “top news of the year.” The results are published in the January issue of Cardiology Today each year.

Below you’ll find the top news during the past decade. Feel free to agree or disagree.

For more information:

Carl J. Pepine, MD, MACC, is the Chief Medical Editor of Cardiology Today. He also holds the title of Eminent Scholar Emeritus and professor in the division of cardiovascular medicine at University of Florida, Gainesville. Pepine can be reached at Cardiology Today, 6900 Grove Road, Thorofare, NJ 08086; email: cardiology@healio.com.

Disclosure: Pepine reports no relevant financial disclosures.

Carl J. Pepine

by Carl J. Pepine, MD, MACC

This was an odd decade — uneven and erratic for the biggest killer and contributor to poor quality of life in the United States, CVD; yet, celebratory and euphoric in other areas of medicine.

No question that there was plenty to write about in Cardiology Today, on Healio and beyond. More recently, the decades have been filled with increasing numbers of randomized clinical trials to gather evidence to support or modify our practice patterns. These data could be considered “our national championships.” There, the decade clearly did not disappoint.

We saw major breakthroughs in patient management — for example, with transcatheter aortic valve replacement, the development of PCSK9 inhibitors and remote monitoring by wearable technologies — in landmark clinical trials such as FREEDOM, CANTOS, SPRINT and ISCHEMIA; the emergence of new CV subspecialties including but not limited to cardio-oncology, cardioimmunology, cardio-gynecology and maternal-fetal medicine; increased “de-prescribing” of long-standing therapies such as aspirin and digoxin; renewed interest in old drugs like colchicine; unforgettable personalities; and some other moments that you’d surely like to forget (fill in your own blanks).

There were moments where we were delighted, like when the CANTOS trial proved the inflammation hypothesis, but also times when goosebumps felt like they were going to take over your whole body, like when the PARTNER TAVR results were first presented, and other moments that alternated between feelings of morose and anger.

The past decade was dominated by atherosclerotic CVD, primarily ischemic heart disease and stroke, because in the United States for most decades during the past century, ASCVD has continued to cause the most deaths and disabilities and consume a tremendous amount of health care resources.

What about the next decade?

What 2020 and beyond holds for the field of cardiology is anyone’s guess right now. But, I think we can certainly anticipate updates in the following.

Much more use of artificial intelligence and wearables to capture not only activity, heart rate and heart rhythm, but also BP, oxygen saturation, temperature, sleep pattern and more. More importantly, information gleaned from AI and tech will influence patient outcomes, and provider care. I anticipate that new small molecules will enter the field while regenerative CV medicine greatly expands. We are a decade away from cardiac recellularization to restore contractile function, but I foresee continued progress in noncontractile benefits with selected cell-based approaches including allogeneic cells and secretome products, such as exosomes, growth factors, microRNAs, etc. Look for expanded use of extracellular matrix and scaffolds. With the success of TAVR, nonsurgical approaches to other valves should, and likely will, continue. I also anticipate cardiac preservation will improve markedly, expanding the availability of transplantable hearts. The next decade of CV medicine is bright, indeed.

A look back

Each year, the Cardiology Today Editorial Board is asked to vote on the “top news of the year.” The results are published in the January issue of Cardiology Today each year.

Below you’ll find the top news during the past decade. Feel free to agree or disagree.

For more information:

Carl J. Pepine, MD, MACC, is the Chief Medical Editor of Cardiology Today. He also holds the title of Eminent Scholar Emeritus and professor in the division of cardiovascular medicine at University of Florida, Gainesville. Pepine can be reached at Cardiology Today, 6900 Grove Road, Thorofare, NJ 08086; email: cardiology@healio.com.

Disclosure: Pepine reports no relevant financial disclosures.