The field of cardiology is fast-paced, both clinically and in the research arena, and 2024 will be no exception. There are a number of developments worth keeping an eye on this year. Let’s take a look at some of the highlights.
Lipidology
Lipoprotein(a), or Lp(a), has been called “one of the last untreatable frontiers of cardiovascular risk.”[]
"Preventive cardiologists and clinical lipidologists like myself have been checking Lp(a) levels for well over 2 decades now, but there has been little we could do medically to reduce high levels."
— Yasmine S. Ali, MD, MSCI, FACC, FACP
This is because Lp(a) is largely unaffected by available lipid-lowering agents. However, that may change by next year, given the number of nucleic acid therapeutics currently in trials. In particular, phase 3 results on pelacarsen are expected in 2025 from the HORIZON trial.[] You can expect to see a ramp-up of information, awareness, and interest in the pathophysiology of Lp(a) and its role in cardiovascular disease (CVD) risk this year.
Cardiovascular autonomic dysfunction due to COVID-19
The lingering effects of post–COVID-19 syndrome, also known as long COVID, remain a hot topic of research. Cardiovascular complications of COVID include autonomic dysfunction, which may affect as many as one-third of highly symptomatic patients with COVID-19. It can present as postural orthostatic tachycardia syndrome (POTS) or inappropriate sinus tachycardia in severely affected patients with long COVID.[]
Research into effective treatment and management of COVID-related autonomic dysfunction will continue this year, and cardiologists like myself must be prepared to perform structured diagnostic work-ups in line with best practices for recognizing and diagnosing these phenotypes.
The rise of RNA-binding proteins
RNA-binding proteins (RBPs) are those with RNA-binding activity, and identification of these proteins has more than tripled during the past decade. More recently, the identified cardiomyocyte-specific RBPome has greatly expanded, with implications for therapeutic agents that target these proteins, their variants, and their functions in order to treat CVD.[]
The broader class of RNA therapeutics has particular significance for the field of cardiology, because these agents “have the potential to reach previously ‘undruggable’ pathways in CVD,” according to the authors of a state-of-the-art review.[]
We have already seen the impact of rapid development of RNA-based vaccines in the area of COVID-19; this year, in addition to the clinical trials of Lp(a)-targeting agents noted above, we will also see movement in research and outcomes results for RNA-based agents for cardiac amyloidosis, congestive heart failure (both heart failure with preserved ejection fraction [HFpEF] and heart failure with reduced ejection fraction [HFrEF]), dilated cardiomyopathy, and hypertrophic cardiomyopathy.
The evolution of obesity management
As a slew of weight-loss drugs have entered the market, with corresponding positive clinical trial outcomes, cardiologists will be challenged to decide whether and when to enter the treatment arena for obesity.
Given the multiple connections of obesity with different forms of CVD, including atherosclerosis, heart failure, lipid disorders, hypertension, and atrial fibrillation, the need for treatment is undeniable.[] Cardiologists may elect to assume some or all of the treatment responsibility for obesity, or, as is increasingly preferred, to coordinate with PCPs and specialists in a multidisciplinary care team approach.
Regardless of approach, all eyes will be on the clinical outcomes data that will continue to be released this year for new obesity medications, particularly with GLP-1 agents, such as semaglutide, and dual GLP-1/gastric inhibitory peptide (GIP) agonists, such as tirzepatide.
New guidelines for atrial fibrillation
The management of atrial fibrillation continues to evolve as well. At the end of 2023, the American College of Cardiology (ACC)/American Heart Association Joint Committee on Clinical Practice Guidelines released the latest Guideline for the Diagnosis and Management of Atrial Fibrillation.[]
This single guideline updates two separate guidelines from 2014 and 2019, and has new recommendations for thromboembolic risk assessment in patients with atrial fibrillation, anticoagulation, catheter or surgical ablation, and left atrial appendage occlusion.
The new guideline also includes recommendations for risk factor modification and prevention, including a more prescriptive focus on healthy lifestyle to prevent the development of atrial fibrillation and lessen the burden of existing atrial fibrillation. Additionally, use of clinical care pathways and team-based care in the management of atrial fibrillation are new topics that are addressed in detail.
AI advancements
We can all expect to see more on the use of AI in the field of cardiology, from cardiac imaging to the development and use of large language models (LLMs) specifically for cardiology. A review article published in the European Heart Journal described how these tools may revolutionize cardiology.[]
The article elicited expert commentary from the ACC, summarizing the main takeaways. One important point was that any LLM used in cardiovascular medicine should have three key principles: (1) Clinicians and patients should trust the model, (2) use of the models should provide benefit, and (3) the models should be safe to use.[] Several trials are underway to assess each of these principles, so stay tuned for more developments in this active area of research.
What this means for you
Important changes across the field of cardiology will be prevalent in 2024, following on the heels of emerging therapies for residual lipid risk factors, increased understanding of COVID-19's lasting impact on heart health, evolving treatment options for obesity, and RNA therapies for management of CVD and related diseases. It’s important to stay abreast of the latest developments in order to provide optimal patient care and to potentially transform clinical outcomes.
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