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2012: A year of progress
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Health care reform and the election year garnered tremendous attention from the Cardiology Today Editorial Board, but, importantly, the field of cardiology continued to move forward at a fantastic pace in 2012.
Controversy surrounding the optimal revascularization method for the complex CAD patient with diabetes has roared for many years since the BARI trial suggested that surgical revascularization was the preferred technique. Then, several smaller trials, such as SYNTAX, also hinted at the same, but only in patients with severe complex disease. But many believed that the introduction of drug-eluting stents would place more advantage to PCI. Now, results of the FREEDOM trial presented at the American Heart Association’s 2012 Scientific Sessions finally put that notion to rest. Among diabetic patients with multiple vessel disease, CABG reduces all-cause mortality and MI at the expense of a small increased risk for stroke, and this holds across all levels of disease complexity as reflected by SYNTAX score.
Carl J. Pepine
New research into percutaneous renal denervation takes us back to the original surgical concepts from the late 50s. Evolution of ablation techniques for arrhythmias led to the notion that we can now ablate the sympathetic nerves that surround the renal arteries safely and effectively. Results from Europe indicate that the BP reduction is enduring. Even more encouraging, there is a suggestion that in the future we may be able to perform renal denervation in a noninvasive manner using ultrasound, which would be revolutionary.
There is also a great deal of excitement surrounding PCSK9 inhibition to treat dyslipidemia, which will surely continue into 2013. This stands to be the next lipid-modification therapy.
Looking at the year ahead and into the future, renal denervation may travel the route of many interventional procedures and migrate well beyond the patient with resistant hypertension to the treatment of other conditions like metabolic syndrome, diabetes and HF. There are also several emerging devices to better manage HF that are currently in trials.
Furthermore, I believe we will see the cell therapy field continue to gather no moss. We have evidence now that we can safely deliver cells to sick patients using several cells, both allogeneic and autologous, particularly the cardiac progenitor cells. Phase 1 trial data are encouraging, and many trials have moved into phase 2. Moreover, the Nobel Prize in Physiology/Medicine in 2012 recognized two scientists who discovered that mature, specialized cells can be reprogrammed to become immature cells capable of developing into all tissues of the body. We should all look for this field to really take off.
Carl J. Pepine, MD, is professor of medicine in the division of cardiovascular medicine at the University of Florida, Gainesville. He is Chief Medical Editor of Cardiology Today.
Carl J. Pepine, MD, can be reached at the Cardiology Today office, 6900 Grove Road, Thorofare, NJ 08086; email: carl.pepine@medicine.ufl.edu.
Disclosure: Pepine reports no relevant financial disclosures.