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Cardiology Today Editorial Board identifies top cardiology trends for 2018

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With new guidelines and new therapies to absorb, 2018 should be a very interesting year for cardiologists. Cardiology Today asked members of its Editorial Board to identify what they believe will be the top three trends in cardiology for 2018, and to give reasons for their thinking. Here are some of the results.

Douglas L. Mann, MD; Barnes-Jewish Hospital and Washington University at St. Louis

1. Use of sodium-glucose co-transporter 2 (SGLT2) inhibitors in diabetic and non-diabetic populations — because it affects so many people.
2. Implementation of the new hypertension practice guideline — because it too affects so many people.
3. Use of PCSK9 inhibitors — the issue of how insurance companies will deal with the cost for a lifesaving drug will be important.

Bruce L. Wilkoff, MD; Cleveland Clinic

1. Anticoagulation with direct oral anticoagulants will become an even more prominent issue.
2. Control of infection for patients with pacemakers and implantable cardioverter defibrillators is crucial to achieving positive outcomes with those devices.
3. Use of percutaneous valves should grow in prevalence.

Barry Greenberg, MD; University of California, San Diego

1. There will be more widespread use of SGLT2 inhibitors in patients with diabetes based on favorable results in reducing CV risk.
2. We should see increased use of sacubitril/valsartan (Entresto, Novartis) in patients with HF with reduced ejection fraction as providers recognize the advantages of this combination compared to an ACE inhibitor or angiotensin receptor blocker alone.
3. An increased focus on prevention and cardiac rehabilitation should occur.

Timothy Henry, MD; Cedars-Sinai

1. There will be an increased focus on cardiogenic shock to influence outcomes in those patients.
2. Machine learning will grow in prominence. We are approaching an era of artificial intelligence in CVD.
3. Value-based case in cardiology will be emphasized.

Allan S. Jaffe, MD; Mayo Clinic

1. More implications for anti-inflammatory therapies on the heels of the CANTOS trial.
2. Many more high-sensitivity troponin assays should be approved, prompting further discussion of the pros and cons of those technologies.
3. Additional progress with percutaneous valves should be observed.

Javed Butler, MD, MPH, MBA; Stony Brook University

1. Implementation science will receive more of a focus.
2. Mobile technologies will become more prominent in how cardiologists assess their patients, and how patients care for themselves.
3. Personalized medicine has great potential to change the CV medicine landscape.

William H. Frishman, MD; New York Medical College and Westchester Medical Center

1. We should see more aggressive therapy for hyperlipidemia.
2. We should see more aggressive therapy for hypertension.
3. Now that we have more evidence showing the benefits of prevention, there should be greater emphasis on overall prevention.

Peter Libby, MD; Brigham and Women’s Hospital and Harvard Medical School

1. More cardiologists will be treating diabetes with increasing comfort.
2. There will be increasing personalization of CV care based on biomarkers and clinical characteristics.
3. The use of late-generation troponin assays will bury the diagnosis of unstable angina and consternate consultative cardiologists.

Deepak L. Bhatt, MD, MPH; Brigham and Women’s Hospital and Harvard Medical School

1. Transradial access will continue to increase vs. transfemoral access in diagnostic angiography and PCI.
2. There will be a greater focus on the CV potential of diabetes drugs.
3. The challenge of choosing among multiple effective but expensive therapies will be an issue tackled by many cardiologists.

Dan Roden, MD; Vanderbilt University Medical Center

1. There is a lot of buzz around mobile devices, but there are no solid data yet.
2. New approaches to manipulate PCSK9 will be studied.
3. Spontaneous coronary artery dissection is a problem that will receive more attention.

Keith C. Ferdinand, MD; Tulane University School of Medicine

1. More data on the safety and benefits of high BP treatment should be released.
2. More data on safety of very low LDL cholesterol should be released.
3. We are likely to learn more about the benefits of PCI in stable CAD.

Disclosures: Bhatt reports financial ties with multiple pharmaceutical and device companies. Butler reports he speaks for Novartis and receives research funding from Amgen and Bristol-Myers Squibb. Ferdinand reports he is a consultant for Amgen, Boehringer Ingelheim, Novartis, Quantum Genomics and Sanofi. Jaffe reports he has consulted for most biomarker companies. Wilkoff reports he is a consultant for Medtronic, Spectranetics and St. Jude Medical. Frishman, Greenberg, Henry, Libby, Mann and Roden report no relevant financial disclosures.