JACC editor excited by progress during a 'very important moment' for cardiology
Cardiology is entering a period of rapid innovation, with advancements in prevention, treatment and technology providing hope for tackling the world’s leading cause of death. Cardiovascular Business spoke with Harlan Krumholz, MD, SM, editor-in-chief of the Journal of the American College of Cardiology (JACC), and a cardiologist and the Harold H. Hines, Jr. Professor of Medicine at the Yale School of Medicine, to find out what new technologies and trends he is watching closely.
He stressed that while the innovations are exciting, they are part of a larger effort to reverse concerning trends in cardiovascular mortality. After decades of declining cardiovascular death rates, a plateau occurred around 2010, followed by a more recent increase in mortality. Krumholz linked this trend to stagnation in risk factor management and quality of care, but expressed optimism that emerging technologies and treatments could turn the tide.
"We were actually losing ground. I think now with these innovations as they're coming through, it's our job to get back on that curve that was going down," he said.
"And when I'm at a meeting like [the European Society of Cardiology (ESC) conference] and seeing the things that are coming out, I'm getting excited. And for many conditions where we had nothing, like heart failure with preserved ejection fraction (HFpEF), amyloid disease, hypertrophic cardiomyopathy, we now have these novel medications that are providing hope for people with these conditions and and seeing dramatic improvements in their outcomes. I think we're at the cusp of a very important moment," Krumholz explained.
New cardiovascular drugs and prevention strategies
Reflecting on his experience at the recent ESC meeting, Krumholz noted a renewed enthusiasm within the field. After years of concern that progress in cardiovascular research was slowing, he described how new targets for treatment, such as lipoprotein a (LPa) and inflammation, are poised to transform care. He pointed to the upcoming ZEUS trial investigating the role of interleukin-6 (IL-6) inhibition with the drug ziltivekimab to treat coronary inflammation and to see if they can lower cardiovascular events. He also pointed to breakthrough research on anti-obesity medications that could revolutionize therapy for cardiometabolic health. These treatments, which impact conditions like hypertension and lipid management, represent a promising frontier.
"The anti-obesity medications and their effect on cardiometabolic health are creating an entire new frontier where we can make progress," Krumholz explained. "The prevention area is also exploding with new ideas, new targets, new opportunities, with ways to treat people that may be intermittent, where they're getting injections every six months or once a year, more like a vaccine approach."
Explosion in structural heart therapies and new approaches to heart failure
The growth in cardiovascular device innovation, particularly in structural cardiology, also caught Krumholz’s attention. Areas like mitral, tricuspid, and aortic valve interventions continue to see substantial advancements, raising important questions about the durability and timing of interventions for conditions such as aortic regurgitation. Meanwhile, heart failure treatment is experiencing a “revolution,” he added, with both devices and novel drug therapies dramatically improving outcomes. Krumholz specifically highlighted the positive evidence supporting tirzepatide (Mounjaro) in treating heart failure with preserved ejection fraction, a condition that has long lacked effective treatment options.
AI will change how cardiac patients are monitored
In addition to breakthroughs in pharmacology, Krumholz highlighted how artificial intelligence (AI) and digital health technologies are reshaping cardiovascular care. AI is being leveraged to enhance patient monitoring, especially through wearables, and it is opening new opportunities for out-of-hospital care and real-time intervention. He said this isn having an especially large impact on electrophysiology, because patients can now more easily be monitored with wearable devices remotely and the AI can send an alert to the physician when there is a problem. Krumholz described this as the advent of “super medical intelligence,” which could redefine how clinicians diagnose and manage cardiovascular conditions.
As the editor of JACC, Krumholz said he is eager to facilitate the translation of these scientific advances into clinical practice more quickly, with the ultimate goal of reducing cardiovascular disease's burden worldwide.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com