What will be the biggest challenges in cardiology in 2018? Over the coming weeks, we will share the predictions from some of Australia’s leading cardiovascular specialists.

Cardiovascular medicine

Professor Garry Jennings is senior director at the Baker Heart and Diabetes Institute

Developments and challenges in cardiovascular medicine 2018

Expect to see some exciting new developments in the realms of cardiovascular medicine over the next few years, says Professor Garry Jennings, senior director of Baker Heart and Diabetes Institute and chief medical advisor at the Heart Foundation.

The patient demographic is changing – patients are typically older, with higher rates of obesity, diabetes and economic disadvantage – and so are our diagnostic and treatment protocols, he says.

One big game changer occurred last year when the American College of Cardiology and the American Heart Association moved the goalposts to redefine hypertension as blood pressure >130/80 mmHg rather than 140/90 mmHg.

“In the stroke of a pen about half of the adult US population are now labelled as having hypertension,” Professor Jennings says.

“It is not yet clear how much of the rest of the world, including Australia will follow suit but the recommendation was based on an extensive review of recent evidence and there is no doubt the trend is back towards better alignment of ‘normal’, ‘optimal’ and ‘target’ blood pressure.”

This in turn put a focus on how we define and apply absolute risk to those with risk factors slightly elevated above optimal, especially in younger patients, he says.

“As well as the conventional approach combining Framingham risk factors, the evidence base around imaging techniques such as coronary calcium scores is improving.  This also defines risk but in an overlapping (and) partly different population to those defined by absolute risk scores.”

The future may, however, lie in the ‘new biology’ with reports of biomarkers emerging fields such as from genomics, proteomics and lipidomics, Professor Jennings suggests.

“Most of all we need a test that will tell us who amongst people at high risk, or with known coronary artery disease, have plaques that are vulnerable to future disruption and cause acute coronary syndromes and/or sudden cardiac death.”

And he says the changing demographic will also put more focus on atrial fibrillation, its premonitory risk factors and the subclinical prevalence in the community.

There is much more to come as diagnostic protocols change and new therapies are introduced, he concludes.

“We are in for an exciting few years.”