By Matthew Jay Budoff, 


David Geffen School of Medicine at UCLA Los Angeles, California

As we move into the next decade and beyond, a strong shift will occur from intervention to prevention. Not only driven by Courage, Orbita and Ischemia Trials, but by the understanding that treating the vulnerable patient is more important than treating the vulnerable plaque. Risk stratification will continue to improve, shifting from ACC/AHA Pooled Cohort ‘population’ based stratification to personalized medicine, with coronary artery calcium scanning, personal monitoring devices and genotyping leading the way. This allows physicians to identify the person who has disease, as compared to the person who may be at increased risk of developing the disease. This approach is not only well proven, but advocated by our more recent Cholesterol and Prevention Guidelines from the ACC and AHA.

Based on multiple outcome studies and results from the ISCHEMIA Trial, we will shift from ischemia based testing (stress nuclear, echocardiography) to anatomical based testing (CT angiography) to assess the presence of left main and subclinical atherosclerosis. This will improve outcomes, as seen in the SCOT-HEART Trial, and improve yield of obstructive disease in the cardiac cath lab.

Finally, cardiology will see a new specialty, cardiometabolic medicine, develop, ushering in a new age of advanced diabetes treatment to improve cardiovascular outcomes. This has taken too long, as cardiovascular disease claims the lives of 2/3 of our patients with diabetes, and new therapies, such as SGLT-2 inhibitors and GLP-1 receptor agonists, are implemented by cardiology and nephrology with increasing frequency.

The Next Decade in Cardiac Care