The field of cardiology is fast-paced, both clinically and in the research arena, and 2024 will be no exception. There are a number of developments worth keeping an eye on this year. Let’s take a look at some of the highlights.

Lipidology

Lipoprotein(a), or Lp(a), has been called “one of the last untreatable frontiers of cardiovascular risk.”

Cleveland Clinic. Lipoprotein(a): Progress on one of the last untreatable frontiers of cardiovascular risk. Consult QD. January 4, 2024.

Preventive cardiologists and clinical lipidologists like myself have been checking Lp(a) levels for well over 2 decades now, but there has been little we could do medically to reduce high levels.

This is because Lp(a) is largely unaffected by available lipid-lowering agents. However, that may change by next year, given the number of nucleic acid therapeutics currently in trials. In particular, phase 3 results on pelacarsen are expected in 2025 from the HORIZON trial.

ClinicalTrials.gov. Assessing the impact of lipoprotein(a) lowering with pelacarsen (TQJ230) on major cardiovascular events in patients with CVD (Lp(a)HORIZON). Last update: November 14, 2023.

You can expect to see a ramp-up of information, awareness, and interest in the pathophysiology of Lp(a) and its role in cardiovascular disease (CVD) risk this year.

Cardiovascular autonomic dysfunction due to COVID-19

The lingering effects of post–COVID-19 syndrome, also known as long COVID, remain a hot topic of research. Cardiovascular complications of COVID include autonomic dysfunction, which may affect as many as one-third of highly symptomatic patients with COVID-19. It can present as postural orthostatic tachycardia syndrome (POTS) or inappropriate sinus tachycardia in severely affected patients with long COVID.

Fedorowski A, Fanciulli A, Raj S, et al. Cardiovascular autonomic dysfunction in post-COVID-19 syndrome: a major healthcare burden. Nature Reviews Cardiology. January 2, 2024.

The rise of RNA-binding proteins

RNA-binding proteins (RBPs) are those with RNA-binding activity, and identification of these proteins has more than tripled during the past decade. More recently, the identified cardiomyocyte-specific RBPome has greatly expanded, with implications for therapeutic agents that target these proteins, their variants, and their functions in order to treat CVD.

Volkers M, Preiss T, Hentze MW. RNA-binding proteins in cardiovascular biology and disease: the beat goes on. Nature Reviews Cardiology. January 2, 2024.

We have already seen the impact of rapid development of RNA-based vaccines in the area of COVID-19; this year, in addition to the clinical trials of Lp(a)-targeting agents noted above, we will also see movement in research and outcomes results for RNA-based agents for cardiac amyloidosis, congestive heart failure (both heart failure with preserved ejection fraction [HFpEF] and heart failure with reduced ejection fraction [HFrEF]), dilated cardiomyopathy, and hypertrophic cardiomyopathy.

The evolution of obesity management

As a slew of weight-loss drugs have entered the market, with corresponding positive clinical trial outcomes, cardiologists will be challenged to decide whether and when to enter the treatment arena for obesity.

Regardless of approach, all eyes will be on the clinical outcomes data that will continue to be released this year for new obesity medications, particularly with GLP-1 agents, such as semaglutide, and dual GLP-1/gastric inhibitory peptide (GIP) agonists, such as tirzepatide.

New guidelines for atrial fibrillation

The management of atrial fibrillation continues to evolve as well. At the end of 2023, the American College of Cardiology (ACC)/American Heart Association Joint Committee on Clinical Practice Guidelines released the latest Guideline for the Diagnosis and Management of Atrial Fibrillation.

Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2024;83(1):109–279.

The new guideline also includes recommendations for risk factor modification and prevention, including a more prescriptive focus on healthy lifestyle to prevent the development of atrial fibrillation and lessen the burden of existing atrial fibrillation. Additionally, use of clinical care pathways and team-based care in the management of atrial fibrillation are new topics that are addressed in detail.

AI advancements

We can all expect to see more on the use of AI in the field of cardiology, from cardiac imaging to the development and use of large language models (LLMs) specifically for cardiology. A review article published in the European Heart Journal described how these tools may revolutionize cardiology.

Boonstra MJ, Weissenbacher D, Moore JH, et al. Artificial intelligence: revolutionizing cardiology with large language models. European Heart Journal. 2024;ehad838. January 3, 2024.

The article elicited expert commentary from the ACC, summarizing the main takeaways. One important point was that any LLM used in cardiovascular medicine should have three key principles: (1) Clinicians and patients should trust the model, (2) use of the models should provide benefit, and (3) the models should be safe to use.

Barnes GD. Using AI large language models for cardiology: key points. American College of Cardiology. January 8, 2024.

Several trials are underway to assess each of these principles, so stay tuned for more developments in this active area of research.