Challenges and opportunities in CAD

Among the distinguished line-up of presenters at the 73rd ICS Annual Scientific Meeting and AGM was Prof John Deanfield CBE, who delivered the British Cardiovascular Society Centenary Lecture, which was titled ‘Coronary artery disease: Triumphs and opportunities’. 

Prof Deanfield gave the attendees a brief overview of the history of the management of coronary artery disease (CAD), including life-saving and life-extending treatments, advances in the acute management of coronary complications, and said “very importantly, I am going to suggest to you that managing established clinical disease, despite all of these advances, is not enough to tackle the ongoing population burden of coronary disease”. 

“We have to be much more ambitious in what we need to do in our specialty. The challenge and opportunity for the 21st Century, I would argue, is that atherosclerosis and CAD should be largely preventable diseases in the population.” 

Prof Deanfield outlined the contribution of British cardiology in terms of large-scale trials, which has helped to contribute to a reduction in myocardial infarctions. He also briefly discussed the development of statins, which he described as “the biggest landmark change in therapeutics in cardiology that has occurred in my career”. 

His talk emphasised the need to promote preventative measures in public health, including lifestyle changes and increased awareness of CAD, as well as a number of other diseases. “Prevention at an early stage is a no-brainer,” said Prof Deanfield. “But we haven’t communicated this very well to the public, or indeed to our healthcare providers or politicians,” he said.

“Cardiovascular disease is a unique opportunity for prevention… it starts early, it’s driven by exposure to potentially modifiable risk factors, and we know now that early intervention leads to greatly leveraged gains – ‘compound interest’,” he said. 

The challenge now, said Prof Deanfield, is to align all stakeholders and use novel concepts to deliver what he described as “effective, scalable, personalised population [disease] prevention”. 

Prof Deanfield concluded: “We have to transform our ambitions in medical care. We have been great in the past 100 years in developing effective treatments for cardiovascular disease.

We have been great at understanding the causes and structure of those diseases, and developing effective treatments. We now have to think about saving our healthcare systems by using them as late as possible [because of lifestyle interventions] and by preventing diseases and keeping people out of the healthcare system.

“I will leave you with a quote from Dr Ernst Wynder [US epidemiology and public health researcher]: ‘It should be the function of medicine to have people die young as late as possible.’ We won’t be able to achieve that, and we won’t be able toafford to continue doing what we are doing, with our current strategy. That’s the challenge for the 21st Century.”

The meeting also heard a presentation from Prof Robert Byrne, Director of Cardiology at the Mater Private Hospital in Dublin, who spoke on the topic ‘2022 focused update of the 2018 ESC/EACTS guideline on myocardial revascularisation: Recommendations for management of left main coronary artery disease’. The session also heard from Dr Rebecca Hahn, Director of Interventional Echocardiography at New York Presbyterian/Colombia University Medical Centre in the US, who delivered a talk titled ‘Dispelling misconceptions of tricuspid regurgitation: Anatomy, pathophysiology, and treatment.’