We’ve seen the headline too often: Heart disease remains the leading cause of death in the United States. However, that often-cited fact is far from the whole picture.
Yes, an aging population, rising rates of diabetes and obesity -- along with limited access to care for some -- continue to fuel the incidence of heart disease. However, the way medicine prevents and treats it has advanced dramatically.
Over the past 15 years, cardiology has undergone a quiet revolution -- one marked by safer procedures, better medications, earlier detection and increasingly personalized prevention strategies.
“The changes have reduced complications, extended life and lowered the risk of recurrent events like heart attacks and strokes,” said Dr. Anand Prasad, interventional cardiologist and director of the University Health Cardiovascular Center.
More effective medications saving lives
Medications that better control cholesterol, blood pressure and blood glucose levels have been game changers.
Fifteen years ago, treatment options for cholesterol were largely limited to statins. Today, newer therapies like PCSK9 inhibitors and small interfering RNA treatments allow for more aggressive and precise LDL cholesterol reduction.
“Generally, these drugs have fewer side effects than traditional statins, and they are more effective,” Dr. Prasad explained. “They can drop the LDL cholesterol by 50%. They can be used on top of statins, so you can have both at the same time. And they reduce adverse cardiovascular events like heart attacks and stroke.”
Cardiovascular prevention now includes metabolic medications -- SGLT2 inhibitors and GLP-1 agonists -- for patients with diabetes and heart disease.
“They can help with renal disease, treatment of sleep apnea, and there’s evidence that they prevent plaque buildup in the arteries and events like stroke.”
Blood pressure targets have also tightened. Cardiologists like Dr. Prasad increasingly stress the importance of lifestyle changes.
“We’ve really pushed the benefits of not smoking, weight loss, diet and exercise over the last 15 years.”
Treatments: Safer, less invasive and more durable
As prevention has grown more sophisticated, heart procedures have become significantly less invasive.
Severe aortic stenosis -- a narrowing of the heart’s aortic valve commonly associated with aging -- once required open-heart surgery and months of recovery.
Today, many patients are candidates for transcatheter aortic valve, or TAVR, a procedure that guides a tube with the replacement valve through the femoral artery to the heart.
“There’s no incision -- it’s just a puncture,” Dr. Prasad said.
Other heart procedures have also advanced.
“We have better stents that are less prone to clotting and easier to use,” Dr. Prasad said. “We have devices like lithotripsy that modify calcium. Those things were not even on the table when I started.”
Methods available to access heart problems have evolved, too. Doctors once primarily provided treatment for blocked arteries, heart valves and rhythm disorders with access through an artery in the groin. Now, they reach the heart through an artery in the wrist where there’s less bleeding and fewer complications.
“Our therapies -- whether you look at TAVR, whether you look at using the radial artery, the blood thinners -- those have all had positive impact on mortality and morbidity,” Dr. Prasad said. “So much of what’s developed over the last 15 years has prolonged life and reduced adverse events like another heart attack.”
Imaging and diagnosis: Seeing the heart more clearly
Advances in imaging technologies are providing earlier, more precise diagnosis.
“We’re getting more detailed resolution of the coronary vessels, and it’s done with less radiation than it was 15 years ago,” Dr. Prasad said.
Modern CT scans can now be paired with blood-flow algorithms that help determine whether a blockage is significant, often without invasive testing. MRI, nuclear imaging and echocardiography have improved, enabling earlier treatment.
The next 15 years: Artificial intelligence
Looking ahead, Dr. Prasad believes artificial intelligence could prove to be the most transformative development yet.
AI is already being integrated into clinical documentation and imaging interpretation, and its role is expanding rapidly.
“I see that progressing exponentially,” he said. “It will be an integrated tool for cardiologists across every modality.”
Beyond efficiency, AI has the potential to identify disease earlier and help prevent medical errors.
If the past 15 years were defined by safer procedures and more effective medications, the next may be defined by smarter systems that enhance human decision making.
At the University Health Cardiovascular Center, those advancements are already improving longevity and quality of life. Patients today face safer interventions, more effective therapies and a more precise understanding of risk.
For Dr. Prasad, the future of heart care is more promising than ever.
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