December 22nd, 2010
John Ryan: Looking Back at 2010 and Ahead to 2011
To celebrate the holiday season, CardioExchange asked several of our contributors to choose the 3 most important cardiology-related events of the past year and to make 3 predictions for 2011.
Looking back at 2010:
1. Effects of CYP2C19 Genotype on Outcomes of Clopidogrel Treatment: Ten years after the initial decoding of the human genome, we felt we finally had a genetic test and a drug with clinical applicability. However, this study and others cast doubt on the ability to predict response to anti-platelet therapy, demonstrating that we still have a lot to learn in order to develop individualized medical therapy.
2. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery: I choose this paper because it has the potential to represent a paradigm shift and offers an entirely new therapy to patients. It is exciting to think about this as a natural progression of the advances that interventional cardiology has made in the past forty years.
3. Exposure to low-dose ionizing radiation from medical imaging procedures: It is always a good thing when studies provoke controversy, but these two studies in JACC and Circulation reminded us of the potential harm we can do to patients even with “non-invasive” imaging.
Predictions for 2011:
1. Now that there is published and presented literature on dabigatran, rivaroxaban, and apixaban, 2011 could represent a seismic shift away from warfarin. Or will physicians and patients want to learn more about these medicines before leaving the known for the unknown?
2. As health care reform continues to gather pace, expect more trials to be published aimed at decreasing costs and hospitalizations such as the telemonitoring in heart failure research that was presented at AHA this past November.
3. With the large number of studies looking at hypertension management in diabetics, such as ACCORD BP, it will be interesting to see if the JNC-8 guidelines due to be published in 2011 will have dramatically new recommendations.