Deepak Bhatt, MD: Upcoming Advances in Cardiology

While every field of medicine is constantly pushing for newer and greater advances to aid physicians in their mission to provide safe, effective treatments — as of late, few have advanced as rapidly as cardiology.

With GLP-1RAs, PCSK9 agents, and SGLT2 inhibitors firmly grounded in guidelines for a host of different conditions, the onus has been on developing additional therapies that can improve upon the current standards of care. When novel therapies, like the EPA-based icosapent ethyl, begin to return positive results in clinical trials, it quickly captures the attention of the community.

Among cardiologists, Deepak Bhatt, MD, MPH, executive director of Interventional Cardiovascular Programs at Brigham and Women's Hospital and professor of medicine at Harvard Medical School, is often considered to be at the forefront of major advances in the field. Lead investigator of the REDUCE-IT trials, Bhatt has a nearly unmatched perspective on potentially ground-breaking advances we could see in the coming years.

Bhatt recently sat down with MD Magazine® to discuss everything from fighting cardiovascular disease to the biggest threats to heart health in the US and which advances he is most excited about looking forward.

MD Mag: Looking forward, what potential advances in cardiology excite you most?

Bhatt: There is a lot of excitement right now in cardiovascular prevention. It seems like there are multiple different approaches that appear promising. Of course, LDL reduction and incremental LDL reduction is something that already on the map with respect to things like PSK9 inhibitors.

It also appears that one approach to triglyceride reduction, with icosapent ethyl, is a way that has been validated to reduce cardiovascular disease, and there are a couple of other trials that are ongoing with alternative approaches to lower triglycerides, and it will be interesting to see if those trials do or don’t show benefit in terms of reducing hard, cardiovascular events — we should find out in the next couple of years. As well, I think molecules designed to lower LP Level A are quite exciting, and those trials will be unfolding in the next few years. We'll see what they show.

I think the CANDLE trial, by validating an anti-inflammatory drug to reduce cardiovascular events, is a huge scientific advance and even though that particular compound, canakinumab, doesn’t look like it’s going to proceed for cardiovascular indications due to price and other concerns, it has opened the door for other therapeutics that target inflammation. Indeed, a bunch of companies are working on such specific anti-inflammatory drugs.

I think as anti-thrombotics go, there’s still more to do. I keep thinking, okay ‘With this trial, I'm not sure we can add another anti-coagulant or anti-platelet subsistent,” but then, you know trials like COMPASS come along, or PEGASUS come along, where there is validation of a new approach in new population with respect to anti-thrombotics - and in fact there are a bunch of companies finding antithrombotic in planned trials TO further reduce ischemic events and/or to try and reduce bleeding hazards from anti-thrombotic therapy. Even if there is better efficacy, if a new therapy can reduce bleeding compared to the current standard of care, that’s still a win.

So, all these different axes to residual risk reduction I think are very exciting and there are all sorts of large clinical trials that are ongoing, that are planned. Some are in earlier phases, with respect to different compounds that are being studied in phase 2 or phase 1 evaluations or even preclinical studies. I think there is a lot going on in cardiovascular prevention. The next 5-10 years should be super exciting.