Changes in the practice of cardiology: therapies at the forefront of science

Abstract

T he practice of cardiology has evolved significantly over the years. The availability of current diagnostics and therapeutics has enabled physicians to treat increasingly complex cardiovascular diseases (CVDs). Despite this, the burden of CVD is increasing in Southeast Asia, with ischaemic heart disease and cerebrovascular disease accounting for the majority of cardiac-related deaths in this region.(1) To address these unmet needs, we must first acknowledge that Asian-specific data is required to better understand treatment effect on Asian populations, in particular the heterogeneous composition in Southeast Asia. This issue of the Singapore Medical Journal (SMJ) features a collection of local and Asian original research and review articles, which centres on current and novel approaches to treating CVD.Managing cardiovascular risk factors is the cornerstone of cardiology practice. In the practice of preventative cardiology, there is an ongoing controversy with regard to managing cholesterol levels to lower cardiovascular risk. In particular, the 2013 American College of Cardiology/American Heart Association Cholesterol Treatment Guidelines adopted a statin-centric approach, disregarding low-density lipoprotein (LDL) goals.(2) Similarly, the revised 2015 American Diabetes Association guidelines also recommended high-intensity statins for diabetic patients.(3) In contrast, the Europeans adopted an LDL-centric approach based on cardiovascular risks.(4) How do we adopt these seemingly differing recommendations in our daily practice? Are the risk prediction models developed based on Western populations accurate in Asian patients? Are Asians more intolerant of high-dose statins? The review article by Yan et al summarises the key findings and recommendations of these various guidelines.(5) The Singapore Ministry of Health (MOH) guidelines on lipids have not yet been published. These two articles (Yan et al and the yet to be published MOH guidelines) will discuss key principles for effective management of cardiovascular risk locally.Teong et al focused on the treatment effect of valsartan, an angiotensin receptor blocker (ARB), in a group of hypertensive Asians, as measured using central aortic systolic pressure (CASP).(6) This study used the BPro® (radial pulse wave acquisition device) watch to measure the CASP by capturing radial arterial waveforms at the wrist.(7) The BPro watch, developed by Dr Ting Choon Meng, a Singaporean doctor and an inventor of medical devices, was validated to accurately measure CASP.(8) This study is important to the cardiology community, as CASP has been shown to predict cardiovascular events better than brachial blood pressure.(9) Moreover, ARBs are thought to act more favourably on CASP than other classes of antihypertensive drugs, albeit only in Western populations. (10) This open-label prospective cohort study, which demonstrates the changes in CASP with treatment over 12 weeks in an Asian population, reflects the potential in marrying the use of locally developed medical technology an...

A time for reflection and thanks

“…The fields of science and medicine are continually growing with new discoveries, (2) more clinical trials and new, improved patient management strategies, and the number of new journals has expanded even more, including open-access journals with fast turnaround times and wide accessibility. Therefore, the SMJ must constantly evolve and keep up with the times to remain relevant.…”

Moving forward in the new year

“…In addition, we will publish some themed issues that bring together articles from similar specialties, to give focused attention to topics that are of great interest. (2,3) The SMJ website has also been upgraded to be more mobile-and user-friendly. Articles can now be read on our SMJ website instead of as PDF files.…”