Harvard Heart Letter

2020 vision: Cardiology trends to watch

Several new technologies and medications that may benefit the heart are moving into cardiology care.

As regular readers of the Heart Letter know, our features tend to focus on lifestyle advice and currently available therapies for heart disease. As the new decade begins, weíre also looking to the future. Editor in Chief Dr. Deepak L. Bhatt selected five promising new developments in cardiovascular research that you may be hearing more about in the coming years.

1. Digital stethoscopes

First developed more than 200 years ago, the instrument doctors use to listen to the heart and lungs has undergone some high-tech improvements in recent years. The latest digital stethoscopes feature specialized microphones and sensors that filter, buffer, and amplify sounds from the heart. The sounds are then converted to a digital signal and sent wirelessly to a smartphone, where the patterns can be visualized and further analyzed. Some models are so sensitive they can detect turbulent blood flow in the arteries of the heart, possibly enabling doctors to detect coronary artery disease. Studies assessing that potential use are currently under way.

2. Finding safer anti-clotting medications

A chip the size of a postage stamp may help researchers quickly screen new anti-clotting medications. The ďlab-on-a-chipĒ contains an array of miniature channels, valves, processors, and pumps that enable precise manipulation of different fluids. The chip was specially designed to reveal how specific compounds interact with blood and platelets (the components in blood that clump together to form clots). The chip, which can screen hundreds of compounds in just a few hours, was developed by Australian scientists, who hope to identify better and safer anti-clotting treatments.

3. New ways to lower cholesterol

For people with stubbornly high LDL (bad) cholesterol, an experimental drug called inclisiran may cut LDL by about half. Like two other injectable cholesterol drugs, alirocumab (Praluent) and evolocumab (Repatha), the new drug targets a protein called PCSK9 that regulates LDL. But inclisiran blocks the expression of PCSK9 in the liver, whereas the other drugs block the protein after itís been made. Inclisiran requires just two injections a year (given by a clinician), whereas the other drugs require self-injections at least once a month. Large studies to evaluate inclisiranís safety and ability to lower heart-related complications are currently under way.

Another new drug, bempedoic acid, also reduces LDL and is currently under evaluation. Taken in pill form, it can lower LDL by about 25% in people who canít tolerate high doses of statins. Unlike statins, bempedoic acid is not converted into its active form in muscle tissue, which means it may not have muscle-related side effects.

4. Cuffless blood pressure monitor

Last summer, the FDA approved the first blood pressure monitor that doesnít require an inflatable cuff squeezing the upper arm. Instead, the Biobeat device relies on a small skin patch that can measure light absorbed or reflected by blood vessels, a technique called photoplethysmography. Paired with a special smartwatch, the device continuously measures a personís heart rate and oxygen level in addition to blood pressure. The patch is placed on the upper torso and lasts for 10 days, providing real-time, wireless monitoring of these three vital signs. Hospitals, clinics, and long-term care facilities are the main target audience, but the Israel-based manufacturer suggests a consumer version may be available in the future.

5. Handheld ultrasound

Cardiologists have long relied on echocardiography (heart ultrasound) to diagnose cardiac conditions. Increasingly, doctors are using miniaturized ultrasound devices that can be used at a patientís bedside to quickly visualize the heart. Designed to fit into a doctorís lab coat pocket, the device plugs into a smartphone or tablet, providing images that can detect problems with the aorta (the heartís largest vessel) or the heart valves and also determine the severity of heart failure. Other potential uses include checking the health of the arteries in the neck, abdomen, and legs. The handheld devices wonít replace high-end standard echocardiograms, some of which provide three-dimensional images. But because the handheld devices are portable, they hold the promise for faster diagnosis and treatment of common heart problems.

Image: PeopleImages/Getty Images

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