Gut Reaction with 2027 HOC KOLs: CCTA versus CAC, Most Controversial Treatment Option, All Things Lp(a), Most Promising Advance, and more!

Welcome back to MedscapeLIVE! Cardiology E-News. Our guests this month are extremely good sports and candid participants, and we cover it all, including these hot topics: most promising advance on the horizon, biggest practice challenge, lipoprotein(a) (Lp(a)) universal screening, most important message to patients, biggest patient challenges, most controversial treatment option, oral versus injectable PCSK9, CCTA versus CAC, most important thing I tell patients and preferred guideline recommendation

‍

It’s interesting to note that both the potential most promising advance on the horizon and the biggest practice challenge concerns Lp(a)-targeted therapies. We cover quite a bit here, so read on for fresh takes on Lp(a) plus this field’s most current topics.

‍

Don’t miss your chance to register and get the Early Bird discount for the January 2027 HOC at the OMNI in Fort Lauderdale—click here to register.

‍

Thanks so much to our guests for sharing their time and expertise! Make sure to also check out this issue’s Pulse—it’s an easy way to keep current. Please contact me with comments and/or suggestions at colleen@cmhadvisors.com! –Colleen Hutchinson

‍

Gut Reaction With HOC 2027 KOLs

‍

Geoffrey D. Barnes, MD, MSc, is Associate Professor, Cardiovascular and Vascular Medicine, Frankel Cardiovascular Center, University of Michigan Medical School, Ann Arbor, Michigan.

Michelle Kittleson, MD, PhD, is Professor of Medicine, Smidt Heart Institute, Cedars-Sinai, Los Angeles.

Pamela B. Morris, MD, FACC, FAHA, FASPC, FESC, FNLA, is Professor of Medicine, Cardiology, Paul V. Palmer Chair of Cardiovascular Disease Prevention, The Medical University of South Carolina, Charleston, South Carolina.

‍

Critical new cardiology-related advance I’ve recently adopted into practice:

Dr. Geoffrey Barnes: Lp(a) testing and GLP1-ra prescribing

Dr. Michelle Kittleson: Due to the CARDIO-TTRansform trial, which demonstrated no benefit of eplontersen when 81% of patients with ATTR-CM were receiving tafamidis by the end of the trial, I have started to dissuade patients from combination therapy.

Dr. Pamela Morris: Use of the PREVENT equations for risk assessment

‍

Potential promising advance on the horizon:

Dr. Barnes: I’m very excited for two potential therapies on the horizon. The first are the Factor XI inhibitors and how they could change the landscape of antithrombotic therapy for patients with stroke, atrial fibrillation, and other thrombotic disorders. The other is the Lp(a)-specific therapies. Since I’ve started testing for Lp(a) levels, I’ve been shocked by how common it is for patients with premature ASCVD to have elevated Lp(a).

Dr. Morris: Lp(a)-targeted therapies.

‍

Biggest challenge in my practice:

Dr. Barnes: Selecting WHICH patients with acute PE need an intervention

Dr. Morris: Elevations in Lp(a) and lack of specific Lp(a)-directed therapies

‍

Most important thing I tell my patients:

Dr. Barnes: Stay active - that’s the number 1 thing you can do to help improve your cardiovascular health

Dr. Morris: "You are the decision maker. I am the informer."

Dr. Kittleson: 1) My goal is to help you feel better and live longer. 2) These are the most important modifiable targets and our goals to achieve this. 3) These are the warning signs to look out for and when you should call me.

‍

Guidelines I find most helpful/relevant in my practice today:

Dr. Barnes: While I’m partial to the 2026 AHA/ACC Acute PE guidelines, I find myself referencing the new 2026 Dyslipidemia guidelines almost every week in clinic

Dr. Morris: 2026 ACC/AHA Dyslipidemia Guideline

Dr. Kittleson: HF Guidelines, since I'm a HF cardiologist, and Dyslipidemia Guidelines, since I also see many patients interested in primary prevention.

‍

How the HOC fits into the landscape of education for cardiologists:

Dr. Barnes: This intimate course allows attendees to interact with one another and the faculty while getting an in-depth review of all things cardiology - what’s new, what’s essential for your practice, and what’s on the horizon!

Dr. Morris: It provides an annual update on all that is new and emerging in cardiology

Dr. Kittleson: HOC provides a trusted and reliable resource to guide clinicians on implementation of the most timely science into clinical practice so patients receive the best care.

‍

Biggest challenge with my patients:

Dr. Barnes: The ever-increasing number of medications they are prescribed, many of which have high out-of-pocket costs

Dr. Morris: Misinformation on statins

Dr. Kittleson: Saying no is harder than saying yes; declining to perform unnecessary testing (like tracking coronary calcium scans in patients on statin therapy) which is a disservice to patients and the healthcare system.

‍

Topic I’d like to see addressed at the 2027 HOC:

Dr. Barnes: Following up from the brand new 2026 ACC/AHA guidelines, I’m really excited for our dedicated Cardiovascular-Kidney-Metabolic Syndrome session. The Hot Topics sessions is always a particular favorite of mine

Dr. Morris: Combating disinformation/misinformation in healthcare

‍

Best device/tool in my clinical arsenal:

Dr. Barnes: I use an ambient AI scribe every time I’m in clinic - and it has dramatically improved my efficiency. It’s really a game changer!

Dr. Morris: The clinician-patient discussion

Dr. Kittleson: Being able to explain medical topics clearly to a nonmedical audience.

‍

Controversial treatment option in cardiology medicine:

Dr. Barnes: Are GLP1ra drugs that cardiologists should be prescribing and managing? I firmly believe yes… but I think many others aren’t yet ready to jump on the GLP1ra bandwagon!

Dr. Morris: Medications in pregnancy/conception/lactation

‍

Something I recently learned from other faculty/conference that I’ve adopted:

Dr. Barnes: At last year’s HOC meeting, Amy Pollack gave a masterclass on hypertension management. I’ve incorporated her algorithms into my practice.

Dr. Morris: Disciplined approach to assessment of female-specific risk factors

‍

Oral versus Injectable PCSK9:

Dr. Barnes: I’m still primarily prescribing injectable PCSK9 inhibitors, but I’m starting to have patients ask about the oral option. It’s very attractive!

Dr. Morris: Exciting option if it is affordable, with NO cumbersome prior authorization process, otherwise I'll stick with injectables.

‍

Lipoprotein(a) universal screening:

Dr. Barnes: Absolutely!!

Dr. Morris: Support measurement for risk assessment as a risk enhancer

‍

Thoughts on this year’s Keynote—Dr. Richard Califf:

Dr. Barnes: He’s one of those individuals who has had an impact on medicine and public health far beyond cardiovascular disease. I’m ecstatic to listen and learn from his illustrious career that has crossed clinical practice, research, and policy.

‍

Is there a too low for LDL-C?

Dr. Barnes: I probably wouldn’t go below 0! In all seriousness, I’m certain that LDL<55 is safe, and LDL down to 30 doesn’t concern me, especially for patients at highest risk of ASCVD

Dr. Morris: No

‍

Coronary Computed Tomography Angiography (CCTA) versus Coronary Artery Calcium (CAC): Dr. Barnes: I’m still primarily using CAC, but I’m open to broader use of CCTA. If anyone could convince me to change my practice, it’d be Dr. Matt Martinez!

Dr. Morris: Only needed in symptomatic patients or in select patients with FH

‍

CME

Going Back to the Heart of Cardiology Medscape Conference (7th Annual)

January 29-31, 2027: The OMNI in Fort Lauderdale, Florida