MedscapeLIVE! Cardiology E-News
MedscapeLIVE! Cardiology E-News Readers—This is the last issue of 2027! Don’t miss your chance to SAVE registering for the January 2027 HOC in sunny Fort Lauderdale—click here to register. For a short time, use code FALL30 to receive 30% OFF your registration.
This month we have the All-Female Key Opinion Leader Panel, here to candidly discuss debatable topics ahead of HOC2027:
- Stroke Prevention in Atrial Fibrillation—Drug or Device?
- Women in Cardiology: Where Do We Stand?
- Pick A Side: Traditional Risk Score or Imaging for Primary Prevention?
- AI in Patient Care?...And More!
Make sure to also check out this issue’s Pulse, with articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Medscape MedNews, Journal of the American College of Cardiology, Cardiology News, and the New England Journal of Medicine.
CME—Let’s Go!!
Going Back to the Heart of Cardiology Medscape Conference (7th Annual)
January 29-31, 2027: The OMNI in Fort Lauderdale, Florida
- Earn up to 14 CME/CE credits
- Limited time offer! Use code FALL30 to receive 30% OFF your registration.
- Cardiovascular Prevention, Atherosclerosis and Thrombosis, Cardiovascular Dysfunction, Arrhythmia Management and Valvular Heart Disease
- To register, click here!
Thanks so much to our guests for sharing their time and expertise! Please contact me at colleen@cmhadvisors.com with any comments and/or suggestions! –Colleen Hutchinson
The 2027 All-Female Key Opinion Leader Roundtable
Danielle Belardo, MD, is Founder and CEO, Precision Preventive Cardiology, Los Angeles, CA.
Michelle Kittleson, MD, PhD, is Professor of Medicine, Smidt Heart Institute, Cedars-Sinai, Los Angeles.
Megan Coylewright is a Structural Interventional Cardiologist in St. Paul, Minnesota.
Neha Pagidipati, MD, MPH is Director, Duke Cardiometabolic Prevention Program, Duke University School of Medicine in Durham, North Carolina.
Women in cardiology: Equally represented now or does the gender gap remain?
Dr. Neha Pagidipati: Much progress has been made but much remains to be done. There is still a gender gap in pay and in representation in cardiovascular research.
Dr. Megan Coylewright: Women cardiologists continue to be underrepresented in the field, in institutional leadership, and within research. While cardiology is very slowly becoming more welcoming, we can all work together to ensure we continue to develop organizational systems that are transparent and equitable, and that we stand for others when witnessing unfair treatment. I believe we can make this the most competitive specialty for trainees by creating a dynamic, healthy and inclusive culture.
Dr. Michelle Kittleson: Equality can mean a lot of different things: equality of opportunity for advancement to leadership positions, clinical trial representation (as subjects and trial leaders!), pay, work-life balance, job satisfaction—the list goes on. I'm old enough that my parents taught me to expect that, as a woman, I would have to work twice as hard to be considered half as good. So I was already primed for disappointment and I'm grateful for every bit of support that has resulted in professional success. I do my best to pay it forward, showcasing and rewarding outstanding work whenever I can.
Dr. Danielle Belardo: The gender gap remains, and closing it requires a sustained commitment to helping women envision, build, and thrive in a career in cardiology. That means investing in mentorship, sponsorship that opens doors to leadership, and support reflected in how many women enter our field, feel supported enough to stay, and have the opportunity to lead.
Inflammation: Should you measure high-sensitivity C-reactive protein (hs-CRP)?
Dr. Belardo: Yes, selectively, when hs-CRP could resolve an uncertain primary-prevention statin decision, consistent with ACC/AHA guidelines. In secondary prevention, intensive lipid lowering is already indicated. Before ordering the test, I want to identify the evidence-based treatment decision that its result would actually change.
Dr. Coylewright: As a practicing interventional cardiologist, I am not very engaged in the use of early biomarkers. I must admit, I think most of cardiology clinicians' focus should continue to be on lifestyle modification basics (no smoking, healthy weight, diet in moderation with low salt, keep moving, good sleep, etc.) and knowing your basic numbers (blood pressure, cholesterol, and A1C). For the more advanced discussions when patients are already doing all of these things, I send them to my Cardiometabolic Clinic!
Dr. Kittleson: You should only measure a test that will change your management. In this case, C-reactive protein is a risk enhancer, meaning for those patients at intermediate risk for atherosclerotic cardiovascular events, elevated CRP offers added evidence of benefit from statin therapy. So if a patient is already on statin therapy or is of high or low risk where CRP will not move the needle on the need for statin therapy, checking it would not make sense.
Dr. Pagidipati: hs-CRP can be very useful when trying to risk-stratify primary prevention patients and determining what their LDL goal should be. It can also be useful in secondary prevention patients when trying to determine whether to initiate colchicine, particularly in those who are very high risk (i.e. ASCVD at a young age or multiple ASCVD events).
Should artificial intelligence (AI) document patient care?
Dr. Belardo: Not yet. I’m cautiously optimistic that AI can reduce administrative burden and give physicians more time with patients, but I’m not convinced the technology is ready to reliably capture the nuance and uncertainty of clinical care. Writing the assessment and plan is itself an exercise in clinical reasoning, and we should be careful about outsourcing that thinking.
Dr. Kittleson: The answer is—maybe. AI is a tool like any other, and it's essential to understand the advantages as well as the pitfalls before putting it into practice. So if AI is used to document the patient encounter, careful review for inaccuracy is essential.
Dr. Coylewright: Documentation of the conversation between clinicians and our patients is an appropriate role for AI—there are unique opportunities to reflect on how we share information with patients (if we are listening well) and the ways in which we incorporate informed patient preferences into decision-making. Do all clinicians know you can read the entire transcript of your visit in most cases? This is eye-opening and an awesome way to reflect upon and grow our communication skills.
Primary Prevention: Traditional risk score versus imaging?
Dr. Kittleson: Like CRP, CAC is a risk enhancer. The 2026 Dyslipidemia Guideline recommends CAC scoring for adults at intermediate risk and select adults at borderline risk (PREVENT-ASCVD 3% to <10%) when the lipid-lowering decision is uncertain. But what about those with low risk, but other concerns, like a strong family history of premature ASCVD or younger adults with multiple risk factors? For these patients, I would consider CAC to guide the decision for statin initiation.
Dr. Belardo: Risk assessment first, using contemporary PREVENT equations and relevant risk enhancers, with coronary artery calcium scoring reserved for treatment decisions that remain uncertain.
Dr. Pagidipati: Both are useful. Traditional risk scores are easy to implement, inexpensive, and do not expose the patient to any radiation. However, they are based on population-level estimates and can often miss individuals at elevated long-term risk, particularly younger individuals. Imaging, such as with CAC score, gives a direct assessment of whether the process of atherosclerosis has begun, and can be very helpful in deciding whether to initiate lipid lowering therapy (and in convincing the patient of the need for it!).
Dr. Coylewright: Risk scores are limited by implementation challenges- they are more rarely used. We may have a greater opportunity for incorporating them in decision making as our systems begin to use EMR data to calculate them automatically and pair them with up-to-date guideline recommendations. I love thinking about how our shared decision making will become more individualized, and with data ready for us—this allows us to spend our time in our greatest human task in clinic: listening to what matters most to patients.
Stroke Prevention in Atrial Fibrillation—Drug or Device?
Dr. Belardo: Drug for most patients who warrant anticoagulation, with a direct oral anticoagulant preferred when appropriate. Before recommending an invasive alternative, we should scrutinize procedural harms, noninferiority margins, and individual stroke outcomes. Left atrial appendage closure has a role in selected patients, but enthusiasm should remain proportional to the evidence.
Dr. Kittleson: The data appears very clear: the standard of care for stroke prevention in patients with atrial fibrillation and higher risk is anticoagulation. Left atrial appendage occluder devices should remain an option only for those patients with life-threatening contraindications to anticoagulation, as the stroke prevention these devices offer is inferior to anticoagulation.
Dr. Coylewright: Based on my review of the evidence, and my experience listening to patient preferences in this decision over the past decade in my own clinic and my research, the answer is clear: all patients should be informed there is a choice to be made. This shared decision-making conversation (meaning an exchange of information between patient and clinician!) is best when based on the available data on contemporary drugs and devices (not outdated models).
The Pulse
JACC Editorial: The Quiet Mathematics of American Health Care
NEJM Original Article: Milvexian with Antiplatelet Therapy after Acute Coronary Syndrome Event
Medical Intelligence Quiz: Coffee Consumption and Heart Failure
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