Twenty-First Century Cardiology: The Beat Goes On

From the WebMD Archives

March 15, 2000 (Anaheim, Calif.) -- Imagine yourself at 100 years old, feeling alive and vigorous. Your internal organs were swapped for new body parts when you were only 80. And that was just the beginning of your heart rejuvenation.

Microscopic nanolabs were installed in your bloodstream to churn out telomerase, the enzyme that keeps new cells from showing telltale signs of age. The year is 2049, and the invasive procedures of 20th century cardiology have been transformed into preventive techniques that regulate body chemistry internally.

That utopian scenario is one vision of the future that was discussed here this week during the 49th annual Scientific Session of the American College of Cardiology (ACC). Looking into the 21st century, here's what cardiologists foresee in terms of treating heart disease, the No. 1 killer:

  • So-called angiogenesis drugs succeed at growing new heart vessels, eliminating the need for many bypass surgeries.
  • Vaccines are designed to raise protective HDL cholesterol, the "good" cholesterol.
  • Gene therapies can repair the damage after a heart attack and prevent massive cell death.

These tools may be on the near horizon, but cardiologists argued in a forum titled "Delivering Quality Care in the 21st Century" that there are developments farther out that are, well, far out. For example, instant diagnosis may be available by reading genetic codes from a patient who can be analyzed at home.

In the early part of this century, we may be able to re-engineer 500,000 pig hearts to end the drought of transplant organs. Moving on to midcentury, transplants could become obsolete as nanotechnology allows microscopic "drug factories" to circulate throughout our bodies and regulate our internal chemistry, thereby making cardiology a science of prevention rather than intervention.

"So rather than try to cure a disease, we want to interfere with the process of the disease," says Leonard Dreifus, MD, of the University of South Florida. That doesn't mean cardiology or cardiologists will become medical fossils.

"In the 21st century, we will need more cardiologists to manage the increased numbers of people with heart disease," George Beller, MD, FAC, the ACC's new president, tells WebMD. Beller says that while the death rate from heart disease will fall, aging baby boomers will create new demands on the medical system. Beller is chief of the cardiovascular division and vice chairman of the department of medicine at the University of Virginia Health Sciences Center.

Though the century's technical promise seems limitless, the financial challenges of providing care raise hard questions. In one scenario, the ACC sees a 15% increase in the national expenditure for heart disease by 2010, escalating to a 46% jump by 2025.

In another, less drastic, scenario, science finds a "magic bullet" to decrease the risk of heart disease, with the cost of the treatment running about $250 per month. Under that view, overall expenses would only rise 5% by 2025. With health-care issues from Medicare reform to the patient bill of rights still on the table, long-term financing for new research and treatment remains in doubt.

But Beller is optimistic about programs already in play. "The completion of the mapping of the human genome [genetic material] will lead to the ability to screen people for heart diseases early in life, allowing physicians to intervene early in life, and allow us to develop targeted therapies that will address that risk to develop disease 20 to 30 years later," he says.

Another 21st century innovation could be less face time with the cardiologist and more e-communication over the Internet. The Web could become the ultimate tool for monitoring a patient's progress and answering health-related questions.