Cardiovascular Risk Management in Patients With Diabetes - Episode 8

Cardiovascular Disease: Future Perspectives

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Marc P. Bonaca, MD, MPH, of the University of Colorado School of Medicine, comments on the potential to personalize treatment with emerging therapies in the pipeline to better manage patients at high risk for cardiovascular disease in the future.

Marc P. Bonaca, MD, MPH: I think the future is bright. I think there are new therapies that are coming to light, which hold the promise of improving risk or reducing risk in our patient populations. There are novel agents for lipid modification that are allowing us to achieve lower and lower LDL cholesterols even with more simplified dosing regimens and perhaps less resource intensive. There are also novel targets like LPa, which may be particularly important in disease states like peripheral artery disease. And then I think we’re learning more about the use of antithrombotic therapy and low-dose anticoagulants like rivaroxaban. There will be more data out coming from the VOYAGER trial and others truly showing the broad benefits of such strategies. There are a lot of promise out here. There’s new diabetes agents and combination agents that people are talking about. That being said, the more therapies that we learn are efficacious, the more we need to be able to tailor and personalize those therapies. And I do think that the broad atherosclerosis approach of treat every patient the same way probably will shift even more to an individualized approach. I will take for example, the patient with peripheral artery disease. You may choose to treat them differently than a patient with coronary disease or a patient who has PAD and diabetes and how do you – or how one sort of stages the different therapies. And that’s only going to get more complicated as we have new approaches on the horizon. I hope in concert with all of these new and exciting agents that can reduce risk that there is an equal effort to study implementation science, real-world data to enable clinicians to really understand how to best personalize and how to deliver care to patient populations.

I really want to thank you for your attention here. I think if you are feeling a bit overwhelmed by all of the data and new agents and new outcomes, you're not alone. As a clinical community the pace of discovery has absolutely accelerated. But I think the more that we can work together as a clinical community and we can work as multidisciplinary care teams, the better we can do to really systemize therapy across these populations. And I do take particular heart in dedicated trials in these high-risk populations. For example, VOYAGER PAD where we are really looking at specific population at a specific time and the right outcomes that are relevant to that population rather than trying to do one size fits all. And I hope that our research continues to move in that way to enable us as clinicians to understand how to personalize the preventive therapy and speak to our patients about risk and how to avoid the worst complications of atherosclerotic vascular disease.

Transcript Edited for Clarity