Prediction: 6 developments in the field of cardiology for 2015

What will be the top cardiac stories in 2015?  It is always hard to predict the future, but here is my spin on what might happen over the next 12 months in the field of cardiology.

1.  For the first time in 15 years, a new drug to treat congestive heart failure (CHF) may come to market in the US. This new medication, called Neprilysin, has been shown to extend the lives of those living with CHF. If the Food and Drug Administration (FDA) approves this brand new therapy in 2015, it could help thousands of people suffering from this condition live with better quality of life.

2.  We will hear much more about a brand new kind of cholesterol lowering medication.  Several major pharmaceutical companies are finishing up promising trials of these new drugs, called "PCSK9" drugs. Once approved by the FDA, these medications will lower LDL cholesterol without the muscle aching side effects we often see from common cholesterol medications, called statins.  Unfortunately, two major problems exist with these new medications. First, they will be phenomenally expensive. We are talking costs that may be as high as $2,000-$3,000 dollars per month! Second, these medications will need to be injected into the skin twice per month, as they are not available in pill form. I suspect this will be off-putting for most of us. (I surely wouldn't want to inject myself with medication if there was any alternative.) This new medication will definitely help a small number of people (those of us who have genetically high cholesterol and premature heart disease and may really need this medication). But, will pharma companies find a way to sell it to millions who may not have as clear an indication at a price of thousands of dollars per months? Only time will tell.

3.  We will see much more of a special kind of pacemaker/defibrillator. Pacemakers have always required a wire, which connects the pacemaker to the heart itself. The device is surgically placed under the collarbone in the upper chest, and provides electrical activity for the heart when its own electrical system is on the fritz. A special kind of pacemaker, called a defibrillator, can jolt the heart if the recipient has a life-threatening arrhythmia. The new kind of device, called subcutaneous defibrillator, is still placed surgically under the skin, like a regular pacemaker, but without the traditional wires that go into the heart, as these wires can sometimes become infected, or malfunction. The new defibrillators can prevent the risk of sudden cardiac death from arrhythmias, and are meant for people who have had large heart attacks or have a condition called a cardiomyopathy. They are now approved by the FDA, and are an exciting new development, which will now be more available.

4.  Generic medications will be in the news, and not in a good way. Generic medications, which are a supposed to be a lot cheaper than their trade name counterpart, have recently become more expensive. No one seems to know exactly why companies are charging more for these medications. Possibly even more troubling, there are concerns about how some generic drugs are being manufactured. They are often made overseas, and not subject to the same quality controls as the trade name medication. Expect that this issue will explode in the news sometime this year.

5.  The debate about who should be on cholesterol lowering medications like Lipitor and Crestor (statins) will continue to confuse the public. Currently, doctors have been urged to not even bother to check cholesterol values, but to prescribe statins to everyone at "high risk" of having a heart attack.  There are several problems with this approach.  First, there are ways besides prescribing medications to help lower this risk, namely diet and exercise. Second, many patients like to know what their cholesterol numbers are — they want to know their HDL (good cholesterol) and LDL (bad cholesterol) levels. It is hard to motivate people to follow a good lifestyle without goals, and these new guidelines have taken away a means to motivate. Third, about 10-15 percent of people who take statins have side effects. These side effects, mainly muscle aching, lead to almost half of prescribed statin users to stop taking them in the first year that they are prescribed.  Rather than deal with this issue, and help motivate people to make the kind of lifestyle changes that would preclude the use of statins, these guidelines sell the not so subtle message that more medication is better.

6.  Finally, 2015 will witness an explosion in use of wearable trackers. From Fitbits, which can be worn to monitor your own physical activity, to new devices to monitor for arrhythmias, we will see increasing use of this technology.  New devices that are just becoming available will simplify how doctors can monitor the heart, make it much easier on the person to wear, and get information that is just as useful.

Dr. David Becker is a board certified cardiologist with Chestnut Hill Temple Cardiology in Flourtown, Pa. and has been in practice for 25 years. In 1993, after extensive research, Dr. Becker launched Healthy Change of Heart™, an innovative 10-week program designed to reverse heart disease and improve quality of life through diet, exercise, and stress management. Since then, thousands of patients have participated in the program, achieving significant results in improving cardiac wellness.