Current and future challenges in cardiology: An introduction

The present supplement contains papers based on the content of the second annual Canadian Journal of Cardiology (CJC) Symposium held at the Canadian Cardiovascular Congress (CCC) in Montreal, Quebec, on October 23, 2005. The annual CJC Symposium is jointly sponsored by the Canadian Cardiovascular Society and Pulsus Group Inc, the publisher of the Journal, and in 2005 was presented in collaboration with the Montreal Heart Institute (MHI). The CJC Symposium has been established as an annual plenary session at the CCC to highlight important topics in cardiovascular medicine while featuring excellence in Canadian research. Beginning in 2005, the symposium is offered in collaboration with a Canadian centre – although not all of the speakers will necessarily come from that centre. For the 2005 CJC Symposium, it seemed natural to feature the MHI, Canada’s senior heart institute, which had just celebrated 50 years of excellence. The MHI has a rich tradition of exceptional patient care services, as well as outstanding research contributions. The Institute is respected internationally particularly for its many contributions to clinical research in the surgical and medical management of ischemic heart disease. These traditions continue as the Institute enters its second 50 years. For the 2005 CJC Symposium, we chose to focus on current and future challenges in cardiology. There are many such challenges despite the numerous advances of the past two decades, with none greater than the issue of developing better means to prevent progression, or cause regression, of coronary atherosclerosis. Dr Jean-Claude Tardif led off the symposium with a discussion of the demonstrated effects of statins in slowing atherosclerosis progression and perhaps promoting some regression, which, importantly, has translated into fewer cardiovascular events. Dr Tardif also reviewed some of the early results with approaches to increase levels of high density lipoprotein cholesterol and speculated on the potential for combinations of these approaches. Although Dr Tardif acknowledged the importance of these and other new pharmacological approaches, he reminded us of the increasing burden of atherosclerosis as a result of lifestyle choices and how we must continue (actually increase) our efforts to address these issues with our patients. Dr Pierre Theroux reviewed current challenges with acute coronary syndromes and pointed out the requirements for better algorithms for risk stratification, particularly the need to include markers of the activity status of the atherosclerotic process. From the viewpoint of pathophysiology, Dr Theroux focused on our deficient knowledge concerning the factors that determine why a plaque destabilizes, why some lesions are so thrombogenic and why the prognosis in some patients is impaired well beyond the acute phase. Dr Theroux also dealt with the need for new therapeutic approaches to this common clinical problem, particularly for improved antithrombotics and effective approaches to immune modulation. The most common arrhythmia, and the one that continues to challenge our therapeutic approaches, is atrial fibrillation. Dr George Wyse acknowledged that the major problem continues to be an incomplete understanding of the pathophysiology of this arrhythmia; therefore, therapeutic approaches continue to be empirical. An important modulating factor in the genesis of atrial fibrillation is inflammation, although therapeutic approaches to this issue have not yet been established. Dr Wyse also discussed the importance of structural and electrical remodelling, as well as genetic factors, to the genesis of atrial fibrillation and speculated on the potential of therapeutic options to address these factors. In a review of the therapeutic approaches currently used, Dr Wyse recognized the challenges and opportunities associated with each approach. The final presentation was by Dr Jean-Lucien Rouleau, who addressed the therapeutic challenges associated with chronic heart failure. Both the incidence and the prevalence of heart failure have been increasing, and, despite many advances in therapies, this remains a major challenge to health care systems. Dr Rouleau reviewed the surgical approaches to the management of heart failure, with a particular focus on coronary artery bypass grafting (CABG) and surgical ventricular restoration. There is a need for new studies to compare bypass surgery with current pharmacological management in heart failure patients, especially in patients in whom myocardial viability has been demonstrated. The Surgical Treatment for Ischemic Heart Failure (STICH) trial is an example of such a study in which CABG will be compared with pharmacological therapy; the study will also determine whether CABG and ventricular restoration surgery combined is better than CABG alone. The large attendance at the 2005 CJC Symposium and the spirited discussion period confirmed that the speakers addressed important questions, and were able to clarify the challenges and opportunities for these important cardiovascular problems. We thank each of the speakers for their participation, and certainly appreciate that they and their co-authors have provided these manuscripts so that their insights are available to a wider audience.