With another successful ESC Congress under its belt, the European Society of Cardiology’s new president Professor Thomas Lüscher speaks to Helen Quinn about the current challenges and opportunities in European cardiology, his highlights from the congress and his thoughts on the future of cardiovascular care.
In September 2024, at the European Society of Cardiology (ESC) annual congress, delegates welcomed Professor Thomas F. Lüscher as their new president and it’s a role he is excited about taking on.
Professor Lüscher is a world-renowned cardiologist, ranking in the top 0.5% globally of most cited scientists and currently a consultant cardiologist and director of research, education and development at the Royal Brompton and Harefield hospitals in London and professor at King’s College London, UK.
Having been involved with the ESC for many years, Professor Lüscher has chaired various working groups, became vice president in 2003 and then editor-in-chief of the European Heart Journal in 2008 – a position he held for 11 years. He describes the society as ‘a fantastic success story’ that has evolved from ‘a small club of friends into the largest and most influential society in medicine’.
With seven associations, seven councils, 15 working groups, 57 national societies, 47 affiliated national societies, 17 journals, 18 textbooks, an annual congress and nine speciality congresses, the ESC works hard to improve cardiovascular care and patient outcomes throughout Europe.
‘[It’s] an institution that dominates the field in a positive manner by providing guidelines, education and registries to improve the burden of cardiovascular disease. So, it’s a really exciting position I have,’ Professor Lüscher says.
Challenges in cardiovascular care across Europe
Cardiovascular disease is still the leading cause of morbidity and mortality in Europe, and there are significant challenges facing the field. In the past, support from the EU has favoured oncology over cardiovascular healthcare. To try to change this imbalance, the ESC has responded by putting together a cardiovascular health plan, which has been submitted to the EU Council of Health Ministers to raise the profile of research and increase the quality and equality of care patients receive.
‘We hope this will impact the support for cardiovascular science and education in the future,’ Professor Lüscher says. ‘Europe has had a fantastic history. Most of the interventions have been invented in Europe, starting with pacemakers, atrial fibrillation ablation, percutaneous coronary intervention, transcatheter aortic valve implantation and MitraClip. It’s quite an amazing story.’
Today, however, innovation and development are hampered by regulations, according to Professor Lüscher. At the same time, the Food and Drug Administration in the US has become more lenient and much quicker and effective in approving drugs and trials.
‘I’m concerned that the speed and impressive innovation we have delivered over the last 200 years may be fading a little bit. There has been a bit of a shift from Europe to the US. [There are] a lot of rules and regulations in the EU and the UK,’ explains Professor Lüscher.
A lack of centralised device regulation in Europe is also impeding developments in field. Consequently, the ESC is working constructively with the European Medicines Agency and the Notified Bodies to make Europe fitter for innovation.
Overcoming inequalities
For some patients, differences in access to care is one of the main barriers to improving cardiovascular health across the continent. Such inequalities are highlighted in the ESC’s publication ‘Atlas of Cardiology’, which gives a picture of the current state of cardiovascular across Europe and shows vast differences in modern management options for cardiovascular conditions in different countries.
Patients in countries like Germany, Switzerland, Scandinavia and the Netherlands have good access to the latest treatments and medications. In other European countries, access is much more difficult, with many patients – particularly those in Eastern Europe – missing out.
And in the UK, for example, there is a concern that lower social classes have limited access to the latest cardiovascular treatments, Professor Lüscher explains, with deprived areas experiencing worse levels of care and, in turn, worse outcomes.
‘If you have severe heart failure, you might need a left ventricular assist device and in many countries that’s not available. Also, some novel, more expensive drugs are not available in certain countries,’ Professor Lüscher says. ‘There’s a huge heterogeneity in access to treatment across European countries. These are ethical concerns for medicine that, by nature, is a humanistic profession. The ESC tried to address this problem.’
The European Union has tried to overcome these inequalities in care by putting pressure on the prices of medications. There is also pressure on patent durations to make generic therapies available more easily and earlier, which is beneficial in the short term, but it is something that Professor Lüscher worries will obstruct innovations in the long term.
‘In the end, this is an economic problem,’ Professor Lüscher says. ‘There’s a close correlation between gross national product and availability of medical services, and currently in Europe the economy is not doing well. In many countries, we have issues with the economy that reflect on the service for patients.’
Emerging innovations in cardiovascular care
There is, however, much to be excited about in the field of cardiology, with many innovations and new research shared at the ESC Congress 2024. For Professor Lüscher, two significant potential developments excited him the most.
The first is the development of genetic tools as therapeutic agents to treat and prevent cardiovascular disease. This cutting-edge approach focuses on the use of antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs), which can block the production of certain proteins in the body and currently mainly target the liver.
‘The liver has specific receptors, in particular the asialoglycoprotein receptor, mainly expressed in hepatocytes. So, once linked with a GalNac residue, you can direct these double-stranded RNAs specifically to the hepatic cells. Then they bind to the RISC complex within the cell and inhibit the translation of a transcript to a protein over several months,’ Professor Lüscher explains.
This process enables a long-lasting therapeutic approach. There are now siRNAs for PCSK9, which lower low-density lipoprotein (LDL) plasma levels for six months, and others, including a new development for lipoprotein(a). In addition, siRNA therapies can target angiotensinogen to lower blood pressure for several months. Other siRNAs, like those that reduce transthyretin (TTR), help treat ATTR amyloidosis by preventing the formation of harmful amyloid deposits.
Gene editing tools, such as CRISPR-Cas9, are also emerging, which can precisely modify nucleoid acid sequences in the DNA. In animal trials, this tool has been used to permanently block the production of PCSK9, preventing it from binding to LDL receptors and thus lowering cholesterol levels and potentially offering a one-off, lifelong treatment.
‘The long-term vision is that we cure rather than treat. These genetic tools are a completely new chapter in pharmacotherapy,’ Professor Lüscher says.
Digital transformation in cardiology
A second area of innovation that will continue to be incredibly influential in cardiovascular medicine is the development of artificial intelligence (AI) and machine learning. As part of his presidency, Professor Lüscher has set out his vision for the digital transformation of cardiology in Europe.
Beginning with online consultations, he believes AI has much to offer clinicians and patients. ‘With an algorithm, you can analyse the face of a person, see the pulse, see the wrinkles, see the amount of sweat, and you can make outcome predictions,’ he says.
‘AI analyses any sort of picture, not just faces, but echocardiograms, CT scans, MRIs, nuclear scans, pathology specimens, biopsies – anything that’s visual and can also diagnose patients,’ he adds.
Analysing the human voice is also possible using AI, which can be incredibly helpful for cardiovascular diagnosis by identifying atrial fibrillation and arrhythmias through variations heard in the vocal cords as well as congestion caused by heart failure.
Professor Lüscher believes AI algorithms will become important ‘co-pilots’ for clinicians, prompting them to think about diagnoses they may have missed. Other algorithms can read reports shared as part of a referral, giving summaries and analysing volumes from images in seconds that would otherwise take clinicians significant chunks of time.
‘It makes us faster and more precise, provided the algorithms are good,’ Professor Lüscher says. ‘Algorithms that are not good or false can potentially kill patients. These algorithms have to travel well and work in different geographical areas and countries, otherwise it’s not acceptable.’
As such, the ESC is involved in developing quality standards for algorithms across Europe and only uses algorithms that they can show are well-verified in independent cohorts.
Amidst the innovations and new pathways, there will inevitably be challenges ahead, but there is much to look forward to in cardiology as Professor Lüscher begins his two-year presidential journey.
