Dr Martha Gulati Previews ESC 2024: Obesity, Heart Failure, and the Ongoing Debate on HRT

In anticipation of the European Society of Cardiology (ESC) Congress 2024, Martha Gulati, MD, a leading cardiologist and the director of Preventive Cardiology at the Smidt Heart Institute at Cedars-Sinai, shares her insights on the pivotal topics expected to highlight the conference. As a specialist deeply invested in the prevention of cardiovascular disease, Gulati is particularly excited about the latest advancements in obesity and heart failure treatments, as well as the potential impact of these innovations on patient care.

In this interview, she also delves into her involvement in key conference sessions, including a highly anticipated debate on hormone replacement therapy (HRT) and its role in primary cardiovascular disease prevention, as well as a joint symposium with the Japanese Cardiology Society on coronary microvascular dysfunction.

This transcript has been lightly edited for clarity.

Transcript

What topics do you expect to take center stage at the European Society of Cardiology Congress 2024?

I'm very excited about ESC 2024; the ESC Congress always proves to be one of the best meetings out there, and probably the topics I'm most interested in are the ones related to prevention. Since I am a preventive cardiologist, they actually have a lot of late-breaking trials that are going to be presented at ESC related to some of the new medications that we're using for obesity and for heart failure to really look at other pathways that might be driving some of the benefits, meaning changes in inflammation, changes in atrial fibrillation. And so I think this will be just reaffirming the use and the impact of these medications that I think we're all pretty excited about because, really, our treatment for obesity has been quite limited. And now we do have a new arsenal of medications, a class of medications, that are really driving differences. More and more, we'll understand them a little bit more, I think, we'll come from this meeting with a greater understanding of how they might work and mechanistic pathways, I think are very exciting.

Obviously, one of the best parts of this meeting is that people come from all over the world to be together and to share science and to talk about other important topics that aren't always the late-breaking clinical trials necessarily, but are clinical issues that we deal with. I'm certainly presenting a debate on hormone replacement therapy, which I know people will say, "But weren't we done with that debate in 2001?" But really, we know in our medical community, the debate has not finished, and so I'm excited to actually hear from my opponent, who is the pro [perspective of] HRT, I'm the con side of HRT, and, I think there's emerging evidence, but it's good for us to share both points of view because we know clinically physicians are on both sides and so these things are still timely.

Can you shed some light on the conference session you're involved in?

The biggest session that I'm involved in, and I already sort of touched on, but they always have a session on great debates, and one of the great debates is about hormone replacement therapy and its role in primary cardiovascular disease prevention and should we be using it in that way? And I think that, again, clinically, the message about HRT continues to fluctuate in our medical community. And you know, of course, there's still a lot of people who don't like the interpretation of the Women's Health Initiative, but we do have some new data that hopefully will help people understand the pros and cons of using HRT. Obviously, we're not debating about the need for women to use it when they're symptomatic, but in terms of prevention, I think we still need to recognize both sides of this issue. So, I'm excited to be on the con side of the HRT debate.

I will also be presenting in a joint symposium with the Japanese Cardiology Society. We'll be talking about coronary microvascular dysfunction, so that small vessel disease that tends to disproportionately affect women, but it can also affect men. And I think the whole session will be great because it will be reviewing from the beginning onward. My particular discussion will be related to the phenotype of the patients: who does badly, and who does okay? And I think as we're understanding more and more about coronary microvascular dysfunction, as testing has been increasing across the United States and in Europe, I think that it is important to know what we know, but also what we don't know. You know, this is pretty early when we think in terms of understanding microvascular dysfunction; we're just at the earliest stages. We don't even actually, to date, have a perfect medical treatment, and we're waiting for studies.

One of the studies that took place here at Cedars was the Warrior Study, and it took place at multiple centers across the United States. We don't have those results yet, but really that's been a struggle in how to care for patients. And again, talking about it from a tertiary center is a different thing than talking about it for somebody that's practicing in rural America, and what are the available testings there? So I think it's going to be a great discussion. It's also interesting to learn from countries that do things a little bit differently. The Japanese cardiologists do tend to be a little bit more aggressive about testing for microvascular disease, so they're in some ways ahead of the game compared to the US, and I think Europe is ahead of us as well, and so sharing the stage with our Japanese colleagues will be enlightening and hopefully bring home for many of us: what are the things that we can incorporate and do differently? But I think in the future, we're all waiting for new test results and new studies. We have trials now ongoing that are going to teach us a lot.