VIJAYAWADA: Cardiology remains a field fraught with controversies, particularly concerning cholesterol, statins, and treatment options like stents or bypass surgery. However, the evolving clinical trials and the growing use of Artificial Intelligence (AI) have significantly impacted these uncharted territories in the domain of healthcare.
By analysing coronary angiograms with high accuracy, AI can predict which plaques might rupture, leading to heart attacks.
Speaking to TNIE, Dr Pothineni Ramesh Babu, Chief Interventional Cardiologist at Aster Ramesh Hospitals, said, “AI can now identify subtle abnormalities that the human eye might miss, making it an invaluable tool in preventing future cardiac events. Statins do far more good than harm when prescribed properly, especially when started early in life.”
Another key area of debate involves the choice between stents and bypass surgery. For patients with multi vessel disease (MVD), especially those with diabetes, bypass surgery generally offers better survival rates. Stents, while crucial in acute heart attacks, remain controversial for elective procedures, with recent guidelines favouring surgery for long-term outcomes.
Despite advances in diagnostics, silent heart disease remains a significant threat, particularly in India. Many patients with severe coronary artery disease show no symptoms, and traditional tests like ECG or treadmill stress tests often fail to detect critical conditions. “Even a patient with a 99 percent blockage may remain asymptomatic until it’s too late,” warned Dr Ramesh Babu, underscoring the importance of advanced imaging and proactive screening.
Much of the confusion in diagnosing asymptomatic patients and predicting outcomes in established heart disease arises from numerous confounding variables and complex prediction models. However, the emerging role of AI, including machine learning, deep learning, and convolutional neural networks, is improving prediction models and enhancing the accuracy of cardiac imaging, particularly with advanced cardiac CT, MRI, and intracoronary imaging technologies. Despite these advancements, areas like microvasculature, collateral circulation, and genetics remain poorly understood and continue to be challenging aspects of cardiac disease comprehension.
One of the most enduring discussions is the ‘cholesterol controversy.’
While it is now well-established that LDL cholesterol is linked to coronary artery disease, not all LDL particles are equally harmful. Small, dense LDL particles are more likely to penetrate vessel walls, posing a greater risk than larger, more buoyant particles, leading to misunderstandings among patients and healthcare providers alike.
The debate over statins, medications that lower cholesterol, adds another layer of complexity. Statins, particularly when started early, can prevent heart disease, but fears of rare side effects continue to hinder their acceptance.
