IPM Take
Cardiology spent decades becoming extraordinarily good at rescuing people after disease declared itself.
Now the field is trying to get there first.
That shift is visible across several fronts at once. The 2026 US dyslipidaemia guideline recommends measuring lipoprotein(a), or Lp(a), at least once in every adult. AI systems are being developed to extract additional risk information from familiar tests such as ECGs. Newer obesity and diabetes medicines are increasingly relevant to cardiovascular prevention. And health systems are placing greater emphasis on finding hypertension, dyslipidaemia and metabolic risk before patients feel unwell. (heart.org)
Yet World Heart Day 2026 also exposes a paradox.
The future of cardiology may involve sophisticated algorithms and molecular biomarkers, but some of its largest preventable losses still come from people who do not know they have high blood pressure, cannot access effective treatment, or encounter prevention only after risk has accumulated for years. The World Heart Federation estimates that cardiovascular disease causes more than 20 million deaths annually and says many of the underlying risk factors can be prevented or managed. World Heart Federation
The frontier is becoming more precise.
The unfinished business remains remarkably basic.
Executive Summary
World Heart Day 2026 continues the World Heart Federation’s “Don’t Miss a Beat” campaign, focused on recognising cardiovascular disease earlier and preventing avoidable deaths. World Heart Federation
Cardiologists interviewed for the occasion describe a field moving toward earlier identification of risk. Singapore-based cardiologist Pinakin Parekh highlighted improved imaging, inherited risk markers such as Lp(a), and newer treatments for cholesterol, diabetes and obesity as part of a broader move from treating established disease to detecting vulnerability sooner. Pasted text
That direction is already entering formal guidance. The 2026 ACC/AHA multisociety dyslipidaemia guideline recommends that all adults have Lp(a) measured at least once for atherosclerotic cardiovascular disease risk assessment. Elevated Lp(a) is largely genetically determined and can identify risk that a conventional LDL cholesterol result may miss. professional.heart.org
At the same time, clinicians are exploring whether AI can uncover disease from routine tests earlier than conventional interpretation alone. Hafiz Naderi of Queen Mary University of London described the potential for AI to detect subtle ECG patterns, while warning that technology must not widen existing inequalities in cardiovascular care.
Why it matters
- HTA bodies: Prevention is increasingly becoming a portfolio of technologies rather than one intervention. Biomarkers, risk scores, imaging, AI and cardiometabolic medicines may need to be evaluated not only individually but also as components of earlier risk-stratification pathways.
- Payers: Earlier detection creates downstream costs as well as savings. Finding more people with elevated inherited risk, hypertension or metabolic disease only improves outcomes if health systems can fund follow-up, treatment and long-term prevention.
- Industry / innovation partners: The competitive opportunity is shifting upstream. Diagnostics that identify hidden risk, AI that extracts more information from routine clinical data and therapies that modify multiple cardiometabolic pathways are becoming increasingly interconnected.
The biggest change in cardiology may be happening before the patient ever reaches a catheterisation laboratory.
For much of modern cardiovascular medicine, innovation has been measured in better rescue: faster reperfusion after myocardial infarction, more sophisticated stents, better surgery and increasingly effective drugs for established disease.
Those advances remain essential.
But cardiologists speaking ahead of World Heart Day 2026 describe a different ambition: identify the person on the path toward cardiovascular disease years before the event itself. Pasted text
That philosophy is already changing lipid assessment.
Lp(a) moves into routine risk assessment
Lipoprotein(a) has become one of the clearest examples of cardiovascular risk hidden by conventional screening.
Lp(a) resembles an LDL particle but carries an additional apolipoprotein(a) component. Its concentration is predominantly inherited and remains relatively stable across life. Higher levels are associated with increased risk of atherosclerotic cardiovascular disease and calcific aortic valve disease. (ahajournals.org)
The 2026 ACC/AHA multisociety guideline now gives Lp(a) measurement a Class 1 recommendation at least once in all adults. The guideline considers concentrations of at least 125 nmol/L, or 50 mg/dL, a risk-enhancing factor and recommends using an elevated result to intensify management of LDL cholesterol and other modifiable risks. AHJournals
The change reflects a larger shift in cardiovascular prevention: risk assessment is becoming less dependent on a single cholesterol value and more attentive to inherited biology, lifetime exposure and subclinical disease.
AI is looking for information hidden in familiar tests
Another frontier is not a new test at all.
It is extracting more information from tests already performed.
Naderi told the South China Morning Post that AI could identify subtle patterns in ECGs that may reveal more about cardiovascular risk than clinicians can detect through conventional interpretation. He framed AI as an additional clinical tool rather than a replacement for physicians. Pasted text
That distinction matters.
AI-enabled ECGs, imaging tools and risk models are attracting intense interest because they could potentially identify ventricular dysfunction, arrhythmia risk or other occult disease using data already generated during routine care.
But adoption will depend on more than predictive accuracy. Health systems will need evidence that earlier identification leads to useful clinical action, improves outcomes, works across diverse populations and does not simply generate more downstream testing.
Cardiometabolic medicine is collapsing old specialty boundaries
The other major shift is therapeutic.
Obesity, diabetes, chronic kidney disease and cardiovascular disease are increasingly being treated not as separate silos but as overlapping biological and clinical systems.
Professor Yeo Khung Keong of Singapore’s National Heart Centre pointed to GLP-1 therapies as an example of medicines capable of influencing weight and cardiometabolic risk simultaneously, while also highlighting affordability as a continuing constraint. Pasted text
That matters because cardiovascular prevention is no longer confined to blood pressure tablets and statins.
Newer metabolic medicines are changing how clinicians think about obesity and diabetes as cardiovascular-risk states, while kidney disease is increasingly incorporated directly into cardiovascular-risk frameworks.
The resulting model is becoming more personalised, but also more complex.
The technology paradox
Then comes the uncomfortable part.
The same cardiologists discussing AI, Lp(a) and next-generation medicines returned repeatedly to ordinary risk factors.
High blood pressure is easy to measure and highly treatable, yet it often causes no symptoms before producing vascular damage. Naderi argued that some of the biggest improvements in global cardiovascular health will still come from finding and treating hypertension, reducing tobacco exposure, improving access to healthy food and making established therapies affordable. Pasted text
World Heart Federation’s 2026 campaign makes a similar argument. Its message is that cardiovascular disease can “hide in plain sight”, with people appearing healthy while risk accumulates silently. World Heart Federation
That makes prevention partly a technology problem, but equally an implementation problem.
An AI-enabled ECG cannot compensate for a patient who never reaches primary care.
A one-time Lp(a) recommendation has little impact if the test is unavailable or no action follows the result.
And highly effective medicines cannot reduce population cardiovascular risk if cost, health literacy or fragmented care keeps them out of reach.
That tension may define the next phase of cardiology.
The field is becoming better at predicting disease before it happens.
The harder task is making sure health systems can act while there is still time to prevent it.
