A Crossroads in Cardiovascular Medicine: Progress and Barriers to Impact

During the past 75 years, advances in cardiovascular science and technology have significantly reduced morbidity and mortality. In 2012, Drs Nabel and Braunwald reviewed this progress in A Tale of Coronary Artery Disease and Myocardial Infarction, highlighting the landmark innovations that contributed to the decline in cardiovascular death rates from 1950 to 2010. Since then, groundbreaking developments in pharmacologic therapies, interventional procedures, surgical techniques, and molecular medicine-including gene editing and RNA-based treatments-have emerged. However, despite these innovations, improvements in cardiovascular mortality have stalled, driven not only by epidemiologic shifts but also by persistent inequities in implementation. This article examines the past 15 years of progress in cardiovascular medicine and proposes a forward-looking roadmap focused on prevention, responsible innovation, and thoughtful health care delivery to ensure technological advancements translate into improved health outcomes for all.