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Published July 19, 2023

The field of cardiology has come a long way since John Warren published his “Remarks on Angina Pectoris” in the first issue of the New England Journal of Medicine in 1812. Although his description of angina pectoris still resonates today, our understanding and treatment of cardiovascular disease has changed drastically.

One of the first major contributions to the modern understanding of cardiovascular disease was the monumental Framingham Heart Study, started in 1948. This was the first study to identify hypertension and hypercholesterolemia as risk factors for heart disease, and it paved the road for drug-therapy research, the basis for today's therapies. Subsequent implementation of prevention strategies for heart disease has significantly lowered age-adjusted cardiac death rates.

Innovation and drug development continued to shape the field of cardiology during the latter half of the twentieth century. The development of coronary arteriography in 1958, coupled with the first use of streptokinase (a fibrinolytic agent) in 1976, forms the basis of treatment for acute myocardial infarction today.  Several landmark trials in the 1980s and 1990s (SOLVD [Studies of Left Ventricular Dysfunction], MERIT-HF [Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure], EMPHASIS-HF [Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure], and TOPCAT [Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist]) still dictate how we treat congestive heart failure currently.

As the field evolves, researchers are discovering minimally invasive alternatives to high-risk open-heart surgery, which allows previously unfit patients to undergo life-extending procedures and advancing the field of interventional cardiology.