New Therapies Are Redrawing the Map of Cardiology: Sheng Fu, MD

In this interview, Sheng Fu, MD, a cardiologist at Baptist Health Miami Cardiac & Vascular Institute, part of Baptist Health Heart & Vascular Care, discusses how rapidly evolving cardiometabolic therapies are reshaping both clinical practice and health system strategy, particularly for complex patients with overlapping cardiac, renal, and metabolic disease. He begins by describing a common challenge in current care: there is often no clearly designated “quarterback” responsible for coordinating treatment. While cardiologists frequently take the lead—partly because they tend to be early adopters of novel therapies—they rely heavily on nephrology and endocrinology colleagues to manage intricate comorbidities. In practice, however, care is frequently driven by whichever clinician happens to see the patient first.

Fu warns that this ad hoc approach contributes to a “bystander effect,” where clinicians may avoid raising issues like glucagon-like peptide-1 (GLP-1) agonists or weight-loss strategies, assuming another specialist will address them later. This diffuse responsibility is particularly problematic for patients with cardiorenal-metabolic (CRM) disease, who are among the highest-cost, highest-readmission patients in the system. He argues that health systems must formally recognize CRM as a distinct clinical reality—whether through subspecialty training pathways or dedicated disease centers that integrate pharmacists, dietitians, and other support staff—because these patients disproportionately shape resource use and outcomes.

Using sodium-glucose cotransporter 2 (SGLT2) inhibitors as a case study, Fu illustrates a major paradigm shift in drug discovery and deployment. Originally developed as glucose-lowering agents for diabetes, SGLT2 inhibitors unexpectedly demonstrated powerful cardiovascular benefits in trials that were meant only to prove safety. Although their precise mechanisms in reducing cardiovascular risk and mortality remain uncertain, their performance has transformed thinking about how therapies are discovered and evaluated. He notes that GLP-1 agonists have similarly “knocked it out of the park,” solidifying a new era in cardiology where treatments are understood not just through neurohormonal or hemodynamic models but through a broader metabolic, multiorgan lens. For Fu, this evolution confirms CRM as a true, integrated disease space that demands equally integrated care models.