Practice Impact Extra: Recent Episodes
AccessCardiology
Dr. Bernard Monteleone, former Head of Cardiology at St. Francis Hospital in New York, gives an informed analysis of highly-anticipated trials and whether or not their findings could impact clinical practice guidelines and reduce the risk of cardiovascular disease.
Influenza is a trigger for CV disease. What can be done to reduce complication risk after myocardial infarction?
Is there any additional benefit in outcomes noted for the SGLT2/1 drug Sotagliflozin in improving heart failure outcomes?
Two trials that do not support the routine use of Omega 3 fatty acid in the reduction of cardiovascular events.
Can we reduce the rate of cancer therapy related cardiac dysfunction in treated patients?
Does replacement of iron in this patient group have an impact on cardiovascular events?
Is there any trial evidence that adding beta blocker therapy improves survival in CVD and COPD patients?
Dr. Bernie discusses the use of Omecamtiv as a new approach to the treatment of heart failure.
What are the impacts of treatment of atrial fibrillation and anticoagulation in patients with diabetes?
Dr. Bernie presents updated studies on inflammatory effects of low-dose Colchicine and coronary artery disease.
Dr. Monteleone discusses the possibility of a more effective treatment for patients with atrial fibrillation.
Is there anything new in outcomes regarding transfusion recommendations in patients with acute myocardial infarction?
Guidelines developed by ACC Sports and Exercise Cardiology Council provide a consensus expert opinion clinical framework on return to play in the era of Covid 19.
Dr. Monteleone explores the possibility of identifying hypertrophic cardiomyopathy patients who are at risk of arrhythmic sudden cardiac death and would benefit from a prophylactic implantable cardioverter/defibrillator.
Recent studies examine the association between mital valve prolapse and sudden cardiac death.
Sudden Cardiac Death in Heart Failure trial takes a look at effective therapies for this devastating event.
Prevention Guidelines published by the ACC/AHA are not gendered. Should cardiologists be looking at a different set of risk factors for cardiovascular disease in women?
Researchers examine whether self-reported physical activity characterized as low, moderate or high reduced the mortality risk associated with coronary plaque burden measured by CAC score.
Researchers examine whether Transcatheter Mitral Valve Clip can improve clinical outcomes in patients with severe functional mitral valve regurgitation.
Bempedoic Acid has shown promising results in the treatment of patients with high LDL levels. Should there be any concern in its use to treat patients with diabetes?
Myocardial injury caused by Covid 19 continues to be reported in hospitalized patients. Researchers are analyzing MRI data to determine sustained cardiac involvement after a patient’s recovery.
Evidence regarding various oils and their effect on LDL cholesterol and other CV risk modifiers can be controversial as is the case with coconut oil consumption. A closer look at coconut’s long-chain fatty acids explains the potential CVD risk of this trendy oil.
The development of monoclonal antibody PCSK9 inhibitors has allowed for dramatic lowering of LDL and CV events, but what new analysis adds knowledge to the benefits of PCSK9? Dr. Bernie reviews the practice impacting results of a prespecified analysis of FOURIER trial published in JAMA-Cardiology April 2020, to evaluate the LDL cholesterol-lowering effect of Evolocumab on different types and sizes of myocardial infarction.
A 2016 study from Washington University School of Medicine in St. Louis showed that long term use of VKA’s (Warfarin), led to a 25% increase incidence of fracture. When Direct Oral Anticoagulants, DOAC’s, were developed their great benefit was that they did not inhibit vitamin K and adversely affect bone density. A study in December 2019 is the latest assessment as to whether these new blood thinners are actually lowering the risk fractures in the elderly.
The NAVIGATE-ESUS and the RE-SPECT ESUS randomized trials assessed the risk of recurrent ischemic stroke comparing aspirin antiplatelet therapy to 2 NOACs rivaroxaban and dabigatran. Major bleeding events from both trials suggest ineffective and unsafe results from indiscriminate anticoagulant treatment with NOAC rivaroxaban or dabigatran for patients with ESUS, stressing the importance of performing comprehensive diagnostic work-ups in patients to assist in uncovering occult causes of Embolic stroke of underdetermined source.
In contrast to the findings of the Simplicity trial in 2014, recent trials reported positive results after catheter-based renal artery denervation. The SPYRAL HTN-OFF MED trial presented at the ACC 2020 scientific meeting evaluated the Spyral catheter renal denervation compared with sham patients off medication with uncontrolled hypertension. The results on blood pressure were significant, but is there more to learn about the effectiveness of RDN on patients taking multiple hypertension medications?
Four observational studies regarding outcomes of COVID patients treated with ACEI and ARB were published in May 2020. More than 22,000 patients were analyzed at Bringham and Woman’s Hospital, University of Milano, NYU Grossman School of Medicine, and the Cleveland Clinic with overall results that do not suggest continued use of ACE inhibitors or ARBs contribute to the severity of COVID 19 in patients.
COVID 19 has been associated with a number of life-threatening conditions beyond respiratory complications including blood clotting leading to potentially deadly thromboembolic events. In order to improve outcomes, should all hospital admitted COVID 19 patients receive anticoagulants?
The REDUCE-IT EPA trial assessed the association of EPA blood levels with outcomes from the REDUCE-IT Trial first published in 2019. Researchers found on treatment the higher the EPA blood level, the lower the rates of different cardiovascular events, deaths, and total mortality. Could this introduce a new era of CV therapies?
Two studies from academic hospitals in Wuhan, China, and a third from NYU find that COVID-19 can cause heart injury even in people without underlying heart issues. High mortality rates in patients with elevated TNT levels as well as elevated C-reactive and BMP levels were evident across the three studies. With so much more to learn from the virus, the long term cardiac effects for recovered patients is still a great unknown.
Backed by machine learning and statistical models that analyzed how patients described their heart attack symptoms based on patient gender and obstructive disease, the Hermes trial found these symptoms reported by 90% of men and women consistently similar.
The Victoria trial assessed the drug Vericiguat in patients with heart failure and reduced ejection fraction. Although the absolute reductions were small, decreases in hospitalization and CV deaths in patients <75 could see Vericiguat added as a treatment for very ill CHF patients.
Research continues to find newer pharmacologic treatments to improve outcomes.
One year after the 2019 Ischemia trial assessed interventional treatment to drug therapy with established angina, ischemia, and stable obstructive coronary artery disease, Dr. Bernie breaks down outcomes related to symptoms and degree of ischemia.
The Treat Stroke to Target Trial demonstrates a reduction of non-fatal CVA and stroke events as a result of aggressive LDL reduction. The trial, like others before it, supports that lower cholesterol is better for the family of atherosclerotic disease, but how low should we go?
A 2016 Danish study showed remnant cholesterol, VLDL, was as critical as LDL cholesterol in myocardial infarction and ischemic stroke. Is it a practice impact opportunity that deserves closer attention to reduce the incidence of myocardial infarction and stroke?
Impressive results from the trial on PCKS9 inhibitors include a 59% reduction in LDL cholesterol and 25% reduction in CV death, MI, and stroke, with new findings on safety. Is the high cost sustainable, and what will the longer, ongoing ODYSSEY trial show?
For cardiologists considering treatment options for chronic stable angina with moderate to severe myocardial ischemia, the ISCHEMIA Trial offers evidence on the benefit of optimal medical management and treatment versus invasive therapy.
If the five-year data on the Scott Hart reported in 2018 showed that the use of CTA in addition to standard care resulted in more correct diagnosis of coronary artery disease than standard care alone, then is it time we lowered the threshold for referring patients for CTA?
The COLCOT Trial’s 4,700 patients were randomized to 0.5mg of Colchicine per day for 22 months. Trial outcomes saw impressive reductions in CV events, but is the anti-inflammatory a game-changer?
CANTOS finds the drug Canakinumab’s impact on cholesterol levels, inflammation, and coronary artery events range from none to significant, and delivers important analysis from its pre-specified cancer event look.
Dr. Bernie discusses the treatment of cholesterol in patients who have had a heart attack or acute coronary syndrome.
The RECOVERY trial yields a promising intervention option to watchful waiting for asymptomatic patients with very severe aortic stenosis.
Dr. Bernie sees the DAPA2 trial as a game-changer in the treatment of heart failure, but what’s the greatest benefit of its impact on the elderly?
Dr. Bernie explains how the EVAPORATE trial sheds light on the CV benefits of the REDUCE-IT trial and what it means for US population outcomes.
Dr. Bernie spotlights two trials from the ESC 2019 Congress in Paris: AFIRE indicates limited benefits of aspirin while DAPA signals a new approach to treating congestive heart failure.
VITAL and REDUCE-IT trials conclude with different results on the impact of Omega-3 on the reduced risk of cardiovascular disease.