MDedge Cardiocast

ISCHEMIA trial hailed as practice changing
The largest-ever RCT of initial invasive versus conservative management of stable ischemic heart disease makes waves.

DAPA-HF: Dapagliflozin’s HFrEF efficacy confirmed in nondiabetics
Further analyses from the DAPA-HF trial showed dapagliflozin cut death and heart failure events in HFrEF patients with no diabetes.

Colchicine cut post-MI CVD events
Colchicine fulfilled the promise first seem in CANTOS that anti-inflammatory treatment can reduce cardiovascular disease events.

Getting high heightens stroke, arrhythmia risks
Cannabis use or abuse among the young was associated with adverse cardiovascular consequences in two studies.

Editor's note: This is the final episode of the MDedge Cardiocast. On behalf of Dr. Jim Dwyer and all of us at MDedge, thank you for supporting Cardiocast.

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Vascepa approved for cardiovascular risk reduction
The FDA’s decision on cutting events in high-risk patients was based primarily on the REDUCE-IT trial.

ENGAGE AF-TIMI: Insulin linked to greater risk for stroke, CV death, bleeding
Novel oral anticoagulants may be preferred over warfarin in patients with diabetes and AFib.

HHS drug importation proposals aim to address high costs
Trump administration drops key health care proposal on day of impeachment vote.

End ‘therapeutic nihilism’ in care of older diabetic patients, says expert
‘It’s not hyperglycemia that’s killing people; it’s heart disease and renal disease.’

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Women have fewer cardiovascular events after non–ST-segment elevation ACS
But they also remain undertreated with guideline-directed therapies.

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FDA panel rejects vernakalant bid for AFib cardioversion indication
Eleven years after the first attempt of the antiarrhythmic agent, the FDA panel voted resoundingly against approval.

Bariatric surgery tied to fewer cerebrovascular events
The incidence of cerebrovascular events was 65% lower in obese people who underwent bariatric surgery compared with those without surgery

Intensive BP control cut dementia but increased brain atrophy and hurt cognition
The small but significant ill effects worried some researchers at the Clinical Trials on Alzheimer's Disease conference.

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Icosapent ethyl cost effective in REDUCE-IT analysis
Treatment with the fish-derived drug Vascepa for CV event reduction is more effective and less costly than placebo.

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DAPA-HF: Dapagliflozin benefits regardless of age, HF severity
The SGLT2 inhibitor had similar efficacy in the elderly and across the spectrum of baseline symptom status.

Colchicine cut post-MI CVD events
Colchicine fulfilled the promise first seem in CANTOS that anti-inflammatory treatment can reduce cardiovascular disease events.

Cardiac arrests peak with pollution in Japan
The incidence of out-of-hospital cardiac arrests in Japan increased on days when counts of particulate matter spiked from the day before.

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This week’s Cardiocast is devoted entirely to Card Talk with cardiologist brothers Jim and Jerry Dwyer. They welcome two structural interventionalists at the Structural Heart and Valve Center at Emory Healthcare, Kendra J. Grubb, MD, and Isida Byku, MD. Both followed a unique track, training in both cardiac surgery and interventional cardiology and practicing in the fast-moving field of structural heart disease.

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From the “picture that went around the world” of an all-female transcatheter aortic valve replacement team at Emory to advances in structural heart disease treatment, this interview includes expanding TAVR beyond the aortic valve and interventional heart failure treatment using “hooks and anchors and pulleys” to reshape the heart.

Dr. Grubb is assistant professor in surgery and medicine at Emory University in Atlanta and surgical director of the Structural Heart and Valve Center at Emory Healthcare. On Twitter @KendraGrubb. She is an adviser, consultant, and/or speaker for Boston Scientific, Edwards, and Medtronic. She is also a principal investigator in Medtronic’s Optimize PRO trial and Ancora’s CorCinch PMVI studies.

Dr. Isida Byku is an assistant professor at Emory University. On Twitter @IsidaByku. She has no disclosures. 

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In this special meeting edition of the Cardiocast, MDedge Cardiology editor Catherine Hackett is joined by MDedge reporters Mitchel L. Zoler, Bruce Jancin, and Richard Mark Kirkner. 

The MDedge cardiology team reviews three big stories from the 2019 annual scientific sessions of the American Heart Association in Philadelphia. 

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ISCHEMIA trial hailed as practice changing

The results of the ISCHEMIA trial were emphatically declared practice changing by interventional cardiologists and noninterventionalists alike at the AHA meeting. 

Bruce Jancin discusses the story.

DAPA-HF: Dapagliflozin's HFrRF efficacy confirmed in nondiabetes

The results in nondiabetics from the practice-changing DAPA-HF trial gives clinicians strong evidence that the diabetes drug dapagliflozin is equally effective at reducing cardiovascular death and acute exacerbations in heart failure patients regardless of diabetes status. 

Mitchel L. Zoler discusses this report. 

Weakness exposed in valsartan recall

ED visits for hypertension in the month after the 2018 recall spiked 55%. The 2018 recall of generic forms of the antihypertensive drug valsartan exposed weaknesses in the recall systems for generics in both the U.S. and Canada that caused many patients who were on the drug to fall through the cracks. 

Richard Mark Kirkner goes deeper into this story. 

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For full coverage of AHA 2019 visit MDedge Cardiology

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ISCHEMIA trial hailed as practice changing

The largest-ever RCT of initial invasive versus conservative management of stable ischemic heart disease makes waves.

*  *  *  

Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019

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DAPA-HF: Dapagliflozin’s HFrEF efficacy confirmed in nondiabetics

Further analyses from the DAPA-HF trial showed dapagliflozin cut death and heart failure events in HFrEF patients with no diabetes.

The TWILIGHT of aspirin post-PCI for ACS?

Patients do better post-PCI for non-ST-elevation ACS with ticagrelor monotherapy

Weaknesses exposed in valsartan recall

ED visits for hypertension in month after the 2018 recall spiked 55%

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Getting high heightens stroke, arrhythmia risks

Cannabis use or abuse among the young was associated with adverse cardiovascular consequences in two studies.

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Bempedoic acid cuts LDL by 15% in patients with high levels despite maximal treatment

CLEAR Wisdom may fill a niche for patients who can't get levels down.

Low LDL-C and blood pressure can reduce lifetime risk of CVD by 80%

The effects were seen in those with genetic variants linked with low LDL cholesterol and systolic blood pressure.

Statins in children cut long-term CVD risk in familial hypercholesterolemia

There were no cardiovascular-related deaths and one event in treated patients who were followed for 20 years

Closing the missing link between childhood risk factors and adult cardiovascular outcomes

Prescient childhood cohort studies launched in the 1970s are paying off. 

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Metabolic signs of adult diabetes apparent in very young children

Disturbed HDL cholesterol metabolism may be one of the earliest features of type 2 diabetes.

Sacubitril/valsartan suggests HFpEF benefit in neutral PARAGON-HF

The primary endpoint was neutral, but desperation for a HFpEF therapy highlights a subgroup analysis.

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Patients frequently drive too soon after ICD implantation

Many patients didn’t recall ever receiving instruction about when to drive again.

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One-third of CVD disease in blacks linked to hypertension

A large analysis suggests intervention throughout all ages could have substantial impact.

Cancer overtakes CVD as cause of death in high-income countries

The balance is shifting because cardiovascular deaths are way down in high-resource nations.

Virtual visits may cut no-show rate for follow-up HF appointment

No-show rates cut by about one-third for patients who met their clinician via video.