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. For more MDedge podcasts, go to www.mdedge.com/podcasts. Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

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.’ * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

Women have fewer cardiovascular events after non–ST-segment elevation ACS But they also remain undertreated with guideline-directed therapies. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * 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. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

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. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * 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. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

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. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * 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. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

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. * * * Help us make this podcast better! Please take this short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * 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. * * * For full coverage of AHA 2019 visit MDedge Cardiology For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeCardio

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 * * * 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% * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

Getting high heightens stroke, arrhythmia risks Cannabis use or abuse among the young was associated with adverse cardiovascular consequences in two studies. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * 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. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * 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. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

Patients frequently drive too soon after ICD implantation Many patients didn’t recall ever receiving instruction about when to drive again. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * 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. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

Strong showing for TAVR after 5 years in PARTNER 2A Transcatheter and surgical aortic valve replacement had similar rates of death or disabling stroke. * * * Help us make this podcast better! Please take our short listener survey: https://www.surveymonkey.com/r/podcastsurveyOct2019 * * * Patiromer allows more CKD patients to continue on spironolactone After 12 weeks, 86% of the patiromer patients remained on spironolactone, vs. 66% of the placebo patients. Native Americans appear to be at increased risk for AFib Atrial fibrillation was significantly more common among Native Americans than in other racial and ethnic groups. Certain diabetes drugs may thwart dementia Intriguing findings from a Danish national registry study For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeTweets

MDedge reporters discuss the latest in practice-changing data from the 2019 annual congress of the European Society of Cardiology in Paris. Join Mitchel L. Zoler, Bruce Jancin, Kari Oakes, and MDedge Cardiology editor Catherine Hackett as they discuss what they reported from the annual meeting.

Statin use linked to risk of skin and soft tissue infections Use of statins was associated with increased risk of SSTIs at an average of 91, 182, and 365 days. Rivaroxaban trends toward higher thrombotic risk than vitamin K antagonists in APS Patients who took rivaroxaban experienced almost two times as many thrombotic events as patients who took dose-adjusted vitamin K antagonists. HHS floats Stark/anti-kickback revisions to support value-based care Health law attorneys say reforms should remove some of the risk in value-based care arrangements that exist under current law. * * * Card Talk: Cardiologist brothers Jim and Jerry Dwyer welcome Jennifer N. Avari Silva, MD, and Berk Tas, to talk about an investigational system for electrophysiology procedures that displays holograms of patients’ anatomies in real time. The SentiAR system uses an augmented-reality head-mounted display that allows physicians to manipulate the data and enhance their understanding of the case. Dr. Avari Silva, MD, is assistant professor of pediatrics at Washington University in St. Louis and director of pediatric cardiac electrophysiology at St. Louis Children’s Hospital, where she leads the largest pediatric electrophysiology program in the midwest. Dr. Avari Silva has published numerous papers bringing new technologies to pediatric patients. Berk Tas is CEO and president of SentiAR. He has led development of emerging technologies and companies in Fortune 500, private equity, venture capital funded and privately held organizations. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeCardio

Novel cardiac troponin protocol rapidly rules out MI Three-quarters of patients who presented with suspected acute coronary syndrome were safely discharged from ED without hospital admission. Study questions preemptive TEVAR for extended type A dissections Interim results from a single-center study show that preemptive TEVAR may not be necessary for type A aortic dissections. TAVR, SAVR share same infective endocarditis risk Be aware, be careful, and provide appropriate antibiotic prophylaxis, just as surgeons do in SAVR. Moderate aortic stenosis just as deadly as severe AS The current echocardiographic definition of moderate aortic stenosis may greatly underestimate risk. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeCardio

Smoking and inactivity are the most powerful lifestyle risk factors after an MI Insufficient activity beats out obesity or above-target LDL cholesterol. Ticagrelor monotherapy tops DAPT for high-risk PCI patients TWILIGHT findings support move to shorter dual-antiplatelet therapy. Panel releases guidelines for red meat, processed meat consumption "This assessment may be excessively pessimistic; indeed, we hope that is the case." Remember that preeclampsia has a ‘fourth trimester’ Delivering the baby doesn’t always cure the hypertension. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeCardio

Cardiology dead last as women’s IM subspecialty choice Women in internal medicine residencies were more likely than men to report that they had never considered cardiology as a career choice. Beta-blockers effective, safe for HFrEF with renal dysfunction Their role is solidified for essentially all such heart failure patients, regardless of their renal function. Heart failure score derived from machine learning predicts risk in diabetes patients Highest WATCH-DM scores linked to 5-year heart failure risk approaching 20%. Daily polypill lowers BP, cholesterol in underserved population The regimen’s simplicity and low cost may overcome barriers to treatment. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeCardio

Prasugrel bests ticagrelor in ACS in surprise findings ISAR-REACT 5 was the first-ever direct head-to-head look at two potent P2Y12 inhibitors in this setting. European cholesterol guidelines push LDL targets below 55 mg/dL PCSK-9 inhibitors are elevated to a top-tier recommendation in very-high-risk patients. Drug doses for heart failure could possibly be halved for women Women reached the highest level of drug efficacy at half the doses of ACE inhibitors or ARBs and beta-blockers. Post-MI angina in stable patients flags high risk The angina finding should immediately influence practice, expert says. For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeCardio

MDedge reporters discuss the latest in practice-changing data from the 2019 annual congress of the European Society of Cardiology in Paris. Join Mitchel L. Zoler, Bruce Jancin, Kari Oakes, and MDedge Cardiology editor Catherine Hackett as they discuss what they reported from the annual meeting.

We introduce a brand new format with Jerome Dwyer, MD, brother of our host, Jim Dwyer, MD, for a new segment that we're calling 'Card Talk' where Dr. Jim and Dr. Jerry talk about the current clinical state of cardiology and take a peek into the future. This week in cardiology news: Survival at ‘overweight’ BMI surpasses ‘normal’ Visceral fat linked to sixfold increase in masked hypertension New class of drug safely halved LDL cholesterol in ORION-11

DAPA-HF results transform dapagliflozin from antidiabetic to heart failure drug Proof that dapagliflozin significantly helped heart failure patients without diabetes recategorizes the drug as a major agent for treating heart failure. New hypertension cases halved with community-wide salt substitution Social marketing principles achieved near-universal salt replacement, village by village, in rural Peru. Ticagrelor: Modest benefit, bigger bleed risk in diabetes plus stable CAD Patients with prior PCI fared a bit better and may be a target population for long-term DAPT therapy. In PAD, dropping statins ups death risk 43% Statin adherence saves lives in peripheral arterial disease.