Luke Laffin, MD, on OTC heart supplements.

Cardiology Pharmaceuticals

SPORT: Statins Obliterate OTC Heart Supplements

Rosuvastatin 5 mg daily lowered LDL-C levels more than fish oil, cinnamon, garlic, turmeric, red yeast rice, and placebo in those with increased 10-year risk for ASCVD, according to a recent study presented at AHA 2022. 

Over-the-counter heart supplements claim to fight cholesterol and promote heart health, and many Americans subscribe to the hype. The study’s lead author Luke Laffin, MD explained that 75% of Americans take at least one dietary supplement, and 18% percent take a supplement to promote heart function. 

Laffin’s findings challenge the multibillion dollar industry. 

In the study, researchers looked at data from 200 adults with no history of cardiovascular disease, but who had a 5-20% risk of developing ASCVD within 10 years. Researchers randomly assigned participants to one of eight groups: placebo, rosuvastatin (5 mg), fish oil (2400 mg), cinnamon (2400 mg), garlic (with 5000 mcg of allicin), turmeric (3500 mg), plant sterols (1600 mg), and red yeast rice (2400 mg). 

LDL-C levels decreased in the following groups at 28 days: 

• Rosuvastatin: -38%
• Placebo: -2.6%
• Fish oil: -3.4%
• Turmeric: -1.3% 
• Plant sterols: -4.37%
• Red yeast rice: -6.5%

LDL-C levels actually increased in people taking these supplements: 

• Cinnamon: +0.4%
• Garlic: +5.1%

The Takeaway 

Six widely used dietary supplements promoted for improving heart health – including brands of fish oil, cinnamon, garlic, and turmeric – were not as effective as rosuvastatin at lowering “bad” cholesterol more after 28 days of use. Statins are still the cholesterol kingpin. As cardiologists have been saying for decades (and as they made clear on twitter), supplements cannot take the place of an effective statin. 

User Experience and Cardiovascular Imaging Transformation

Check out this Change Healthcare video discussing the importance of user experience in the adoption of structured reporting, and how it can lead to improvements in imaging speed, quality, and cardiologist workflow. 

When It’s Good to Find Something Bad

When Cleerly’s own quality director, Terry Schemmel, underwent a CCTA with Cleerly analysis, he didn’t have any reason to believe there was anything wrong with his heart. But Terry’s Cleerly analysis identified a 95% blockage in his left anterior descending artery, allowing him to get proactive and personalized care.

The Wire

• Us2.ai Validated: A Nature study showed that Us2.ai’s echo AI solution can interpret 23 echocardiographic parameters (e.g. cardiac volumes, ejection fraction, and Doppler measurements) comparably to human experts, but with less variability. Using echo exams from 600 people (421 w/ heart failure, 69% women), the FDA validation study showed that Us2.ai measurements had fewer and smaller differences compared to three human experts than when the experts were compared with each other. Noting that AI measurements were produced in one minute, these results suggest that Us2.ai can improve echo reporting efficiency and accessibility. 

• Iron IV Treatment: A study of 1.1k people with heart failure and iron deficiency revealed that iron administered intravenously was associated with a slightly reduced risk of heart failure and CV death compared to standard treatment, although the difference was not significant. In a mean follow-up of 2.7 years, the Pharmacosmos iron treatment improved patients’ well-being, was well tolerated and did not lead to safety concerns. 

• Early ECMO: Early use of ECMO devices did not improve outcomes in people with cardiogenic shock. In the study, 117 adults were randomized into either an ECMO group or an early conservative therapy group. Within 30 days of experiencing severe or rapidly progressing cardiogenic shock, composite rates of death, cardiac resuscitation, and additional mechanical circulatory support were comparable between groups (64% vs. 71%). Researchers also observed similar mortality rates (50% vs. 48%) and serious adverse event rates (60% vs. 61%).  

• Efficacy of Two Common Loop Diuretics: TRANSFORM-HF trial results suggest torsemide was not superior to furosemide in improving survival among patients treated for decompensated HF. Researchers randomized nearly 3k hospitalized HF patients to receive either torsemide or furosemide. At one year, hospitalization and all-cause mortality rates were comparable between the groups (47.3% vs. 49.3%). 

• Cardiac MRI Feature Tracking: New research strengthens the body of evidence supporting the implementation of feature tracking on cardiac MRI patients with dilated cardiomyopathy. Researchers used feature tracking to calculate six myocardial strain parameters (left and right ventricular global radial, global circumferential, and global longitudinal strain), finding that all six independently predicted composite death or HF hospitalization (HR: 0.92 to 1.16). However, in multivariable analyses that accounted for confounding variables, only LV global longitudinal strain was an independent predictor (HR: 1.13)

• Healthcare Hiring Boost: The October Jobs Report revealed that the healthcare sector added 53k jobs just last month, with ambulatory services, hospitals, and nursing and residential care facilities leading the job gains (31k, 11k, 11k). The industry has now fully recovered any jobs lost during the pandemic after accelerating hiring during 2022, adding an average of 47k new jobs each month (vs. 9k per month last year).

• Cleerly’s Novel High-Risk Plaque Metric: Cleerly showcased a number of abstracts at AHA, including one in which the authors identify a novel metric to better define high-risk plaques with coronary CTA. The high-risk metric, dubbed HRP morphology, states that the shape of the low-density non-calcified coronary plaque must be round or bean-shaped and must be surrounded by non-calcified plaque for at least 270 degrees circumferentially. The HRP morphology was associated with acute coronary syndrome, and substantially improved risk stratification. 

• B-Mode AI Stenosis Detection: A new Circulation study highlighted an AI algorithm that can accurately identify and characterize aortic stenosis (AS) using B-mode ultrasound views (not echos), potentially improving AS detection in low-resource and screening settings. Researchers developed the AI algorithm using 30k labeled echo exams and tested it with B-mode views from 40 patients, achieving high agreement across three echo-trained cardiologists (k = 0.95), and detecting moderate/severe AS with high sensitivity (91%) and specificity (94%). 

• New Four-in-One BP Lowering Strategy: A pill that combines low doses of four blood pressure medications was more effective than standard monotherapy in a small randomized study. Sixty-two patients received either the quadpill or candesartan 8 mg. Change in systolic BP at 12 weeks was 4.8 mm Hg greater in the quadpill group than the control group. While the differences were not statistically significant, the authors note that this is likely due to the small sample size. The quadpill contained candesartan 2 mg, amlodipine 1.25 mg, indapamide 0.625 mg and bisoprolol 2.5 mg.

• Verily’s Virtual Care App: New results show Verily’s virtual care app Onduo improves glucose and cholesterol in type 2 diabetes (T2D) patients. Among 578 participants with T2D – and who had engaged in a different wellness program the previous year – Onduo was tied to improved year-to-year HbA1c, FG, HDL, and LDL levels. People with the highest baseline glycemic indices and who took part in telemedicine visits saw the greatest improvements.

ACC/AHA Chest Pain Guidelines Highlight FFRct

Coronary CTA + FFRct is now a front-line pathway in the ACC/AHA’s 2021 Chest Pain Guidelines. Check out the clinical data supporting FFRct’s positioning as a “dominant strategy” and how HeartFlowFFRct Analysis impacts patients, physicians, and administrators.

Us2.ai Launches Globally

Us2.ai recently announced the global launch of its flagship echocardiography AI solution, leveraging a new $15M Series A round, and its unique abilities to completely automate echo reporting (complete editable/explainable reports in 2 minutes) and analyze every chamber of the heart (vs. just left ventricle with some vendors).