Beth Israel Deaconess cardiologist, Rishi Wadhera, MD, MPP, MPhil, on young adult Americans’ high and rising CVD risk factors.

Population Health

Young Adult Risks Factors Predict CVD Tsunami

Among all the ACC presentations that addressed cardiovascular disease prevention, one particularly alarming study underscored how crucial those preventative actions might be if we’re going to avoid a “tsunami of cardiovascular disease over the long-term.”

The JAMA-published serial cross-sectional study (n=12,924) revealed an alarmingly high and rapidly increasing prevalence of major CVD risk factors among young adult Americans (20-44yrs).

Their comparison of the 2009-2010 and 2017-2020 periods revealed that:

• Diabetes jumped from 3.0% to 4.1%
• Obesity increased from 32.7% to 40.9%
• Hypertension rates rose from 9.3% to 11.5% (not statistically significant)
• Only hyperlipidemia fell 40.5% to 36.1%
• And smoking rates stayed stable and high (40% w/ smoking history)

Racial minorities were among the most affected, as Black young adults had the highest rates of hypertension (1 in 5, 2x higher than any other group), while Mexican American and other Hispanic adults saw notable increases in hypertension and diabetes. 

Treatments rates and effectiveness didn’t keep up with these increases:

• Only 55% with hypertension were receiving treatment in both periods
• The percentage treated for hypertension who achieved blood pressure control didn’t significantly change (65% to 74.8%)
• Diabetes treatment rates stayed low (62.4% to 54.5%)
• Glycemic control among those who received diabetes treatment “remained suboptimal” (45.5% to 56.6%).

Considering that this data is from 22 to 44 year-olds, just about everyone who saw these results were alarmed about future rates of cardiovascular disease and death. 

So what can we do about it? The authors urged expanding risk factor screening and public health efforts, specifically targeting earlier age ranges and at-risk minority groups.

Takeaway

Cardiovascular-related deaths have been on the decline for quite a while, but that progress stagnated during the past decade, and the “smoldering public health crisis” exposed by this data suggests that increasing CVD rates and worsening outcomes could be on the way without action.

Evolving Coronary Disease Imaging Pathways

HeartFlow’s PRECISE trial showed that their precision approach for evaluating stable chest pain avoids unnecessary testing and improves care – without risking missed heart disease diagnoses. In this Cardiac Wire Show, HeartFlow’s Chief Medical Officer Dr. Campbell Rogers dives into the PRECISE trial results and its implications for clinical practice.

Creating A Novice Heart Failure Screening Pathway

We hear a lot about AI’s potential to expand echocardiography to far more users and clinical settings, and a study using Us2.ai’s AI-automated echo analysis and reporting solution showed that echo’s AI-driven expansion might go far beyond what many of us had in mind.

Staging Coronary Artery Disease

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The Wire

• Merck’s Investigational Oral PCSK9i: Merck’s investigational PCSK9 inhibitor, MK-0616, showed promising Phase 2b results for reducing LDL cholesterol in adults with hypercholesterolemia and ASCVD, achieving reductions between 41.2% and 60.9% with no serious adverse events. If successful in Phase III clinical trials, MK-0616 could become the first oral PCSK9 inhibitor and a major player in the dyslipidemia market, joining a field of injectable options that are likely to carry higher patient costs.

• Romanian Pacemaker Harvest: A Romanian cardiologist was arrested for harvesting at least 238 pacemakers and defibrillators from deceased patients and implanting them in unsuspecting patients for financial gain. The physician and four collaborators reportedly identified sick patients whose devices would be harvestable after they died, and then removed them and implanted them in patients who paid €3k to €4k for each device. Some of the recipient patients also reportedly received “fictitious diagnoses” to make them eligible for the implants.

• Tricuspid TEER Safe & Effective for Severe TR: A new study in NEJM found that tricuspid TEER is safe for people with severe TR, and reduces the severity of tricuspid regurgitation to moderate or less in most patients within one year. In the study (n=350), patients who underwent TEER also reported substantial quality-of-life improvements at 1 year compared to the control group (KCCQ increased by 12.3 points vs. 0.6 points), and there were no significant differences in mortality or HF hospitalization between the two groups.

• Tempus Acquires Mpirik: Tempus Labs bolstered its precision cardiology capabilities with its acquisition of Mpirik. Mpirik’s AI-based Cardiac Intelligence software monitors EHRs to track patients with CVD, flag treatment gaps, and automate care coordination. Tempus will integrate Mpirik into its Tempus Air platform, which similarly analyzes cardiology data to identify patients with undiagnosed and undertreated CVD. The acquisition also shows that Tempus is still putting its massive funding to work ($1.3B raised so far), coming 5 months after acquiring imaging AI platform company Arterys.

• IPE Within 12mo of ACS: Treating patients with Amarin’s VASCEPA/VAZKEPA (icosapent ethyl, IPE) within 12 months of acute coronary syndrome might significantly reduce risks of future events. Post-hoc analysis of the REDUCE-IT study compared patients treated with IPE either within 12 months or more than 12 months after ACS against a placebo group (n = 840 & 3,651 & 4,090, all on statins). Patients treated within 12 months had far lower risk of experiencing a first event within 5 years (-9.3% vs. -4.7% risk reduction) and significantly lower rates of first and total ischemic events (-37% and -36%), without increasing bleeding.

• Home‐Based Cardiac Rehab: Although many patients decline home-based rehab after cardiac events and procedures, those that participate might have significantly lower mortality risks. An AHA study (n = 1,120 VA patients, >68 yrs old) revealed that only 44% of eligible patients participated in 12-week home-based cardiac rehab (HBCR), which consisted of 9 telephone sessions, ongoing health documentation, and optional remote BP and weight monitoring. The HBCR participants had far lower mortality rates over 4.2 years than those who declined participation (12% vs. 20%).

• CCTA AI’s CAD Advantage: A new JACC study found that Cleerly’s coronary CTA AI solution “is superior to human core lab readers” for evaluating obstructive coronary artery disease. Using CCTAs from 207 PACIFIC trial patients, the Cleerly AI-QCT solution’s stenosis grading outperformed human readers for identifying patients with ≥50% stenosis (AUCs: 0.92 vs. 0.71), and for detecting obstructive CAD on a per-vessel basis (621 vessels; AUCs: 0.88 vs. 0.77).

• Startup Bank Has a Startup Bank Run: As you’ve probably heard, Silicon Valley Bank collapsed last week in the largest US bank failure since 2008. SVB apparently had business relationships with half of all venture-backed technology and healthcare companies, most of which spent their weekends scrambling to recover deposits. We’ll leave the cause of the collapse to the experts, but a government intervention late Sunday addressed immediate concerns over the risk of runs on other banks and affected startups making payroll. Godspeed to everyone impacted.

• Sotatercept Shines in Phase 3: Expanded phase 3 data from the STELLAR trial (n=323) found that sotatercept, Merck’s potential PAH drug, exceeded expectations by improving patients’ 6-minute walk distance by more than 40 meters after just 24 weeks of treatment, compared to the placebo group. The “impressive” STELLAR results reinforce Merck’s initial announcement in October stating that sotatercept passed the late-stage test with flying colors.

• Viz.ai and BMS’s HCM Alliance: AI-based care coordination company Viz.ai and Bristol Myers Squibb announced a multi-year agreement to use Viz.ai’s Viz HCM solution (FDA de novo-pending) to identify patients with undiagnosed hypertrophic cardiomyopathy. Viz HCM reviews routine ECGs, identifies suspected HCM cases, and notifies appropriate cardiologists. Many of the estimated 750k individuals with HCM in the U.S. are still undiagnosed, and some of them could be treated with BMS’s Camzyos (mavacamten), which is the only drug with FDA approval for obstructive HCM.

• Virtual HF Care’s Guideline Impact: An MGB-led study presented at ACC highlighted virtual care teams’ potential to safely, effectively, and scalably optimize guideline-directed medical therapy (GDMT) in patients with HFrEF. Among 252 hospital encounters with a virtual care team-guided strategy or usual care, the virtual care team significantly improved GDMT scores (adjusted difference: +1.2). New initiations (44% vs. 23%) and intensifications of ≥1 GDMT (50% vs. 28%) were higher in the virtual care team group, while virtual care safety events were lower (21% vs. 28%).

Accurately Measuring Heart Rate Variability

Heart rate variability measurement and analysis involves two critical elements – the ability to accurately discern the R wave in noisy environments, and using the correct analysis method for a given application. Check out how Monebo’s Kinetic HRV ECG Algorithm excels at both of these essential tasks.

PIA’s Post-Processing Solution

Advanced cardiac imaging often calls for a time-consuming post-processing step, requiring costly software, hardware, and training. See how PIA provides this post-processing at lower cost, improved consistency, and greater efficiency.

Cardiovascular Structured Reporting Adoption Benefits

Check out this Change Healthcare report detailing the benefits of cardiovascular structured reporting, and how to drive structured reporting adoption in your own organization.