Dr. Paul Ridker in support of therapies to reduce both inflammation and cholesterol.

Cardiovascular Disease

Inflammation’s ASCVD Risks and Potential

New data reveals that inflammation is a stronger predictor of future cardiovascular events and death than cholesterol among patients who take statins, suggesting that treatment regimens that target both LDL and vascular inflammation are more likely to reduce atherosclerotic risk compared to treatments that only target LDL.

The Lancet meta-analysis used 32k patients’ data from the PROMINENT, REDUCE-IT, and STRENGTH trials, all of whom had or were at high risk of ASCVD and were already taking statins. Across the three trial groups, baseline levels of high-sensitivity CRP (hsCRP) and LDL-C were “almost identical.” The study was also authored by leaders of the three original trials.

After adjustments, comparisons of patients in the highest and lowest hsCRP quartiles seemed to solidify residual inflammatory risk’s association with: 

• Major adverse cardiovascular events (HR: 1.31)
• Cardiovascular mortality (HR: 2.68)
• All-cause mortality (HR: 2.42)

Meanwhile, patients in the highest and lowest LDL-C quartiles revealed that residual cholesterol risk had a “neutral”  association with MACE and a “low magnitude” associated with mortality: 

• Major adverse cardiovascular events (HR: 1.07)
• Cardiovascular mortality (HR: 1.27)
• All-cause mortality (HR: 1.16)

The Takeaway

We’ve seen growing evidence that patients on statins can benefit from adjunctive LDL-lowering therapies, but this study gives a strong argument for combining LDL-reducing and inflammation-reducing therapies. If proven through future trials, that could have a major impact on ASCVD care.

The Benefits of Outsourced Post-Processing

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Democratizing Echocardiography with AI

We talk a lot about AI’s potential to expand echo access, and this Imaging Wire Show reveals that ultrasound’s AI-driven expansion might go far beyond what many of us had in mind. Check out our discussion with Duke Health’s Madhav Swaminathan, MBBS, MD and Us2.ai’s Carolyn Lam MBBS, PhD and James Hare, to see how AI is democratizing echo exams.

Overcoming Cardiovascular Data Challenges

Aggregating multisource cardiology data is a worthy mission, but it’s often thwarted by confusion and complexity. This Change Healthcare article with Dr. Jennifer Hall, chief of data science at the American Heart Association, outlines best practices to help you overcome your cardiology data challenges and start leveraging deeper insights.

The Wire

• Bioprinted Heart Patches: Australia-based researchers found that bioprinted heart tissue “patches” produced from patients’ own stem cells might be able to safely and effectively repair myocardial damage caused by heart attacks. The patches improved cardiac function in mice 28 days after MI, with three different patch techniques achieving LVEF% between 55% and 64% (vs. 41% for untreated mice). The researchers will next explore whether immune response and genetic mechanisms might explain the variations between the different patch techniques.

• Intravascular Imaging-Guided PCI’s Advantage: In a study of 1,639 patients with complex coronary artery lesions, intravascular imaging-guided PCI outperformed angiography-guided PCI. The intravascular imaging group was less likely to experience a composite of cardiac death, target-vessel-related myocardial infarction, or target-vessel revascularization (7.7% vs. 12.3%). The findings point to intravascular imaging-guided PCI’s potential to improve outcomes for patients with complex coronary artery conditions.

• HeartBeam Acquires LIVMOR: Heart attack detection startup HeartBeam acquired key assets from AFib detection company LIVMOR, rounding out its remote cardiology patient monitoring platform. The acquisition combines HeartBeam’s 3D-Vector ECG platform (heart attack detection) with LIVMOR’s Halo+ Atrial Fibrillation Detection System for (continuous cardiac rhythm monitoring), and will include LIVMOR’s patents, business contracts and relationships, key technical employees, and Samsung watch and tablet inventory. HeartBeam should have a head start integrating LIVMOR, as the companies already maintained a rebranding and IP licensing alliance.

• Email Nudges Boost Statin Prescribing: When physicians receive email reminders about proper dosing of high-intensity statins for their ASCVD patients, the medications were more likely to be prescribed and adhered to. That’s from a 15-month study involving 245 clinicians and 37k patients, finding that high-intensity statin prescribing dropped by 2.2% in the usual-care group and rose by 1.6% in the email reminder group. However, 31.6% of physicians in the intervention group dropped out of the study, possibly due to “alert fatigue.”

• EHR Alerts Double HF Prescriptions: In another alert-focused study involving 2,211 heart failure patients, real-time EHR alerts during patient visits substantially increased mineralocorticoid receptor antagonist (MRA) prescribing. During the six-month study, MRA prescriptions rose by 29.6% in the real-time alert group, 15.6% in the monthly message group, and 11.7% in the group who received no intervention. EHR-embedded real-time alerts like this may help ensure that eligible heart failure patients are receiving appropriate (and potentially lifesaving) treatments.

• Post-COVID Inflammation: University of Toronto researchers found that 11.7% of individuals who experienced acute symptomatic myocarditis following COVID vaccination still showed heart muscle inflammation in PET/MRI exams after 2.5 months (2 of 17). However, inflammation wasn’t visible in participants who had cardiac symptoms without myocarditis (0 of 17) or in asymptomatic participants (0 of 20). The researchers suggested that subclinical myocardial injury is uncommon after COVID vaccination and “symptoms alone are a poor indicator of myocardial injury after vaccination.”

• iRhythm’s Zio XT Outperforms Competitors: Results from the CAMELOT study showed that iRhythm’s Zio XT wearable ECG monitoring device achieved a higher 90-day diagnostic yield and lower 180-day retest rate than other ambulatory ECG monitors. Although 54% of patients received the rival Holter long-term continuous monitoring device, those who received Zio XT were nearly twice as likely to receive a diagnosis compared to Holter, and were nearly 30% less likely to require a retest.

• Patients’ Digital Demands: Having an online presence is quickly turning into a non-negotiable for attracting new patients, while “doctor loyalty is a thing of the past.” Those are key takeaways from a Tebra survey of 1.2k US adults, that found that 3 in 4 patients look online to research doctors or medical care, and that nearly half of patients won’t even consider a provider with few or no reviews. The report also found that patients are more likely to switch providers that offer better appointment availability (50%), quicker responses to concerns (41%), and have online access to health records (22%).

• Rheumatoid Arthritis & Heart Disease: A new study out of China identified a causal link between rheumatoid arthritis (RA) and heart disease. The study found that genetic susceptibility to RA was significantly associated with the risk of MI (OR: 1.05) and ischemic heart disease (OR: 1.0006), but not with atrial fibrillation and arrhythmia. The results suggest that controlling RA activity might reduce the risk of CVD.

• GPT-4 Hot Out the Gates: It’s been less than 48 hours since OpenAI took the lid off GPT-4 and nimble entrepreneurs have already started flooding the internet with products leveraging the multimodal model’s new capabilities. The ability to transform text and picture inputs into functioning solutions has already led to some mind blowing GPT-4 use cases: turning a sketch into a functioning website, coding video games from descriptions, and best of all (so far) – drug discovery.

• Radiation Risks to the Heart: Low doses of radiation exposure may be a greater risk to cardiovascular health than previously thought, according to a new BMJ meta-analysis. Researchers reviewed 93 studies, finding an excess lifetime risk of 2.3 to 3.9 cardiovascular deaths per 100 persons per exposure to 1 Gy of radiation. The findings have implications for some health workers who may be frequently exposed to scatter radiation.

The HeartFlow Story

Shifting the standard of care is a monumental undertaking, and yet physicians across the globe are embracing HeartFlow’s FFRct Analysis. Hear from the co-founder how HeartFlow got its start, and why physicians love it.  

Precision QRS Detection

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A New Standard of Heart Care

Open to a more personalized and proactive approach to cardiovascular care? Check out this video detailing Cleerly’s unique approach to heart disease risk assessments and care.