Celine El Baou after finding that psychotherapy is associated with reduced CVD risks.

Preventive Cardiology

Unraveling Depression’s CVD Link

People with depression have up to 72% higher risks of developing cardiovascular disease, but there’s still many scientific blindspots regarding the links between depression and CVD. Two new studies added visibility to those blindspots, particularly related to prenatal depression and psychotherapy. 

Prenatal Depression’s CVD Link – A new AHA Journal study shared the first evidence that women with prenatal depression face increased CVD risks after childbirth. 

Analysis of 119k pregnancies in Maine between 2007 and 2019 showed that women with prenatal depression have 32% to 83% greater risk of developing certain CVDs within 24 months.

• These women were far more likely to experience ischemic heart disease, arrhythmia/cardiac arrest, cardiomyopathy, severe cardiac disease, and new hypertension (adjusted hazard ratios: 1.83, 1.60, 1.61, 1.39, 1.32). 
• The CVD risk increases persisted even if the women didn’t have hypertensive disorders during pregnancy.

In response, the authors urged clinicians to consider women with prenatal depression for postpartum CVD screening, while also encouraging more research into prenatal depression’s CVD risks and potential interventions. 

Psychotherapy’s CVD Impact –  Another study in the European Heart Journal provided the first evidence that depression’s CVD risks can be reduced with psychotherapy.

Analysis of 637k individuals in England who completed psychotherapy found that those whose depressive symptoms reliably improved were 11% to 12% less likely to develop CVD, coronary heart disease, and stroke (HRs: 0.88, 0.89, 0.88) at three years. 

• Individuals whose depressive symptoms improved also had far lower all-cause mortality rates (HR: 0.81)

Psychotherapy’s CVD benefits were greatest among younger individuals, as participants whose depressive symptoms improved before the age of 60 had far lower risks of CVD (15% vs. 6% reductions) and all-cause mortality (22% vs. 15% reductions) than those who improved after 60 years.

The authors highlighted lingering questions about whether there are more complex correlating factors at play (e.g. reducing depression leads to healthier lifestyle decisions). Either way, the study still states a solid case for psychotherapy’s association with CVD risk reduction, especially for those aged under 60.

The Takeaway

Although the association between depression and CVD is well established, there’s still a lot we don’t know about depression’s link to CVD and how to address it. These two studies do a good job clarifying some of those depression-CVD blindspots, potentially in actionable ways.

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.

The Wire

• Casana’s Heart Seat Clearance: Casana announced the FDA clearance of its Heart Seat smart toilet seat, which uses embedded biometric sensors to measure users’ heart rate and oxygen saturation in a way that’s equally practical and unexpected. Armed with $30M in Series B funding from last year, Casana will pursue additional FDA clearances – including systolic and diastolic blood pressure monitoring –  before beginning its commercial launch in late 2023.

• Tadalafil’s CVD Benefits: Men with CAD and ED should consider making tadalafil (aka Cialis) their ED med of choice. A Journal of Urology study analyzed 5-year outcomes from 41,287 men with CAD and ED, finding that both tadalafil and sildenafil reduced HF, MI, and overall mortality progression versus no treatment. However, individuals taking tadalafil showed far lower disease progression than those taking sildenafil (HRs: 0.85, 0.86, 0.85) or no ED treatment (HRs: 0.67, 0.75, 0.59).

• Hospital-Physician Ties = High-Intensity Care: An analysis of 14k Medicare claims in Health Affairs found that heart patients with a stable angina diagnosis were significantly more likely to receive high-intensity interventions when their cardiologists were employed by a hospital rather than if they were independent, including cardiac catheterizations (38% vs. 33%) and coronary angioplasties (14% vs. 11%). The findings led the authors to encourage policy makers to take a harder look at the incentive arrangements between hospitals and physicians.

• AI to Democratize Echo: Us2.ai just published what might be the most comprehensive paper we’ve seen on AI echo, detailing the benefits of AI-automated echocardiography, the global need for more scalable and flexible CVD assessments, and how its technology is fit for the future. We don’t usually cover marketing materials in our news roundups, but this paper is worth reviewing if you’re focused on the echo, echo AI, or echo accessibility and efficiency.

• AHA’s Heart-Healthy Diet Rankings: The AHA ranked some of the most popular diets based on its heart-healthy guidelines, with the Mediterranean and DASH diets scoring the highest, followed by pescetarian and vegetarian diets. These top-scoring diets focus on whole grains, vegetables, low-fat dairy, and unsaturated fats found in plant-based oils, fish, and nuts. Paleo and keto diets ranked the lowest due to their reliance on animal fats and carbohydrate restrictions.

• TAVR vs. Surgery in Low-Risk AS Patients: The Evolut Low Risk trial found that TAVR led to durable benefits compared to surgical aortic valve replacement over a three-year follow-up period. Among 1.4k low-risk patients with aortic stenosis, TAVR had a lower rate of all-cause mortality or disabling stroke compared to surgery (7.4% vs. 10.4%), while demonstrating superior valve hemodynamics, despite higher rates of mild paravalvular regurgitation and pacemaker placement. 

• CVAUSA Acquires Again: Cardiovascular Associates of America (CVAUSA) continued its cardiology practice acquisition spree, partnering with Northern Florida-based practice The Cardiac and Vascular Institute (26 cardiologists & APPs, 3 locations). The partnership comes one week after CVAUSA acquired NovoCardia and marks CVAUSA’s sixth new practice partnership in 2023 (12th since 2021). It also continues CVAUSA’s expansion in Florida, which it has publicly named as its initial targeted growth region.

• CCTA ML MACE Predictions: A cardiac CT machine learning algorithm was able to predict major adverse cardiac events better than traditional methods. German researchers used an ML model that combined CCTA data with clinical parameters such as patient age to assess 5,457 patients with suspected coronary artery disease. The model’s predictive power for MACE was higher than both a Cox proportional hazards model and segment stenosis scores (C-index: 0.74 vs. 0.71 & 0.69).

• CWRU & UH’s CCTA AI Grant: The NIH apparently sees similar potential in cardiac CT AI algorithms, providing a $6.2M grant to support a Case Western and University Hospitals Cleveland Medical Center project that will develop AI tools to analyze cardiac CT images and predict cardiovascular risks. The project will leverage cardiac CT exams from UH’s CLARIFY Registry, which began in 2017 when the medical center began offering high risk community members free cardiac calcium score exams, although the new AI project will study all aspects of these images.

• Adolescent Arterial Stiffness & Metabolic Syndrome: A new study out of the UK found that adolescents with arterial stiffness may have greater risk of developing metabolic syndrome, and its downstream effects (T2 diabetes, CVD, premature death). Researchers followed 3,862 adolescents from age 17 to age 24, finding that worsening arterial stiffness was associated with a 9% risk of metabolic syndrome in males (no association with females), suggesting that metabolic syndrome might be caused by arterial stiffness-related increases in their insulin resistance and low-density lipoprotein cholesterol.

• ChatGPT’s Better Bedside Manner: Buzz around ChatGPT’s healthcare impact continued this week after a study in JAMA Internal Medicine suggested that the generative AI platform has better bedside manner than most physicians. The study had ChatGPT respond to questions patients might send to their doctors, finding that in 79% of the cases, a panel of healthcare professionals rated the ChatGPT responses as more empathetic and higher-quality than those of real doctors.

• Medtronic’s Latest Micra Pacemakers Approved: Medtronic announced the FDA approval of its Micra AV2 and Micra VR2 miniaturized, leadless pacemakers, highlighting their 40% longer battery lifes (to 16yrs & 17yrs) and easier programming than prior Micra pacemakers. The new Micra AV2 includes advanced algorithms that automatically program AV synchrony, coordinating the heart’s upper and lower chambers, and also has a higher available tracking capability for faster heart rates (increased from 115 to 135 beats per minute).

Personalized Cardiac Care Through Science-Based Plaque Analysis

Check out Cleerly’s latest Cardiac Beat video, where National Jewish Health’s cardiovascular prevention and wellness leader, Dr. Andrew Freeman, and Cleerly founder and CEO, Dr. James Min, discuss addressing the root cause of heart disease and personalizing care through science-based plaque analysis.

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.

PRECISE Trial Rewrites the Patient Pathway

HeartFlow’s landmark PRECISE trial found that their precision approach for evaluating people with stable chest pain avoided unnecessary testing and improved care without putting patients at risk of a missed heart disease diagnosis.