Johns Hopkins cardiology fellow Richard Ferraro regarding a new NEJM study finding that microplastics are commonly found in carotid plaque, and could be particularly dangerous.

Preventive Cardiology

Microplastics, Nanoplastics, and Major Cardiac Events

A landmark NEJM study revealed that many patients with carotid artery disease might have microplastics and nanoplastics (MNPs) embedded in their carotid plaque, and those patients  have a massive 4.5-fold greater risk of heart attack, stroke, or death within three years.

The researchers examined carotid plaque specimens from 257 patients with asymptomatic carotid artery disease, analyzing their plaque for the presence of 11 MNPs, and tracking the patients’ cardiovascular outcomes over 34 months.

• An alarming 58.4% of patients had polyethylene in their plaque and 12.1% had polyvinyl chloride in their plaque, while no patients had detectable levels of the nine other kinds of plastics. 
• Even more alarming, 20% of patients with MNPs experienced the primary endpoint (myocardial infarction, stroke, or all-cause death), versus 7.5% in patients without MNPs in their plaque. 
• After adjusting for variables (e.g. age, BMI, comorbidities, prior events), the presence of MNPs in plaque came with a 4.5-times higher risk of experiencing one of the primary events. Yikes.

The scientists also discovered visual evidence of MNPs’ damage to plaque, as electron microscopy showed “visible, jagged-edged foreign particles” in the MNP-containing plaques and those plaques appeared “more vulnerable, more inflamed.”

None of this sounds good, and clinicians and scientists across social media were extremely alarmed by these findings. 

However, there isn’t enough evidence to confirm that microplastics in plaque directly cause cardiovascular events, for example, the factors that helped introduce the MNPs into these patients (e.g. air pollution) could have had significant overall impacts on their health.

The Takeaway

It’s been quite a while since a study inspired such online uproar, and although we don’t know for sure that microplastics in plaque cause cardiovascular events, we have solid evidence that these patients are much more likely to experience them. We also know that their plaque appears more vulnerable. 

Let’s hope future studies lead to a better understanding of how microplastics are making it into our bodies and the harm they are causing — and they inspire action that leads to fewer and cleaner plastics.

Incidental CAC Predicts Long-Term Risks

What if you could identify which of your asymptomatic patients have high risks of future cardiac events? Stanford-led researchers used Bunkerhill Health’s Incidental CAC algorithm to do just that, finding that patients with ≥100 incidental CAC scores had a 24% 10-year risk of developing ASCVD and far higher risks of major adverse events.

ECG Data You Can Trust

Noise and artifacts can make automated ECG analysis less reliable than what’s required for the exacting standards of cardiac safety trials. Monebo’s Kinetic Intervals ECG Algorithm provides precise interval measurements between any two points on the ECG waveform, allowing clinicians to utilize data they can trust.

HeartFlow FFRCT Catches Missed Blockages

Karen Moore had always been diligent about her heart health, which is why she was concerned when she began showing symptoms of heart disease but all of her tests came back negative. See how Karen and her physician used HeartFlow FFRCT to catch a 90% blockage and place a stent in the right location, before it was too late.

The Wire

• Tendyne’s TMVR Promise: The only commercially available TMVR device is showing promising 1-year outcomes. The Abbott Tendyne prosthesis demonstrated a durable MR reduction to ≤1+ among 98% of patients, with a 1-year cardiovascular mortality rate of 17%. Notably, there were no significant differences in outcomes between “real-world” and “on-label” TMVR indications. The results offer hope for patients with severe mitral valve conditions, expanding treatment options beyond traditional criteria.

• Chamber’s VBC Seed Round: Cardiology VBC startup Chamber Cardio completed an $8M Seed round that it will use to further develop its technology and expand nationwide (it’s currently in the Mid-Atlantic region). Chamber aims to support cardiologists’ value-based care transitions by providing them with real-time insights, evidence-based guidelines, care teams, and contracting support. Chamber just launched in December and faces its share of industry and competitive challenges, but it’s backed by General Catalyst and is led by a team of healthcare and payer veterans.

• Sweetened Drinks Linked to AFib: An observational study linked self-reported consumption of sweetened drinks with higher AFib risks. In the study of 202k UK Biobank participants, drinking 67 ounces or more per week of sugar-sweetened or artificially-sweetened drinks came with 10% and 20% higher risks of developing AFib within 10 years. That doesn’t mean that sweetened drinks cause AFib, but it does show that consumption is a factor that could help predict AFib risks.

• First OTC Continuous Glucose Monitor: A landmark FDA approval just made Dexcom’s Stelo the first continuous glucose monitor that consumers can pick up over-the-counter. The Stelo not only allows diabetics to continuously monitor their blood glucose through the companion app, but will now also enable fitness-optimizers without preexisting conditions to track how diet and exercise impact their performance. We’re all-for expanding access, but early reactions are mixed on whether this could lead to consumer confusion without appropriate medical oversight.

• Shockwave Performs: A real-world Spanish registry study highlighted Shockwave Intravascular Lithotripsy’s performance with calcified coronary lesions. In the multicenter study of 435 patients, only 51% of lesions were dilatable, but stent delivery success rate jumped to 99% following Shockwave IVL treatment. A notable 66% of patients achieved the primary effectiveness endpoint (successful IVL delivery, final diameter stenosis <20%, and no in-hospital MACE), while the 30-day MACE rate was 3%.

• ADI’s Sensinel CPM Launch: Global semiconductor company ADI (aka Analog Devices, Inc) announced the FDA 510(k) clearance and commercial launch of its Sensinel Cardiopulmonary Management System. The compact wearable remote management system primarily targets heart failure, providing care teams with nine different metrics (e.g. heart sounds, heart rate, ECG) to allow clinicians to make early intervention decisions and prevent acute decompensation events.

• No Leads, No Problem for Micra: In a 5-year global study (n=1,809), Medtronic’s Micra VR leadless pacemaker experienced complications and revisions in just 4.5% of patients, significantly lower than the 8.5% rate observed with transvenous pacemakers. Notably, the Micra VR was never removed due to device-related infection. These results, along with Micra’s 6.8-year median projected battery life, makes the leadless pacemaker a solid option for long-term cardiac care.

• Lantheus Definity’s Pediatric Approval: Lantheus’ well established cardiac ultrasound agent Definity (perflutren lipid microsphere) will now be available for use with pediatric patients, following a recent supplemental new drug application approval from the FDA. Definity has been used for adult echo enhancement for over two decades, and now adds pediatric coverage with the support of three key studies showing its safety and efficacy in children with severe heart conditions. 

• UnitedHealth Cyberattack Update: UnitedHealth Group provided an update on its steps to counter the cyberattack on its Change Healthcare unit’s claims processing and payment infrastructure, which has halted medical claims processing across much of the US. The company said that electronic prescribing was fully functional on March 8, with electronic payment functionality expected by March 15 and medical claims connectivity restored March 18. UnitedHealth added that there is no evidence that any other of its systems – such as its enterprise imaging division – have been affected. 

• WhiteSwell eLYM’s ADHF Impact: Early findings from the DELTA-HF trial highlight the potential of WhiteSwell’s eLym System in alleviating congestion in ADHF patients. Following eLym treatment, the study showed a remarkable 77% drop in HF-related hospitalizations, coupled with a notable decrease in tissue congestion biomarkers. The eLym system preserved kidney function in all cases, and may be a promising adjunct for physicians treating patients with volume overload.

• Healthcare Burnout Edges Down: A new provider survey found that burnout levels have actually edged down compared to last year. Apollo Intelligence surveyed 253 US physicians in January 2024, finding that fewer reported feeling frustrated by work pressure compared to 2022 (64% vs. 70%), but the numbers are still higher than in 2021 (47%). The results align with Medscape’s recent survey, which also found burnout levels to be easing versus last year (49% vs. 53%).

Merge and Duly Health Streamline Cardiology Reporting

Over the last 10 years, Dr. Sujith Kalathiveetil of Duly Health and Care has seen a significant evolution in cardiovascular imaging and experienced a similar evolution with Merge’s cardiology solutions. See how Merge Cardio has helped make cardiology reporting more consistent, accurate, and easier to obtain for Dr. Kalathiveetil and his colleagues.

Experience the Future of Learning: Medtronic Academy 2.0 is Here!

Unlock your ultimate destination for structural heart medical education with the newly redesigned Medtronic Academy 2.0. Gain access to expert-led courses, webinars, and a wealth of resources to stay ahead in cardiovascular care. Visit now!

The Resource Wire

• Can AI Improve How We Prevent Heart Disease Progression? Tune in to Cleerly’s upcoming webinar (March 19, 2pm ET) where study leaders will discuss how the landmark TRANSFORM randomized controlled trial will test whether an AI-personalized care strategy can outperform traditional risk factor management and prevent cardiovascular events.

• Optimizing Your Post-Processing Workflow: The growth of cardiac CT and CMRI volumes and continued shortages in the imaging technologist workforce can mean big challenges for imaging organizations. Join this Cardiac Wire Show starring Precision Image Analysis’ Jim Canfield and Cleveland Clinic’s Scott D. Flamm, MD, MBA to see how outsourcing cardiac image post-processing can solve this problem, while improving efficiency, accuracy, and standardization.

• Advance Your Cardiac MR Visualization: Ready to advance your CMRI assessments? See how you could leverage TeraRecon’s Intuition Cardiac MR package for a range of cardiac anatomy and physiology evaluations, and how your peers are already benefiting from it.

• A Milestone Study for Cardiac Strain Analysis: Us2.ai’s deep learning algorithm was able to interpret echo AI left ventricular strain images with similar accuracy as conventional measurements. Read all about this milestone study and its implications for echo strain access in EHJ-Digital Health.