Dr. Daichi Shimbo on anger’s short-term (and potentially long-term) endothelial damage.

Preventive Cardiology

Aspirin’s Lp(a) Primary Prevention Potential

An observational study out of Emory suggests that aspirin could be the preventative Lp(a) treatment we’ve been looking for, finding that people with high Lp(a) levels who regularly take aspirin might significantly reduce their ASCVD mortality risks. 

The researchers analyzed 26-year outcomes from 2,990 people without clinical ASCVD (representative of 73M US adults), including 7% who regularly took aspirin, finding that…

• Among participants with high Lp(a) levels, daily aspirin-takers had far lower ASCVD mortality rates per 1,000 person-years than those who didn’t regularly take aspirin (1.2 vs. 3.9).
• Multivariable modeling revealed that regular aspirin was associated with a 52% lower risk of ASCVD mortality among high Lp(a) participants, but not in aspirin-takers who didn’t have high Lp(a).

The fact that aspirin-takers who had high Lp(a) levels had 52% lower mortality risks compared to the aspirin-takers with normal Lp(a) levels got people talking on CardioTwitter, leading to a number of theories (e.g. aspirin’s inflammation benefits), and criticisms (e.g. the study’s reliance on observational and survey data), while most online commenters called for an RCT to know for sure.

Until we get an RCT, any supporters or doubters of this research might be interested to see a pair of previous studies that found high-Lp(a) individuals who regularly took aspirin had a 46% lower risk of coronary heart disease events and 45-55% lower MACE risks.

The Takeaway

Around 20% of people have high Lp(a) levels, but there’s currently no FDA-approved Lp(a) treatment, which creates little reason for Lp(a) testing. A lot more research is needed, but if aspirin truly does prove to slash ASCVD mortality, it could address Lp(a)’s treatment and testing problems, and have a major public health impact in the process.

Monebo’s AF ECG Algorithm

Atrial fibrillation is often difficult to characterize with an automated algorithm due to the changing waveform morphology, system, or muscle noise. This is especially true given the size constraints of ambulatory devices to detect AFib. See how Monebo’s Kinetic AF ECG Algorithm overcomes these size limitations without sacrificing accuracy.

It’s Time to See The Full Picture

See how HeartFlow ONE is transforming precision heart care as the first all-in-one CCTA pathway, combining FFRCT, stenosis, and plaque analysis in a single workflow.

Your Cardiology Data is Valuable. Put it To Work.

See how one major Midwest health system’s decision to implement Merge Cardio transformed physician and staff workflows, improved data entry speed and accuracy, and increased cost savings.

The Wire

• Abbott’s Dissolving BTK Stent Approval: Abbott announced the FDA approval of its Esprit BTK Everolimus Eluting Resorbable Scaffold, which is the first scaffold of its kind that dissolves over time after it has opened blocked arteries below the knee. The Esprit stent was previously found to allow significantly greater freedom from primary events than balloon angioplasty after one year (74.5% vs 43.7%), and was superior to balloon angioplasty for reducing vessel re-narrowing and sustaining vessel openness (25.8% & 14.2% improvements).

• Anger’s Endothelial Damage: There’s plenty of data showing that anger increases the risk for heart attacks, and a new study out of Columbia University might reveal why: anger temporarily hinders blood vessels’ ability to dilate and could contribute to long-term arterial hardening. The JAHA study had 280 healthy young adults discuss personal memories that evoke different emotions for just eight minutes, finding that participants in the anger group saw their blood vessel dilation cut by more than half – peaking a whole 40 minutes after the discussion.

• Ablating AFib in HFrEF: A meta-analysis of 12 trials on AFib catheter ablation in HF patients showed that ablation reduced HF events by 41% and cardiovascular death by 51% among patients with reduced EFs (HFrEF). However, among patients with HFpEF, ablation’s benefits were negligible. The study follows the ACC/AHA’s updated guidelines, which elevated ablation to a class 1 recommended primary therapy for AFib in patients with HFrEF.

• Physician Reimbursements Down, NPPs Up: A new study from the Harvey L. Neiman Health Policy Institute suggests that physicians’ inflation-adjusted Medicare reimbursements declined by 2.3% between 2005 and 2021, while reimbursements to non-physician practitioners surged 207%. Cardiologists saw the fifth largest reimbursement declines out of 39 specialties at 29%, while cardiac surgeons had the greatest reductions with a 57.6% inflation-adjusted reimbursement decrease.

• Us2.ai’s CE AI Correlations: JACC published what might be the first study evaluating the performance of AI-automated contrast echocardiography exams, finding that Us2.ai’s echo AI solution produced LV measurements with “good to excellent agreement” with human experts. Among 171 patients’ contrast echo exams, Us2.ai successfully measured 168 (98.2%) of the exams, while AI-calculated biplane LVEDV, LVESV, and LVEF measurements demonstrated high correlations with human readers (ICC: 0.92, 0.95, 0.82).

• CardioTech’s Solid Q1: Cardiology’s medtech leaders unveiled impressive cardiology-related revenue growth in Q1, driven by solid interventional and EP sales, as well as the adoption of new technologies. The most recent reports revealed solid growth from Medtronic’s Cardiovascular units (+6.1% to $2.9B), Abbott’s Medical Device business (+14.2% to $4.4B; $2.6B cardio related), Boston Scientific’s Cardiovascular unit (+15.9% to $2.4B), J&J MedTech’s Cardiovascular business (+20.2% to $1.8B), Edwards Lifesciences (+10% to $1.6B), and AtriCure (+16.4% to $109M).

• Dollars and Sense of CHD Blood Test: Cardio Diagnostics Holdings published an economic modeling study suggesting that its AI-powered PrecisionCHD blood diagnostic could save a typical health insurer up to $113.6 million annually in secondary prevention costs by minimizing the use of more expensive conventional tests, like ECGs and CCTA. The multiomics test screens for six DNA methylation and ten genetic biomarkers, achieving decent sensitivity (79%) and specificity (76%), with testing performed at patients’ homes.

• Cardiologist vs. Cox: Missouri-based cardiologist Dr. Keesag Baron is suing local health system CoxHealth, after the system allegedly terminated his practice privileges and defamed him for referring patients to outside health systems. Dr. Baron worked for CoxHealth for several years and maintained his staff privileges after starting his private practice in 2008. However, Cox allegedly began pressuring Baron to stop referring patients to other health systems, and then took advantage of an 88-year-old patient’s death to remove his privileges, while criticizing his judgment and capabilities.

• Antimicrobials Regenerate Heart Muscle: UT Southwestern Medical Center researchers discovered that combining two FDA-approved antimicrobial drugs – paromycin and neomycin – regenerates heart muscle and could help treat heart failure. In a study published in Nature Cardiovascular Research, the team reported that the combined drugs, which target transcription factors Meis1 and Hoxb13, improved left ventricular systolic function and decreased scar formation after a cardiac injury in small and large animals.

• Fujifilm’s OPIE Transducer: Fujifilm launched a new transducer for On-Pump Intracardiac Echocardiography (OPIE), calling it the first transducer for the evaluation of ventricular thickness during septal myectomy surgery. The new OPIE Transducer allows for real-time measurements during septal myectomy surgeries, representing a major change from a historical reliance on pre-surgical transesophageal echocardiography.

• AT-001 Misses in Diabetic Cardiomyopathy: Applied Therapeutics’ aldose reductase inhibitor AT-001 failed to significantly improve exercise capacity in the Phase III ARISE-HF diabetic cardiomyopathy (DbCM) study, but it wasn’t all bad news. In 691 DbCM patients, peak Vo2 fell by more in the AT-001 group versus placebo-takers (–0.01 vs. –0.31 mL/kg/min), and participants on AT-001 who were not taking SGLT2i or GLP-1 therapy also had better exercise capacity at 15 months.

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

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Nothing Is More Expensive Than a Missed Opportunity

The emergence of AI CAC detection and new CVD treatments could transform preventative CVD care. Check out this Johns Hopkins editorial in JACC detailing how solutions like Bunkerhill Health’s Incidental CAC algorithm can create opportunities for more effective preventative CVD care, but only if providers seize that opportunity.

The Resource Wire

• How Precision Heart Care Advances the Business of Healthcare: Health systems continue to face economic and regulatory pressure to reduce care costs and improve outcomes. See how Cleerly’s precision heart care approach helps enhance patient care, avoid unnecessary and high-cost procedures, and improve the patient and provider experience.

• The Benefits of Outsourced Post-Processing: Using an outsourced cardiac image post-processing solution doesn’t have to mean sacrificing control of the results. Discover how PIA’s customizable post-processing workflow can help you get the most out of your images.

• TeraRecon’s Mitral Valve Workflow: Are your mitral valve planning workflows ready for higher procedure volumes? Take this step-by-step tour of TeraRecon’s Mitral Valve Workflow to see how it gives imagers the tools to evaluate the mitral valve and support TMVR treatment planning.

• Us2.ai’s Contrast Echo Correlations: Check out what might be the first study evaluating the performance of AI-automated contrast echocardiography exams, which found that Us2.ai’s echo AI solution produced LV measurements with “good to excellent agreement” with human experts.