Randall C Thompson, MD, after finding that over a third of ancient mummies had atherosclerosis.

Preventive Cardiology

Preventive Statins Safe & Effective in Older Patients

There is little consensus on whether or when to use statins for primary CVD prevention in older patients, but a new study in the Annals of Internal Medicine provides compelling evidence for expanding statin use in this population. 

The researchers analyzed matched pairs of statin and non-statin users without pre-existing CVD in the 60-74 (73,427 pairs), 75-84 (21,340 pairs), and 85+ (2,695 pairs) age groups using EHR data from the Hong Kong Health Authority.

Over five years, they found that statin use reduced:

• Composite CVD events (MI, heart failure, or stroke) by 11%, 6%, and 15% in the three age groups.
• Composite CVD events by 23%, 21%, and 35%, among patients who adhered to their statin treatments.
• CVD event risks by 1.2% within the 75-84 age group, and 4.4% in the 85+ age group.
• CVD event risks by 5% and 12.5%, among patients who adhered to their statin treatments.

Statins also didn’t significantly increase the patients’ myopathy and liver dysfunction risks, addressing one of the main arguments against initiating statins in older patients

In other words, this data suggests that preventative statin use has significant benefits among older patients, without significant risks.

• However, observers found plenty of opportunities to poke holes in this analysis, given that it wasn’t an RCT, while others emphasized that older patients’ statin decisions should still be individualized.

The Takeaway

Few would argue against statins’ cardiovascular benefits, and most would agree that cardiovascular burdens are increasing in older populations, but many older people who might qualify for preventive statins still aren’t taking the drugs. This study might not be an RCT, but its results certainly support steering more of those at-risk older patients towards primary prevention statin therapy.

Explore the Potential of Cardio AI

Explore the potential of AI-powered cardiology solutions in this on-demand TeraRecon webinar, detailing how its Cardio Suite solutions help expedite disease diagnosis, care coordination, and provide the data to support cardiac treatment decisions.

Leveraging a Proven Echo AI Platform

Us2.ai has developed a promising new pathway for bringing custom echo AI applications into widespread clinical and commercial use – historically a challenge for algorithms produced by health systems and academic institutions. Find out how it worked in a Ugandan RHD program here.

The Wire

• Mummified Heart Disease: The modern diet and sedentary lifestyle are commonly blamed for our high rates of heart disease, but a recent study shows that CVD was also common 4,000 years ago. Researchers performed CT scans on the mummified remains of 237 adults from seven different global cultures and a range of socioeconomic classes, finding that 37% had atherosclerosis. In addition to being the most unique study we’ve covered in a while, these results highlight humans’ innate cardiovascular risks and underscore the need to control modern risk factors.

• Cardiologist Salaries Up: Doximity’s latest physician salary survey is out, revealing a solid 5.9% compensation increase across all specialties in 2023, after a 2.4% decline in 2022. The survey (n = 33k docs) also revealed that cardiologists are now the 7th-highest paid specialty at $565k annually, up from $544k in 2022 and $537k in 2021 when it was the 8th highest paid specialty.

• Angina Symptoms & PCI Outcomes: An analysis of the ORBITA-2 study shows how patients’ angina symptoms could predict PCI effectiveness. In the study of 301 patients with stable coronary artery disease, two powerful predictors of PCI success emerged: the presence of guideline-based “typical angina” or “Rose angina,” which is defined as exertional chest pain that resolves with rest. All other patients’ PCI procedures only delivered angina relief on par with placebo.

• AstraZeneca’s Oral PCSK9i Results: AstraZeneca released positive Phase 1 results for its oral PCSK9 inhibitor AZD0780, which cut LDL-C by 52% when combined with a statin over four weeks, and achieved a 78% total LDL-C reduction from baseline, while proving to be well tolerated. The results are strong enough to send AZD0780 to Phase 2 trials. Although the PCSK9i segment is currently dominated by injectables (Amgen’s Repatha & Sanofi-Regeneron’s Praluent), progress from AstraZeneca’s AZD0780 and Merck’s MK-0616 suggest that oral options might be on the way.

• MRR for STEMI Risk Predictions: Microvascular resistance reserve (MRR) is emerging as a valuable new way to diagnose coronary microvascular dysfunction and predict MACCE in post-STEMI patients. In a study of 210 STEMI patients, MRR was independently associated with MACCEs at 12 months, and its predictive AUROC curve (0.743) was comparable to fractional flow reserve (0.609), coronary flow reserve (0.762), and the index of microvascular resistance (0.781).  

• Terumo’s Perfusion Monitoring FDA: Terumo Cardiovascular announced the FDA 510(k) clearance of its next-generation CDI OneView Monitoring System, which launches with a new modular design that displays up to 22 vital patient parameters during cardiopulmonary bypass surgeries. The CDI OneView Monitoring System’s newest parameters include measured flow, cardiac index, regional cerebral oxygen saturation, oxygen extraction ratio, Area Under the DO2 Curve, and measured arterial oxygen saturation.

• CTA Overuse in Women: Heart disease is the number-one killer of women, but is coronary CT angiography overused when evaluating women for cardiovascular disease? Researchers studied 1.9k men and women, finding that women had higher negative CTA rates (45% vs. 27%), despite similar obstructive disease prevalance (4.6% vs. 6.5%). The authors encourage the use of risk-prediction tools to better select which women actually require CCTA exams.

• Vantis’ Interventional Funding: Interventional cardiology startup Vantis Vascular added another $5M in funding (total now $24M) to accelerate its product development and support the commercial launch of its CrossFAST system. Vantis’ CrossFAST Integrated Microcatheter Guide Extension is intended to provide interventionalists with enhanced control and maneuverability when delivering therapeutic devices to distal coronary or peripheral anatomies. Further out on the horizon is Vantis’ CrossSHOCK IVL System, which is positioned as a safer, faster, and more efficient addition to the booming intravascular lithotripsy segment.

• FastWave’s 30-Day IVL Outcomes: Speaking of new intravascular lithotripsy entrants, FastWave Medical announced positive 30-day results from its first-in-human study evaluating its FastWave IVL system. The prospective, single-arm study performed IVL on eight patients with moderate to severe calcified occlusions in the SFA and popliteal arteries, finding that 100% of the procedures were successful. After 30 days, no patients experienced major adverse events or revascularization, while all achieved walking and ankle-brachial index improvements.

• Redefining Periprocedural MI: The current definition of periprocedural MI might not effectively predict future events. New data from 1,010 patients undergoing elective PCI showed that periprocedural MIs identified by troponin elevation plus two or three other clinical criteria (e.g. ECG changes, angiography complications, imaging abnormalities) were associated with a fivefold higher risk of one-year mortality compared with MIs identified by only one clinical criterion.

• C-Arm Growth: Signify Research estimates that the global C-arm market will grow from $4.2B in 2023 to $5B by 2028, as both the Interventional X-ray and Mobile C-arm segments maintain steady growth (+3.9% & +5.2% annually). Cardiology will be the fastest growing segment in the interventional X-ray market, driven by an expanded list of structural heart procedures (e.g. mitral valve replacement), TAVR growth, and more demand for ablation therapy.

Cleerly Transforms Personalized CVD Care

Cleerly is launching perhaps the first large-scale randomized imaging AI trial, as it seeks to prove that AI-guided cardiovascular care reduces heart attacks. The five year TRANSFORM trial will investigate whether CVD patients who receive treatments based on results from Cleerly’s investigational AI-based plaque staging system have better outcomes.

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.

The Resource Wire

• 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!

• From CPACS to CVIS: Cardiovascular imaging has come a long way from CPACS. Explore the evolution of cardiology image and data management in this Merge by Merative executive brief, and see what makes CVIS such a significant advancement.

• 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.

• The Bunkerhill Blueprint: Advancing an AI solution from concept to clinic used to take years, but Bunkerhill Health is closing that gap at lightning speed. See how Bunkerhill is streamlining AI training, validation, approval, and commercialization to get better AI tools into clinical practice, faster.

• Precision QRS Detection: QRS detection is essential for any ECG algorithm, and Monebo’s Kinetic QRS ECG Algorithm sets the standard for accuracy. Kinetic QRS accurately detects the QRS complex, no matter the amplitude, waveform, or noise levels.