Senator Bernie Sanders to Novo Nordisk CEO Lars Fruergaard Jørgensen in a hearing regarding the company’s hefty GLP-1 prices.

Preventive Cardiology

Cancer’s CVD Risks and SGLT2is’ Preventative Potential

Better treatments have led to improved cancer survival rates, but new research reveals increased cardiovascular complications in survivors. However, another new study offers hope, suggesting that heart medications like SGLT2 inhibitors may help prevent cancer-related heart disease.

A new Cancer Journal study showed that older cancer survivors have far higher rates of cardiovascular events than their peers who never had cancer. The study analyzed 15,454 ASPREE trial participants (all ≥65yrs) who had no history of cancer, including 1,392 (9%) participants who were later diagnosed with cancer and didn’t have a history of CVD.

• Those cancer survivors proved two-times more likely to develop CVD than participants who never had cancer (21 vs. 10 events per 1k person years).
• Patients treated with chemotherapy had two-times higher CVD incidence, while surgically-treated patients had 56% lower CVD rates.
• CVD risk was greatest soon after cancer diagnosis (potentially due to chemo), and remained elevated across the 4-year follow-up period.

The authors attributed cancer’s CVD risks to a range of factors, including chemotherapy’s already-established CVD risks, but also the two diseases’ shared risk factors (e.g. smoking) and cancer-induced risk factors (e.g. inflammation). They also called for more efforts to expand cardiovascular screening and management efforts among cancer patients.

Another well-timed JACC study suggests that SGLT2 inhibitors could help mitigate cancer treatments’ cardiovascular risks. The study retrospectively analyzed 17,350 cancer patients with type 2 diabetes undergoing chemotherapy with cardio-toxic effects, half of whom were taking SGLT2 inhibitors.

• The SGLT2i-treated patients had a 24% lower risk of developing cancer therapy-related cardiac dysfunction, and a 19% reduction in heart failure exacerbations.
• The SGLT2i group also had 33% lower risk of all-cause mortality and 7% lower risk of all-cause hospitalizations or ED visits.
• A subgroup analysis also showed that SGLT2i patients had lower risk of cancer therapy–related cardiac dysfunction across the various classes of cancer therapies.

The Takeaway

The fact that a cancer diagnosis is often followed by cardiovascular events is one of the many harsh realities of the disease, but this new JAMA study suggests that some heart meds might be able to prevent cancer’s cardiovascular risks. More research is needed before we see increased use of preventative CVD meds among cancer patients, but studies like these seem like a solid first step.

Where to Go for Cardio AI?

TeraRecon’s Cardio Suite is a collection of hand-selected, vendor-neutral Cardiology AI algorithms that aid in the analysis and interpretation of echocardiograms and chest CTs. Learn about TeraRecon’s AI offering and how they improve efficiency and accuracy here.

New Horizons in Structural Heart

TAVR and TMVR rates are rising rapidly, placing more pressure on interventional planning. Tune into this Circle CVI and Radcliffe Cardiology breakout detailing how to leverage modern CT workflows to produce efficient and accurate pre-procedural plans.

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.

The Wire

• J&J’s Cardiometabolic Shutdown: Reports from Endpoint News suggest that Johnson & Johnson is shutting down its cardiovascular and metabolic pharma unit, largely laying off employees in sales, marketing, and medical affairs. Although speculative, the shutdown might be related to J&J’s blockbuster anticoagulant Xarelto’s patents expiring in mid-November. Meanwhile, J&J Medtech is clearly looking to grow its cardiovascular footprint, after making some of cardiology’s biggest acquisitions of the last few years.

• Can’t RELIEVE-HF with Interatrial Shunting: The RELIEVE-HF trial found that transcatheter interatrial shunt implantation doesn’t improve HF patients’ outcomes compared to placebo (win ratio 0.86, P=0.20). Shunt group patients with reduced LVEF did have far fewer CV events (49% vs. 88.6%), however, patients with preserved LVEF experienced far more CV events with the shunt (60.2% vs. 35.9%), suggesting differing impacts based on LVEF status.

• Cardiac MRI Predicts NIDCM Risks: A JAMA study showed that cardiac MRI can help identify which patients with nonischemic dilated cardiomyopathy face the greatest risks, and would benefit the most from receiving an implantable cardioverter-defibrillator (and which might not need ICDs). The meta-analysis of 103 studies and 30k NIDCM patients found that CMRI late gadolinium enhancement was associated with higher risks of all-cause mortality (HR=1.81), cardiovascular mortality (HR=2.43), and heart failure (HR=1.98). Even though it’s the current standard, LVEF was not predictive of NIDCM outcomes.

• Better Diuresis AT-HOME: The AT-HOME HF pilot study involving 34 patients on novel subcutaneous (SC) furosemide and 17 patients receiving usual care (oral diuretic strategy) found that SC furosemide led to a 2.02kg greater reduction in weight loss, improved dyspnea scores, and better 6-minute walk tests. However, the primary composite endpoint (including cardiovascular death and HF events) was not statistically significant.

• Mediwhale’s Retinal AI Funding: Retina AI-based cardiovascular screening gained more momentum last week, after South Korean startup Mediwhale landed a $12M Series A2 round (total now $23M). Mediwhale will use its new capital to enhance its AI algorithms, develop a new CKD solution, and bring its Reti-CVD solution for early cardiovascular disease detection into the U.S. Although retina-based CVD screening is at a very early stage, we’re seeing a growing number of startups in this segment landing solid funding rounds, including Toku, Obtain, and Eyenuk.

• Tragus Stimulation for HTN: In a small trial, young patients with class I hypertension treated with low-level tragus stimulation (LLTS) had greater reductions in systolic blood pressure (12mmHg vs. 7mmHg) and diastolic pressure (5mmHg vs. 2mmHg) after three months compared to controls. The technique, which stimulates the vagus nerve through the ear, shows how neuromodulation could be a promising approach for hypertension treatment and warrants larger randomized trials.

• Medtronic’s ECMO Launch: Medtronic hit a major milestone following its MC3 Cardiopulmonary acquisition with the launch of its VitalFlow ECMO system. VitalFlow is a configurable one-system ECMO, intended to bridge the gap between bedside care and intra-hospital transport, while placing a focus on simplicity and ease of use. The VitalFlow ECMO is the first innovation to come from Medtronic’s acquisition of ECMO-maker MC3 Cardiopulmonary, following an eight-year exclusive distribution agreement.

• BAC Linked to Cardiac Risk: More evidence emerged linking breast arterial calcification to ASCVD. Researchers tracked 383 women, finding that those with BAC on their mammograms were far more likely to experience ASCVD events over 18 years of follow-up (23% vs. 14%), suggesting that BAC status could become a more prominent cardiovascular risk factor.

• Dario Integrates Twill Behavioral Capabilities: Chronic condition management company DarioHealth is integrating Twill’s condition-specific peer groups into its cardiometabolic solution to improve member engagement and outcomes. The integration allows Dario members across its programs for diabetes, hypertension, and weight management to join Twill’s intertwined approach of community support groups, medical expert advice, and customized educational content. When Dario acquired Twill in February, it said it expected moves like this to double its revenue before the end of the year.

• Screening Alone Can’t Keep Pace: A study of 1.2k patients with pacemakers found that echo screening identified left ventricular systolic dysfunction in 34% of the patients. However, screening did not significantly reduce HF hospitalizations or death compared to usual care over 31 months (18% vs. 19%, HR 0.89). Better outcomes occurred when LVSD was managed in a HF clinic rather than in primary care, suggesting that both screening and specialist care is needed to improve outcomes.

• Poor CHD Guideline Adherence: The INTERASPIRE study revealed significant shortcomings in secondary prevention for coronary heart disease and low adherence to guideline-based care. In the study of 4,548 patients hospitalized with CHD across 14 countries, the share of patients achieving treatment targets was very low for blood pressure (38.6%), LDL-C (16.6%) and HbA1c (55.2%), while only 9% were referred to cardiac rehab.

SYMPHONY-HF Starts Recruiting

The SYMPHONY-HF trial – designed to evaluate heart failure screening outside of hospital settings – is now recruiting patients across five countries. See how this combination of Us2.ai’s AI-automated echo reports and NT-proBNP blood testing might help identify more HF patients while it’s still early.

Identify and Treat Cardiovascular Disease

Complex care pathways make getting patients to the next step a challenge. See how Tempus Next, an AI enabled care pathway platform, helps providers identify and reduce under treatment in cardiovascular disease by adding an intelligent layer onto their routinely generated EHR data.

Catch up on 2024’s Cardiology Coffee Breaks

Join GE HealthCare on a journey to bridge the gaps to connected cardiovascular care with this season’s Cardiology Coffee Breaks. In the time it takes you to finish your coffee, these Coffee Breaks demonstrate how GE’s integrated solutions empower healthcare organizations to provide precision care, achieve operational efficiency, and enhance patient satisfaction.

The Resource Wire

• Tracking Your Post-Treatment Plaque: Tune-in to this on-demand Cleerly webinar where preventative cardiologist John Osborne, MD, PhD, FACC, FNLA explores how to use CTA to track plaque progression and identify residual risk post-treatment.

• Redefining Percutaneous Coronary Intervention: Learn about the AGENT™ Drug-Coated Balloon from Boston Scientific and how this technology is expanding the treatment options for patients with in-stent restenosis in the U.S. Rx only. (Sponsored by Boston Scientific)

• HeartFlow FFRCT Avoids Invasive Cath: Despite being conscious about his heart health, 60-year old Mike Gartman suddenly experienced classic symptoms of CAD. See how Mike’s HeartFlow FFRCT Analysis results allowed him to avoid the invasive procedure altogether and gain peace of mind about his disease.

• How UCSD Improved Post-Stroke Care: Viz Connect improves the monitoring of stroke patients with suspected AFib without adding layers of complexity to the clinical workflow. Hear from Brett C. Meyer, MD, on the impact it has had on post-acute stroke patient care at UCSD.

• How to Identify and Treat More CVD Patients: Do you know how many patients with high CVD risks are in your chest CT archive? See how the Stanford Health Care System used Bunkerhill Health’s Incidental CAC algorithm to screen its previous non-gated chest CTs, identify patients with coronary calcium, and get them on statins.

• Improve Clinical Efficiency with Structured Reporting: Structured cardiovascular reporting enhances clinical efficiency, improves diagnostics, and streamlines billing. See how it might impact your team in this Optum report.

• 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. 

• Transform CVIS Workflows: See why Merge Cardio is a 2024 Best in KLAS cardiology solution, and how it can help improve your cardiology workflows, simplify data collection, and automate cardiology reporting.

• 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 Industry Wire

1. LAPD officer’s gun sucked into MRI machine during raid.
2. Dems introduce legislation to permanently lower ACA plan costs. 
3. Cardinal Health acquires Integrated Oncology Network for $1B.
4. CDC: 40.3% of U.S adults are obese, 46.5% of adults aged 40-59.
5. VA’s new Oracle EHR saw 826 ‘major’ incidents since its launch.
6. U.S. House committee passes rare pediatric disease drug bill.
7. 29% of Americans have undiagnosed iron deficiency.
8. Senate holds Steward Health CEO in criminal contempt.
9. PA-based system fires workers for sharing inappropriate patient images.
10. Providers say reimbursement denials are getting worse.