In this post hoc analysis, the frequency of occurrence of an early decline ("dip") in estimated glomerular filtration rate (eGFR) after initiation of dapagliflozin, and its association with outcomes, was evaluated in heart failure patients participated in DAPA- HF trial. The mean change in eGFR between day 0 and 14 was -1.1 with placebo and -4.2 with dapagliflozin, giving a intergroup difference of 3.1. Overall, 38.2% of patients — with older age, lower baseline eGFR, higher LVEF, and type 2 dia...
May 04, 2022•2 min•Season 1Ep. 51
As we know, Lipoprotein(a) [Lp(a)] is an established risk factor for coronary artery disease, large artery stroke, and aortic valve stenosis. The authors measured and genetically predicted lipoprotein(a) [Lp(a)] levels of 4, 35,579 participants from the UK Biobank to investigate the role of Lp(a) in atrial fibrillation (AF) and whether its association is independent of atherosclerotic cardiovascular disease. Interestingly, it was found that there was a 3% increased risk of AF for every 50 nmol/L...
May 04, 2022•2 min•Season 1Ep. 50
This post hoc analysis of the ADAPT-DES study investigated the predictors of dual antiplatelet therapy (DAPT) discontinuation, associations between different types and timing of DAPT discontinuation with thrombotic events, and the impact of on-treatment high platelet reactivity in 8582 patients who were already receiving aspirin and clopidogrel after undergoing PCI. In result it was seen that approximately 50% of patients discontinued DAPT within 2 years, with unplanned DAPT discontinuation occu...
May 04, 2022•2 min•Season 1Ep. 49
This study compared the dementia incidence rate between users and nonusers of oral anticoagulants (OACs) in a large Australian cohort of primary care patients with atrial fibrillation. During the mean follow‐up time of 3.7 ± 2.0 years, 425 patients had a documented diagnosis of dementia. After propensity matching, the incidence of dementia was significantly lower in OAC users (hazard ratio [HR], 0.59; compared with nonusers. Direct‐acting oral anticoagulant users had a lower incidence of dementi...
Apr 04, 2022•2 min•Season 1Ep. 48
Efpeglenatide, is a novel, exendin-4-based weekly GLP-1 Receptor agonist that is administered subcutaneously, it effectively lowers glucose levels in people with T2DM. Recent guidelines have placed this class of agents as first-line glycemic-lowering therapy in people with baseline CVD, high risk for CVD, or chronic kidney disease (CKD) The AMPLITUDE-O Trial enrolled 4,076 adults with T2DM who had an HbA1c >7.0% and either a baseline history of CVD (89.6%) or diabetic kidney disease (DKD) wit...
Apr 04, 2022•4 min•Season 1Ep. 47
Take-Home Message No. 1 Guideline-directed medical therapy (GDMT) for HF with reduced ejection fraction (HFrEF) now includes 4 medication classes 1) renin-angiotensin system inhibition with angiotensin receptor-neprilysin inhibitors (ARNi), angiotensin-converting enzyme inhibitors (ACEi), or angiotensin (II) receptor blockers (ARB) alone; 2) beta blockers; 3) mineralocorticoid receptor antagonists (MRAs); and 4) the new group, SGLT2i Take-Home Message No. 2 Mildly reduced LVEF has new medication...
Apr 04, 2022•6 min•Season 1Ep. 46
There is a need to identify high-risk features that predict early-onset atherosclerotic cardiovascular disease (ASCVD). The authors provide insights to help clinicians identify and address high-risk conditions in 20- to 39-year age young adults. The authors update current thinking on lipid risk factors such as triglycerides, non-high-density lipoprotein cholesterol, apolipoprotein B, or lipoprotein (a). The authors review emerging strategies, such as coronary artery calcium and polygenic risk sc...
Apr 04, 2022•5 min•Season 1Ep. 45
It has been controversial regarding blood pressure (BP) levels at which antihypertensive drug therapy should be started, and the adequate Blood pressure goal to be achieved following antihypertensive drug therapy in women with hypertensive disorders of pregnancy (HDP), which includes chronic hypertension (CH) as well as hypertension occurring at or after 20 weeks of gestation. The Japan Society for the Study of Hypertension in Pregnancy (JSSHP) committee previously recommended that ● antihyperte...
Mar 04, 2022•4 min•Season 1Ep. 44
Chloride is among the major electrolytes that play a unique role in fluid homeostasis and is associated with cardiorenal and neurohormonal systems. Various HF therapies may cause hypochloremia, and hypochloremia itself can initiate and exacerbate diuretic resistance in HF. The increasing burden of heart failure (HF) and emerging knowledge regarding chloride as a prognostic marker in HF have increased the interest in the pathophysiology and interactions of chloride abnormalities with HF-related f...
Mar 04, 2022•2 min•Season 1Ep. 43
Tirzepatide is a dual GIP and GLP-1 receptor agonist under development for the treatment of type 2 diabetes mellitus (T2DM), obesity, and nonalcoholic steatohepatitis. Early phase trials in T2DM indicate that tirzepatide improves clinical outcomes beyond those achieved by a selective GLP-1 receptor agonist like dulaglutide Improved glycemic control was associated with lower circulating triglycerides and lipoprotein markers and improved markers of beta-cell function and insulin resistance (IR) In...
Mar 04, 2022•3 min•Season 1Ep. 42
Systematic review and meta-analysis of 10 real-world observational studies including patients with not valvular atrial fibrillation NVAF on apixaban and rivaroxaban was done to compare the efficacy and safety of apixaban and rivaroxaban for the prevention of stroke. Surprisingly, apixaban treatment showed significantly lower hazard of 0.8 or 20% Risk reduction in stroke/systemic embolism compared to rivaroxaban. Also, meta-analysis for a major bleeding episode was significantly lower with 38% RR...
Mar 04, 2022•2 min•Season 1Ep. 41
Patients who undergo percutaneous coronary intervention (PCI) with drug-eluting stents require dual antiplatelet therapy (DAPT) for at least 6 months for stable ischemic heart disease (SIHD) or 12 months for acute coronary syndromes (ACS) to prevent stent thrombosis and other cardiovascular events (1). The rationale for using DAPT is that aspirin and a P2Y12 antagonist (such as clopidogrel, prasugrel, or ticagrelor) separately inhibit the c (COX-1) and the adenosine diphosphate–dependent pathway...
Jan 31, 2022•6 min•Season 1Ep. 40
The 3 topic is on the top 10 messages we should know about the American College of Cardiology (ACC)/American Heart Association (AHA)/Society for Cardiovascular Angiography and Interventions 2021 coronary artery revascularization guideline Top 10 Take-Home Messages 1. Treatment decisions regarding coronary revascularization in patients with coronary artery disease (CAD) should be based on clinical indications, regardless of sex, race, or ethnicity, 2. In patients being considered for coronary rev...
Jan 31, 2022•4 min•Season 1Ep. 39
As we have seen so far Real-world studies have evaluated the use of anticoagulants in obese patients with nonvalvular atrial fibrillation (NVAF), but they have been limited by sample size or the use of diagnosis codes on claims to define obesity. In a retrospective study of 26,522 NVAF patients with body weight of ≥100 kg or a body mass index of ≥30 kg/m2 , were enrolled from Veterans Affairs and fee-for-service Medicare system. The study evaluated the risk of stroke/systemic embolism (SE) and m...
Jan 31, 2022•3 min•Season 1Ep. 38
Lipoprotein (a) [Lp (a)] is associated with an increased risk of myocardial infarction, although the mechanism for this observation remains uncertain. Objectives A study was conducted to investigate whether Lp(a) is associated with adverse plaque progression. Methods In this study Lp(a) was measured in patients with advanced stable coronary artery disease undergoing coronary CT angiography at baseline and 12 months to assess progression of total, calcific, noncalcific, and low-attenuation plaque...
Jan 31, 2022•3 min•Season 1Ep. 37
Background: EXPLORER-HCM demonstrated that mavacamten, a cardiac myosin inhibitor, improves symptoms, exercise capacity, and left ventricular outflow tract (LVOT) obstruction in patients with obstructive hypertrophic cardiomyopathy (oHCM). Objectives: The purpose of this study was to evaluate mavacamten's effect on measures of cardiac structure and function and its association with changes in other clinical measures. Methods: Key echocardiographic parameters from serial echocardiograms over 30 w...
Dec 31, 2021•3 min•Season 1Ep. 36
Background: The use of β-adrenergic receptor blocking agents in symptomatic patients with obstructive hypertrophic cardiomyopathy (HCM) rests on clinical experience and observational cohort studies. Objectives: This study aimed to investigate the effects of metoprolol on left ventricular outflow tract (LVOT) obstruction, symptoms, and exercise capacity in patients with obstructive hypertrophic cardiomyopathy. In this double-blind, placebo-controlled, randomized crossover trial 29 patients with o...
Dec 31, 2021•4 min•Season 1Ep. 35
1. GIRAF trial was created with a multicenter, randomized, prospective parallel, active-controlled blinded design and conducted in 6 centers in Brazil., the trial assessed multiple cognitive outcomes in a cohort of patients randomized to 110 or 150 mg of dabigatran twice daily or once-daily warfarin. 2. The trial enrolled and randomized 200 patients. For inclusion in the trial, patients needed to have confirmed atrial fibrillation or atrial flutter, a CHA2DS2-VASc Score greater than 1, and be ag...
Dec 31, 2021•4 min•Season 1Ep. 34
1. The study randomized 1,242 patients undergoing knee arthroplasty to one of seven postoperative regimens of milvexian (25 mg, 50 mg, 100 mg, or 200 mg twice daily or 25 mg, 50 mg, or 200 mg once daily) or the anticoagulant enoxaparin (40 mg once daily). The primary efficacy outcome was venous thromboembolism, and the primary safety outcome was bleeding. 2. Results found that in those patients taking milvexian twice daily, venous thromboembolism developed in 21% population taking 25 mg, in 11% ...
Dec 31, 2021•3 min•Season 1Ep. 33
The goal of the trial was to evaluate empagliflozin compared with placebo among patients with acute decompensated heart failure. Empagliflozin is a sodium-glucose cotransporter-2 (SGLT2) inhibitor, which has been shown to reduce the risk of cardiovascular death or heart failure hospitalization among patients with chronic heart failure. 530 participants with acute heart failure were randomized to empagliflozin 10 mg daily versus placebo. Their mean age was 71 years, 47% were diabetics, and were f...
Dec 03, 2021•2 min•Season 1Ep. 32
The investigational PCSK9 inhibitor of Merck, MK-0616 — comes in pill form, in contrast to the three currently available PCSK9-lowering drugs that must be given in injections separated by weeks to months. In two phase-1 studies with a total of 100 participants, MK-0616 was given daily for 2 weeks on a background of statin therapy for 14 days The drug exhibited a dose-dependent increase in plasma exposure and > 90% mean maximum reduction of free plasma PCSK9 levels from baseline at all dose le...
Dec 03, 2021•2 min•Season 1Ep. 31
Prolonged use of dual antiplatelet therapy (DAPT) following PCI may be associated with reduced benefits and greater harms in “real-world” clinical practice in contrast to outcomes of the DAPT Study The study included 8,864 patients from the DAPT study and 568,540 registry patients. Longer-duration P2Y12 inhibitor therapy in the DAPT cohort was associated with a 1.01% decrease in-stent thrombosis, 1.9% decrease in major adverse cardiac and cerebrovascular events and a 2.27 decrease in MI but a 0....
Dec 03, 2021•2 min•Season 1Ep. 30
In this trial, the safety and efficacy of bentracimab was assessed in reversing the antiplatelet effect of ticagrelor among patients needing urgent surgery or a procedure, or with major bleeding. 150 patients with a mean age of 65 years who either needed urgent surgery or a procedure or with major bleeding were enrolled in an open-label single-arm study. On day 1, patients received an intravenous (IV) infusion of an initial IV bolus of 6 g infused over 10 minutes for rapid reversal, followed imm...
Dec 03, 2021•3 min•Season 1Ep. 29
Direct oral anticoagulants have been evaluated in the general population, but proper evidence for their safe use in the geriatric population is lacking. This study compared the bleeding risk of a direct oral anticoagulant (rivaroxaban) and vitamin K antagonists (VKAs) among French geriatric patients aged 80 years and above with non-valvular atrial fibrillation (AF) In this sequential observational prospective cohort study, data from 33 geriatric centres comprised of 908 patients newly initiated ...
Nov 02, 2021•2 min•Season 1Ep. 28
The role of diuretics in patients with intermediate-risk pulmonary embolism (PE) is controversial. In this multicentre, double-blind trial, normotensive patients with intermediate-risk Pulmonary Embolism were randomized to receive either a single 80 mg bolus of furosemide or a placebo. Eligible patients had at least a simplified PE Severity Index (sPESI) ≥1 with right ventricular dysfunction. The primary efficacy endpoint assessed 24 h after randomization included (i) absence of oligo-anuria and...
Nov 02, 2021•3 min•Season 1Ep. 27
Patients at high bleeding risk represent a prevalent subgroup among those undergoing percutaneous coronary intervention. Early aspirin discontinuation after a short course of dual antiplatelet therapy (DAPT) has emerged as a bleeding avoidance strategy. The aim of this study was to assess the effects of ticagrelor monotherapy in reducing the incidence of primary endpoint of 2, 3, or 5 BARC bleeding after 3-month dual antiplatelet therapy in a contemporary high bleeding risk population. Event-fre...
Nov 02, 2021•3 min•Season 1Ep. 26
Statin therapy has been associated with increased insulin resistance; however, its clinical implications for diabetes control among patients with diabetes is unknown. To assess this, a large retrospective cohort study was conducted with 12 years data of 83, 022 propensity-scored matched pairs of statin users and nonusers covered by the US Department of Veterans Affairs from fiscal years 2003 to 2015. Patients included were 30 years or older; diagnosed with diabetes during the study period; and w...
Nov 02, 2021•3 min•Season 1Ep. 25
Severe coronavirus disease-2019 (COVID-19) can progress to an acute respiratory distress syndrome (ARDS), which involves alveolar infiltration by activated neutrophils. The beta-blocker metoprolol has been shown to ameliorate exacerbated inflammation in the myocardial infarction setting. The purpose of this study was to evaluate the effects of metoprolol on alveolar inflammation and on respiratory function in patients with COVID-19-associated ARDS. Methods: A total of 20 COVID-19 patients with A...
Oct 04, 2021•3 min•Season 1Ep. 24
Finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist, has favorable effects on cardiorenal outcomes in patients with predominantly stage 3 or 4 chronic kidney disease (CKD) with severely elevated albuminuria and type 2 diabetes. The use of finerenone in patients with type 2 diabetes and a wider range of CKD is unclear. In this double-blind trial, patients with CKD and type 2 diabetes were randomized to receive finerenone or placebo. Eligible patients of stage 2 to 4 CKD had...
Oct 04, 2021•3 min•Season 1Ep. 23
Background: Even when low-density lipoprotein-cholesterol (LDL-C) levels are lower than guideline thresholds, a residual risk of atherosclerosis remains. It is unknown whether triglyceride (TG) levels are associated with subclinical atherosclerosis and vascular inflammation regardless of LDL-C. Objectives: This study sought to assess the association between serum TG levels and early atherosclerosis and vascular inflammation in apparently healthy individuals. Methods: An observational, longitudin...
Oct 04, 2021•3 min•Season 1Ep. 22
