Discover and read the best of Twitter Threads about #powerofzero

Most recents (6)

@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha hi @TheBhupiThakur

For LDL>190 mg/dl
In MESA nearly 35% have #PowerOfZero
13 yr FU, event rate 3.5% (well below threshold for statin consideration)

atherosclerosis-journal.com/article/S0021-…
@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha #2
For genetically confirmed #familialhypercholesteremia

See below, clearly not a homogenous disease, many shades of atherosclerotic disease

Events track with CAC score

With CAC zero, can possibly avoid PCSK9i (statins for all)
@rauldsf_santos @miguelcainzos23 @reed_mszar
@TheBhupiThakur @jaideeppatelmd @MichaelJBlaha @rauldsf_santos @miguelcainzos23 @reed_mszar #3 Across spectrum of Lipid disorders

Clear doesn't matter how you slice or dice the pie, the risk is related to atherosclerotic disease burden across the spectrum of lipid disorders
Read 7 tweets
Prevalence of Subclinical Coronary Atherosclerosis in General Population
@CircAHA

1/x
🇸🇪 25K randomly invited individuals w/o known CAD underwent CCTA
🇸🇪 51% women
🇸🇪 50 to 64 yrs
🇸🇪 #SCAPIS (the Swedish Cardiopulmonary Bioimage Study)

ahajournals.org/doi/10.1161/CI…
2/x
🇸🇪 42.1% any CCTA-detected atherosclerosis

🇸🇪 5.2% any significant stenosis (≥50%)

🇸🇪 1.9% LM, prox LAD or 3VCAD

🇸🇪 8.3% any non-calcified plaque

🇸🇪 plaques most common in prox LAD

🇸🇪 Participants with only non-Ca plaques were rare (2.4%)

ahajournals.org/doi/10.1161/CI…
3/x
🇸🇪 Prevalence of CCTA-detected atherosclerosis ⬆ w/ ⬆ #CAC scores

🇸🇪#CAC-positive participants:
- Most w/ low (11 - 100) or ultralow (1 - 10) scores
- median score 35 (IQR 8 - 126)

🇸🇪 participants w/ #CAC zero & interm 10-yr risk, 9.2% had CCTA-verified atherosclerosis
Read 7 tweets
While there is so much established about CAC..

for @Heart_SCCT Prevention Symposium, I was asked by @RonBlankstein to talk about

"what's next for CAC Testing in 2021 (and beyond)?"

What are the main applications in the future?

@miguelcainzos23 @jaideeppatelmd
#1 CAC has come a long way
-evolving to the needs of the past decade from screening test to a SDM tool
-best tie breaker, adding the dimension of de-risking
-cost-effective and reassuring ok to avoid treatment
-cautiously approved by ACC/AHA guidelines
@Heart_SCCT
#2
Looking forward, beyond established role as decision tool for statins and possibly ASA
we need to think beyond what the future may hold for CAC testing.

While I have a list of at least 10 applications, I will share today the top 5 immediate future roles for CAC testing
Read 11 tweets
Debate CAC vs CTA in primary prevention?
I will start with a provocative statement
Screening, foundational strategy for decades in prev cardio is a seductive paradigm
Its so 1990’s
We are barking on the wrong tree
In 2020, I will explain why this strategy is a fallacy
#ASPC2020
#1 Both primary and secondary prevention lower disease burden and outcomes
#2 Marginal benefit of extensive screening
#3 Whats left to screen? Majority already treatment candidates
#4 Our stakeholders asking for "derisking" vs "screening"

#APSC2020
-Despite being being an avid advocate of CAC screening in past, it was time to move on
-Showed 1 in 2 statin candidates have #PowerOfZero
-Proposed CAC as SDM tool
-Concept confirmed in 3 other cohorts, better than any neg marker, cost-effective, and no statin treatment benefit
Read 8 tweets
Humbly honored for this recognition today

Thank you, @Heart_SCCT and especially my friends @RonBlankstein @Agatston_Center presenting it, made it more special

Truly proud to be among the pantheon of cardiology giants who were previously recognized.
In reality honor for #PowerOfZero is really a tribute to the man with Midas touch

Privilege to work & learn so closely, this relationship blossoming not only with him but entire family

@Agatston_Center is national treasure & even today remains a source of inspiration for me🙏
Early on I was lucky to run across 3 mentors @Agatston_Center @hmkyale @rblument1 who took immense interest in our mission

I then hit #jackpot with collaboration of most dynami, smartest individuals

#PowerOfFriendship of this group been the biggest gift from this journey
Read 9 tweets
With 5 days to Chol management guidelines update @AHAMeetings..gentle reminder in @JACCJournals: It’s time to accept the #PowerOfZero.

Hope it’s not too late! @rblument1 @hmkyale @MichaelJBlaha @RonBlankstein @ErinMichos @MBittencourtMD.
Some thoughts👇
onlinejacc.org/content/early/…
#1 Going back to early 2000’s when many showed RF-based approach fell short for individual patient management decisions... aspirations for CAC ‘screening’ gained momentum, though progress stalled due to lack of RCT & waiting for prospective cohorts to confirm prognostication
#3, while hard to rationalize @NIH aversion to fund much needed RCT, sig progress with MESA & HNR confirmed CAC risk stratification capacity->In 2010 Class IIa rec for ‘screen-detect disease-treat’. At that time many hoped next guidelines update wud strengthen CAC screening recs
Read 10 tweets

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