Recommendations to ⬇️ #ASCVD with Nutrition: 1. Primary and Secondary Prevention of ASCVD: A diet consisting predominantly of fruits, vegetables, legumes, nuts, seeds, plant protein & fatty fish is optimal for the prevention of ASCVD
🥕🥬🥦🫑🥒🍅🧅🧄🥔🐟🍉🍒🍏🍊🍇🍋🍎🌶️🍈🍐🌿🌱
2. Hyperlipidemia: Replacing saturated fat with polyunsaturated and monounsaturated fat, reducing dietary cholesterol intake, and increasing intake of fiber rich foods, can all lead to a ⬇️ in LDL-C and apoB.
4. Type 2 Diabetes: Preventing weight gain and obesity is pivotal for diabetes prevention. Thus, effective strategies for weight loss and management are likely beneficial for mitigating diabetes progression bit.ly/3tRD0XP
6. Vitamin Supplementation: Vitamin supplementation is not routinely recommended for the prevention of ASCVD; supplementation should be individualized and recommended in those where it is necessary to meet nutrient requirements or as otherwise medically indicated.
7. Children: Primary prevention of ASCVD should begin as early as possible, emphasizing small changes in eating behaviors to promote nutrient-dense dietary patterns to establish nutrition-related goals that are focused, feasible, and measurable.
Dr. Renee Rodriguez-TY!
8. Older Adults: Nutrition therapy can have substantial benefits for individuals across the life span, including older adults with existing disease burden. Dietary recommendations to reduce cardiovascular risk should be counseled, tailored to the patient
9. Social Determinants of Health: Healthcare providers should evaluate patients for inequities in food access and socioeconomic resources, while providing culturally relevant nutrition resources when appropriate.
10. Multidisciplinary approach: Medical nutrition therapy, in collaboration with registered dietitians, results in greater improvements in cardiovascular disease risk factors and referral should be encouraged. @KCKlatt@deirdre_tobias@RonBlankstein bit.ly/3tRD0XP
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Dr. Steve Nissen #FHSummit24
#CvPrev #CardioTwitter
🚨🚨🚨We are failing patients🚨🚨🚨
🚨🚨🚨After 3 decades our practice pattern is the same
It started in the 1970’s with the Cholesterol Skeptics…& now just stronger despite all the evidence
#CVPrev #CardioTwitter
Despite trials that proved the effectiveness of statins, the next studies didn’t help convince people that lower LDL was better (commercial statin wars drove this!)
So patient remained under-treated… as they are now.
#FHSummit24
Then the REVERSAL trial shows no progression with intensive LDL ⤵️ and lower is better.
PROVE-IT showed also lower is better
And so did all these other trials…
And terms, we still don’t use intensive LDL lowering because our guidelines didn’t keep pace with the evidence
@ASPCardio Statement: Defining Preventive Cardiology
🫀Noted ⤵️ in mortality from CVD over the past several decades driven by progress in prevention
🫀More recently CVD mortality ⬆️ w/ ⬆️ risk factors at younger ages
🫀Our goal was to define the field of preventive cardiology
@ASPCardio proposed a unifying definition of preventive cardiology: proactive, patient-centered approach in which clinician, or team of clinicians and non-clinicians, assesses CV risk & implements a comprehensive strategy of risk mitigation to prevent CVD & its clinical sequelae.
CVD Prevention goes far beyond LDL.
Lifestyle Approaches are key and we have had @ASPCardio statements on this, including the role of nutrition on heart health led by @DBelardoMD and myself, with the collaboration of many others
👉Rate of ⬆️ of #WIC is just 0.3%/year
👉No Federal Mandate for Maternity Leave in🇺🇸
👉Issues related to childbearing affect practicing cardiologists
💃purpose of this study was to examine
the impact of pregnancy & maternity leave &
associated institutional policies/practices WIC
📌323 Respondents: ~35% of #WIC so quite good for a survey
📌Practices: Academic🎓/Hospital🏥/🏠Private
📌37% report extra call/service prior to MatLeave
📌<8% have RVUs prorated for MatLeave
📌41% had salary⬇️ during pregnancy year
📌23%: no paid MatLeave
The Chest Pain Guidelines are now released! ahajournals.org/doi/10.1161/CI…
Top 10: CHEST PAINS
Thanks to the entire writing group and my co-cahirs: Deb Murkerjee & Phil Levy
💥First Chest Pain Guidelines @AHAScience@ACCinTouch
Top 10 messages:
#1: Chest Pain is MORE than Pain in the chest
➡️History Matters
➡️ Assess probability of chest pain symptoms being ischemic
#2:High sensitivity troponin are useful and preferred biomarker
💥No more CK/CM, no more myoglobin
@hswapnil showed that until now for CKD, every trial of other drugs has essentially failed.
Although renal function was not a 10 (or 2o or even 3o) endpoint of EMPA trials, the benefits were seen
Work by @ChristosArgyrop (🥬Lover & #Flozinator) showed Renal & CVD benefits #SGLT2i
@hswapnil@uOttawa mentioned that mechanism of how renal protection with #SGLT2i occurs unknown. But asked the proactive question: "Does it Matter?"...and now he is a cardiologists according to @JavedButler1
#ESCCongress#HOTLINE#cvPrev#STEPStudy
Can intensive tx ⬇️ CVD risk risk HTN, older 👴🧓
🫀Optimum BP remains uncertain in older pt: differing rec's worldwide
🫀🇨🇳 age 60-80y, 9624 pts RCT, >50% Home BP cuff provided
🫀Intensive 110-130 SBP vs 130-150: 26% benefit with int tx
#ESCCongress#STEPStudy
🫀 No diff in afib, coronary revasc, Mortality but all other endpoints significant
🫀 Safe: Hypotension more common in Intensive arm but no great syncope
🫀 No subgroup diff
How low should we go? Lower! @NEJMnejm.org/doi/full/10.10… @Steph_Achenbach
#ESCCongress#STEPStudy
➡️Mean age 66 (75% below age of 70)
➡️ Most with well controlled BP at entry
Context of patient heterogenity
🫀Signif impact on CV events
🫀 Tx well tolerated & achieved! (SBP 126 Intensive)
🫀Is this SPRINT? BP achieved similar to STEP