@ASPCardio Statement led by @DBelardoMD & myself w/ @ErinMichos @RonBlankstein @rblument1 @kcferdmd @KCKlatt @pnatarajanmd @DrOstfeld @KoushikReddyMD @deirdre_tobias @KevinH_PhD Practical Evidence-Based Approaches to Nutritional Modifications to ⬇️ #ASCVD
bit.ly/3tRD0XP Image
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.
3. Hypertension: Eating a low sodium DASH dietary pattern, rich in dietary potassium from fruits and vegetables, is recommended for the prevention and treatment of hypertension.
@kcferdmd @BakrisGeorge @NHLBI_Translate @AnastasiaSMihai @jbrianbyrd @ASPCardio
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
5. Obesity: The importance of diet for prevention of weight gain and obesity is well demonstrated, with poor nutritional habits playing a role in gradual midlife weight gain.
@bjcohenmd @EugeniaGianos @DrEugeneYang @KTamirisaMD @DrNasrien @khurramn1 @AnumSaeedMD @netta_doc
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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More from @DrMarthaGulati

Mar 14
Our paper in @JACCJournals today:
Childbearing Among Women Cardiologists
The Interface of Experience, Impact, and the Law
with my coauthors @pamelasdouglas @drmalissawood @sarma_amy @DrToniyaSingh @Drroxmehran Dr. Bairey Merz & legal experts Joan Williams,Rachel Korn,Jessica Lee Image
👉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 ImageImageImageImage
📌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 Image
Read 5 tweets
Oct 28, 2021
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

@HighSTEACS @MaasAngela @mmamas1973 @KTamirisaMD @iamritu @mswami001 @cardiojaydoc02 @onco_cardiology @ShelleyZieroth @fitmslax @DrToniyaSingh
Read 12 tweets
Sep 1, 2021
Great discussion last night with the #EMPEROR in the room
Thanks @JavedButler1 @DrNasrien @hswapnil & Dr. Bayes
If you want to view the recording the link is here:
drive.google.com/file/d/10iTYIN…

We started with @hswapnil disclosing his #flozinator status & how we all need to be as well
@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

Group Hug Endo/Cards/Nehpro

@DBelardoMD @DLBHATTMD @ChristosArgyrop
Read 7 tweets
Aug 30, 2021
#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 ImageImageImage
#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!
@NEJM nejm.org/doi/full/10.10…
@Steph_Achenbach ImageImageImageImage
#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 ImageImageImageImage
Read 4 tweets
Aug 30, 2021
#ESCCongress #HOTLINE #IAMI
Does influenza vaccination improves outcomes in patients with recent MI?
💉 Flu assoc 🫀 death
💉 Vaccine=Class 1 ESC/AHA/ACC
💉8 countries, 4 Flu seasons RCT- double blind of AMI pt, 2571 pts: mostly male (>80%)
💉28% ⬇️ events with vaccine 🆚placebo ImageImageImageImage
#ESCCongress #HOTLINE #IAMI
💉Safe, well tolerated
💉In patients with MI/high risk CAD benefit from influenza vaccination
💉Flu & CVD: 2 of the most common causes of 🏥
Vaccine ⬇️ risk of flu, all cause death and CV events now
High risk pt benefit from flu vaccine
#CVprev ImageImageImageImage
#ESCCongress #IAMI
💉Flu vaccine does ⬇️CV deaths but does not seem to ⬇️ acute CV events in post-AMI patients
💉Data clearly shows influenza vaccine is useful in high risk patients with CVD. Mechanism isn't clear but does that matter?
💉Vaccinate people after #AMI in 🏥! ImageImageImage
Read 5 tweets
Aug 29, 2021
#ESCCongress #HOTLINE #CardioTwitter #CVPrev
#SSaSS Salt Substitute and Stroke Study @georgeinstitute
🫀Included w/ prior stroke or poorly controlled BP
🫀Interventional: Salt subs
🫀 65y 50%💃 73% hx stroke
🫀3.3 SPB⬇️
🫀⬇️ stroke&CV events
🫀Salt subs is effective to ⬇️ stroke ImageImageImageImage
#ESCCongress #HOTLINE #CardioTwitter #CVPrev
#SSaSS
🫀Study could impact CVD health of the world
@NEJM Read here: bit.ly/3yuVqxU
Fantastic study!!!!!!! @ASPCardio @CardioSmart ImageImageImageImage
💥Very Important study
💥High risk group- mean age 65, 3/4 with stroke, high salt intake (but typical in the world for many)
💥5000 MACE: Power enormous
💥3mmHg SBP ⬇️
⬇️ in stroke & mortality HUGE! Simple intervention
#ESCCongress @Steph_Achenbach
#CVPrev #cardiotwitter ImageImageImageImage
Read 5 tweets

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