Claire Davies Profile picture
Nov 16, 2022 12 tweets 5 min read Read on X
Catching @drsarahjdavies and @drnkan in the heart🫀and kidney clinic letting us know about reducing CV events

🧵 ⬇️ @UKCPADiabetes @UKCPACardiac @diabetespc #DPC22
CVD remains responsible for 24% of deaths in the UK

1 death every 3 minutes ⏱️
Range of modifiable and non-modifiable factors which can be discussed in clinic appointments

Individualised advice is 🔑

Biggest risk of having a CV event is having already had one!
Insulin resistance results in ⬆️ triglycerides

Triglycerides help identify adults treated with statins still at CV risk
Do we need to take fasting lipids? Evidence shows there is very little difference between fasting and non fasting results. Non-fasting nicer for pts

If triglycerides 5 or above then repeat fasted!

uACR - don’t need a morning urine sample @drsarahjdavies “any wee will do”
Thinking beyond statins and ezetimbe.

Icosapent ethyl vs placebo significant reduction in first, second, third and fourth events! REDUCE-IT trial

Generally well tolerated, few adverse events

NNT of 10 people with diabetes and CVD
Practicalities

Licensed indication in SPC differs to NICE TA - TA based on trial data (hence mention of fasting trigs)

Remember CV event does not just mean heart event! Can be a vascular event, don’t forget the V in CV
Dosing 2 BD : 998mg

No titration. Take with food as it is a pro drug, needs pancreatic enzymes to bring it to life 🧨
Try to move away from the fire and forget approach for lipid management, i.e add the drug and forget. Now know the risk of CV events remains despite statin or ezetimbe Tx

Now have more 💊 options available
Case studies
1. Make sure STATIN titrated to max tolerated dose. But trigs still high

Patient A - think about injectables 💉 - depending on service might need secondary care input

Patient B - consider orals, icosapent ethyl
Summary:
Trial data here: nejm.org/doi/full/10.10…

• • •

Missing some Tweet in this thread? You can try to force a refresh
 

Keep Current with Claire Davies

Claire Davies Profile picture

Stay in touch and get notified when new unrolls are available from this author!

Read all threads

This Thread may be Removed Anytime!

PDF

Twitter may remove this content at anytime! Save it as PDF for later use!

Try unrolling a thread yourself!

how to unroll video
  1. Follow @ThreadReaderApp to mention us!

  2. From a Twitter thread mention us with a keyword "unroll"
@threadreaderapp unroll

Practice here first or read more on our help page!

More from @claireyrivs

Nov 16, 2022
Lots and lots of #lipids today @diabetespc this time with @PNewlandJones covering the fundamentals we all need to know for #PLWD

Once again standing room only!
And managed to catch his eye to say 😀 for the camera 📸 Image
Phil explaining how lipids have become unnecessarily complicated

We have gone from one medicine and one back up to multiple options for lipid management

Today going to take things back to fundamentals
How complicated lipids can be in one diagram 🖼️

Take away point: multiple mechanisms to lower lipids, work on different parts of the pathway Image
Read 19 tweets
Aug 28, 2022
A 🧵for anyone prescribing, monitoring or seeing people on drug Tx for HF from @escardio #esc2022

"The practicalities of drug treatment in HF" 💔💊 with lots and lots of top tips⤵️

Great advice from conference that you can apply day to day! @GoggleDocs @UKCPACardiac @UKCPA
ESC Guidelines for HFrEF treatment:

Look at the quality of that evidence and recommendations for drug Tx! 😃💊 Image
Beta-blockers:
- start low, go slow
- ALWAYS titrate 📈for maximum benefit
- intolerance likely to resolve with time ⏲️ ImageImage
Read 13 tweets
Aug 28, 2022
Getting my #flozin fix on a Sunday catching up on #ESC2022 #ESCCongress2022 some thoughts in a thread 🧵 @UKCPACardiac @UKCPA @UKCPADiabetes
@escardio @hFRenDsUK

Let's start with the headline, drum roll please 🥁... Dapagliflozin in HFmrEF and HFpEF DELIVER Trial results
1. Background💔
HFpEF pts represent approx 50% of all people with HF
Currently limited Tx options in this group
Uncertainty remains re:
- People in highest part of EF range, ?attenuation of Tx effect
- People initiated on Tx during/soon after hospitalisation
- EF improved to >40%
2. Trial design, Endpoints and Flow
Note: either ambulatory or hospitalised patients
6236 patients. 3131 received dapagliflozin. Across 20 countries 🗺️
Follow up - 2.3 years
Equal drop out and incomplete follow up in Tx and in placebo arms ImageImageImage
Read 12 tweets

Did Thread Reader help you today?

Support us! We are indie developers!


This site is made by just two indie developers on a laptop doing marketing, support and development! Read more about the story.

Become a Premium Member ($3/month or $30/year) and get exclusive features!

Become Premium

Don't want to be a Premium member but still want to support us?

Make a small donation by buying us coffee ($5) or help with server cost ($10)

Donate via Paypal

Or Donate anonymously using crypto!

Ethereum

0xfe58350B80634f60Fa6Dc149a72b4DFbc17D341E copy

Bitcoin

3ATGMxNzCUFzxpMCHL5sWSt4DVtS8UqXpi copy

Thank you for your support!

Follow Us!

:(