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

@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.

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 👉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

@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 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
🥕🥬🥦🫑🥒🍅🧅🧄🥔🐟🍉🍒🍏🍊🍇🍋🍎🌶️🍈🍐🌿🌱

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

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

https://twitter.com/DrMarthaGulati/status/1432847340264726528

@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

#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!
@NEJM nejm.org/doi/full/10.10…
@Steph_Achenbach

#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 #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

#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 #ESCCongress #HOTLINE #CardioTwitter #CVPrev
#SSaSS
🫀Study could impact CVD health of the world
@NEJM Read here: bit.ly/3yuVqxU
Fantastic study!!!!!!! @ASPCardio @CardioSmart

#ESCCongress #HOTLINE #LOOP study #CVprev
Screening for #Afib with loop recorder to prevent stroke
🫀 Incl:age >/=70& 1+ RF; Excl:known Afib
🫀 ILR (Linq) vs Control: afib: tx with OAC
🫀1o: Time to stroke or systemic embolism: 64m F/U
🫀42%💃
💥 AF 32% ILR vs 12% Control w/ OAC #ESCCongress #HOTLINE #LOOP study #CVprev
Screening for #Afib with loop recorder to prevent stroke
🫀1o outcome:NS
🫀2o outcome NS
🫀 death from any cause NS
🩸 NS dif in Bleed
[Baseline SBP>157: benefit from ILR but hope they tx BP!]
💥Afib diagnosed but NS diff in any outcomes

#ESCCongress #Hotlines
#RIPCORD2
Does routine #FFR measurements in assessment of CAD impact Chest pain eval?
🫀 open RCT: angio vs FFR
🫀 1o 🏥costs, QOL- 12m
🫀75% male enrolled, longer with FFR, more additional test with just cath
🫀 NS diff in 1o endpoint or clinical endpoints #ESCCongress #Hotlines
#RIPCORD2
Does routine pressure wire measurements in assessment of CAD for diagnosis of Chest pain?
🫀 No advantage of performing routine FFR
🫀 Not necessary, not beneficial, more complications
🫀FFR better used on specific patients rather than routine

1/ From @BeckersHR 10 numbers thank show how gender gaps keep women out of the C-suite

@DBelardoMD @DrNasrien @netta_doc @ShelleyZieroth @mirvatalasnag @BiykemB @dranulala @DrKLindley @DrJenniferCo_Vu Only 2 health systems ranked in the top 20 hospitals by U.S. News & World Report are helmed by a woman, highlighting how few female leaders are showcased at the top in healthcare.
@AnastasiaSMihai @SharonneHayes @HeartDocSharon @MKIttlesonMD @cardioPCImom @gina_lundberg

10 numbers that show gender pay gap in healthcare- a thread from a recent report
#gendergap #genderpaygap #healthcare

#womeninmedicine @WomenAs1 @DrToniyaSingh @Drroxmehran @DrJMieres @cardioPCImom @athenapoppa @mikevalentineMD @DickKovacs @DBelardoMD @JulieSilverMD #1: The pay gap is widening: from 25.2% in 2019 to 28% in 2020: earning ~$116,000 less than men in medicine per year
#gendergap #genderpaygap #healthcare

Wonderful talk at #AHA10 @MarilynCipolla on #preeclampsia and the Brain #neuroobstetrics #cardioobstetrics @uvmvermont @MaryCushmanMD
🧠Preeclampsia is vascular disorder
🧠Preeclampsia defined below @acog
🧠Once you have PE, greater 🫀 events, HTN, DM
🧠 But also BRAIN effects #AHA20 #preeclampsia
🤰Preeclampsia is an exaggerated response of pregnancy induced inflammation, hyperlipidemia and hypercoagulation
⬆️ risk of:
🧠seizures
🧠stroke
🧠cognitive decline

Dr. Peter Rothwell: Paul Dudley White lecture & reminds us that PDW was ahead of his time, believing lifestyle was key. The Pathway along the Charles River is named after him #AHA20
Best quote " I wish we could do something useful with tobacco- like making fertilizer out of it" Profound effect BP on Risk of Stroke #AHA20
🧠🫀 #BloodPressure... #PDWLecture
16 Fold risk association with mean BP and stroke

#mSToPs Study presented at #AHA20 #LBCT @SteveSteinhubl @EricTopol
💫Lifetime risk of Afib ⬆️ (.40%)
💥Risk of #Afib is stroke but also Heart Failure and CV Mortality is even ⬆️⬆️
🥅 was to assess ECG patch in diagnosis of Afib & improve outcomes Study Design of #mSToPs was direct to participants @Aetna patients with #ziopatch worn for a median time of 24.7 days #AHA20

Dr. David Williams speaking at #AHA20
💸Pay gap for Black Americans is 59 cents vs $1 for White Americans
🛑Same as 1978!
Racial differences haven't changed in all this time
At every level of education, gap persists: income and education matter but race overrides this Racial Segregation is real #AHA20 and was part of racial regulation
💔2/3 of all Black Americans live in very low opportunity neighborhoods
💔This access to opportunity (or lack thereof) is a driver of racial ethnic differences

@AnastasiaSMihai @loriannpeterso1 & I will be presenting Poster #1432 at #AHA20. It will be presented at 9am CT (soon) but before it is, I want to thank you all for filling out my survey on #cardioTwitter because this is what our poster is based on. We wanted to find our how you measure #bloodpressure & how reliable you felt your clinical BPs were. I regret to inform you despite you liking your BP reads & trusting them, most of you don't check it correctly @HeartBobH #AHA20 Thanks to @Heart_SCCT @ASPCardio @HBPRCA for help

#ESCCongress #LoDoCo2 Results #LBCT
Colchicine also a winner of @escardio 2020
This study was building on COLCOT results in secondary prevention in patients w/ chronic CAD
🔺5522 patients enrolled
🔺Randomized to Colchicine 0.5 mg vs Placebo
🔺Excluded advanced CKD, HF, valve ds Characteristics of #LoDoCo2 #ESCCongress
🔺90% of patients tolerated medication
🔺Mostly men (84%)
🔺Most had prior revascularization
🔺 Most well treated

#ESCCongress @MaasAngela presenting on IHD in perimenopause:
So Who is at risk? And why?
♥️Hormones fluctuate over a lifetime in BOTH men &💃♥️There are benefits of estrogen in women protecting them but at menopause it changes and more risk factors ⤴️the risk for ♥️ disease @MaasAngela #ESCCongress
🔺⤴️insulin resistance
🔺⤴️inflammation
🔺⤴️ adverse cardiometabolic risk profile
All seen in menopause, increasing the risk of CVD in 💃

EXPLORER-HCM Efficacy and Safety of #Mavacamten in HCM Presented by Dr. Olivotto
♥️Meds for HCM very limited and don't prevent progression or reverse it
♥️HCM results from too many cross bridging and this drug prevents this
#EXPLORER #ESCCongress EXPLORER-HCM Efficacy and Safety of #Mavacamten:
Study & Characteristics &Results as below:
🔺251 Patients (largest trial in HCM)
🔺97% completed study
🔺Improved functional score and improved NYHA class
🔺⬇️post exercise gradients
🔺⬇️ resting and valsalva gradient