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Paul W. Armstrong, MD Canadian VIGOUR Centre, University of Alberta, Edmonton, AB, Canada speaks about Merck Announces U.S. FDA Approval of VERQUVO® (vericiguat).
The primary efficacy objective of VICTORIA was to evaluate if VERQUVO, in conjunction with other heart failure therapies, is superior to placebo in reducing the risk of cardiovascular mortality or hospitalization for heart failure in adults with symptomatic recurrent heart failure and less than 45% of the ejection fraction following a worsening heart failure case. Based on a time-to-event study, VERQUVO reached the primary efficacy objective (hazard ratio [HR]: 0.90, 95 percent confidence interval [CI], 0.82-0.98; p=0.019). There was a 4.2 percent reduction in annualized absolute risk with VERQUVO compared to placebo over the course of the study. Therefore, to avoid one primary endpoint case, 24 patients will need to be monitored for an average of one year.
Information Supporting the Approval
VERQUVO approval was based on evidence from VICTORIA (NCT02861534), a randomized, concurrent, placebo-controlled, double-blind, event-driven, multi-center clinical trial comparing VERQUVO with placebo in 5,050 adult patients with New York Heart Association (NYHA) class II-IV symptomatic chronic heart failure and left ventricular ejection fraction (LVEF) less than 45% after a wound of symptomatic chronic heart failure (NYHA) class II-IV. A worsening case of heart failure was described as hospitalization for heart failure within six months or less prior to randomization or use for heart failure of outpatient IV diuretics within three months or less prior to randomization. In VICTORIA, the primary outcome was time-to-first cardiovascular death or heart failure hospitalization. The median follow-up time was 11 months for the primary endpoint. Based on a time-to-event analysis, VERQUVO was superior to placebo in reducing the risk of cardiovascular death or hospitalization for heart failure.
Patients were given VERQUVO 10 mg once daily or a matched placebo up to the target maintenance dose. Therapy started with VERQUVO 2.5 mg once daily and increased to 5 mg once daily and then 10 mg once daily, as tolerated, at roughly two-week intervals. The placebo doses were adjusted similarly. 90 percent of patients in both the VERQUVO and placebo arms were treated with the 10 mg target maintenance dose after approximately one year.
Participants in the study were: 76% male, 64% Caucasian, 22% Asian and 5% Black. The mean age was 67. 59 percent of patients were NYHA Class II at randomization, 40 percent were NYHA Class III and 1 percent were NYHA Class IV. The mean LVEF was 29 percent . Approximately half of all patients had an EF of less than 30%, and 14% of patients had an EF of between 40% and 45%. Sixty-seven percent of VICTORIA patients were enrolled within three months of a hospitalization index case for heart failure; 17 percent were enrolled within three to six months of hospitalization for heart failure; and 16 percent were enrolled within three months of outpatient care for worsening heart failure with IV diuretics. At randomization, the median NT-pro B-type natriuretic peptide (NT-proBNP) level was 2800 pg/mL.
Participants in the study were on quality of treatment. At baseline, 93 percent of patients received a beta-blocker, 73 percent received an angiotensin-converting enzyme (ACE) or angiotensin II receptor blocker (ARB) inhibitor, 70 percent received a mineralocorticoid receptor antagonist (MRA), 15 percent received an angiotensin receptor and neprilysin inhibitor (ARNI) combination, 28 percent had an implantable cardiac receptor antagonist (MRA), and 28 percent had an implantable cardiac inhibitor (ARNI). Ninety-one percent of patients were treated with two or more drugs for heart failure (beta-blocker, any receptor of the renin-angiotensin system [RAS], or MRA) and all three were treated in 60 percent of patients. At baseline, 6% of patients received an inhibitor of ivabradine and 3% of sodium glucose co-transporter 2 (SGLT2).
VERQUVO showed an adverse effect profile comparable to placebo in the VICTORIA trial. Hypotension (16% vs 15%) and anemia were the adverse drug reactions that occurred more frequently with VERQUVO than with placebo and in more than or equivalent to 5% of patients treated with VERQUVO in VICTORIA (10 percent vs 7 percent ). The VICTORIA trial included a total of 2,519 patients treated with VERQUVO (up to 10 mg once daily). The mean period of exposure to VERQUVO was one year, with a median duration of 2.6 years.
Jeffrey J. Goldberger, MD, MBA from the University of Miami speaks about the Comparison of Metoprolol versus Carvedilol After Acute Myocardial Infarction.
Link to Article -
https://www.ajconline.org/article/S0002-9149(21)00155-7/fulltext#%20
• Beta-blockers are commonly administered after a heart attack, but no one brand has been recommended.
• In this analysis, metoprolol and carvedilol are compared in a post-MI cohort.
• Carvedilol and metoprolol had comparable overall survival rates in the sample.
• In the ejection fraction 40 percent subgroup, carvedilol outperformed metoprolol in terms of survival.
Summary
Following a myocardial infarction (MI), beta-blockers are commonly prescribed, although no particular beta-blocker is recommended. 4142 patients were discharged on metoprolol and 1487 on carvedilol from the OBTAIN multi-center list of patients with acute MI. The beta-blocker dose was calculated as a percentage of the target daily dose used in randomized clinical trials (metoprolol 200 mg; carvedilol 50 mg). >0 percent -12.5 percent (n=1428), >12.5 percent -25 percent (n=2113), >25 percent -50 percent (n=1392), and >50 percent (n=696) were the beta-blocker dose classes. Three-year survival was calculated using the Kaplan-Meier equation. A multivariable adjustment was used to correct for baseline variations. Carvedilol patients were older (64.4 vs. 63.3 years) and had more comorbidities, including hypertension, diabetes, previous MI, congestive heart failure, lower left ventricular ejection fraction, and a longer period of stay. The mean doses of metoprolol and carvedilol did not vary substantially (37.227.8% and 35.831.0%, respectively). The 3-year survival figures for metoprolol and carvedilol were 88.2% and 83.5 percent, respectively, with an unadjusted HR=0.72 (p0.0001), but HR=1.073 (p=0.43) after multivariable adjustment. In comparison to other dose ranges, patients in the >12.5-25 percent dose range had better survival. In a subgroup of patients with a left ventricular ejection fraction of less than 40%, metoprolol was found to have a worse survival rate than carvedilol (adjusted HR=1.281; 95 percent CI: 1.024-1.602, p=0.03). There were no variations in survival between carvedilol and metoprolol in patients with a left ventricular ejection fraction greater than 40%. Overall survival after acute MI was comparable in patients treated with metoprolol or carvedilol, but carvedilol could be superior in patients with a left ventricular ejection fraction of less than 40%.
C. Michael Gibson, MD, CEO non-profit Baim / PERFUSE Research Institute, Harvard Professor, Cardiologist BIDMC, Founder & Chairman WikiDoc.org speaks about ACC 2021 Abstract - 1063-07 - Association Of Cholesterol Efflux Capacity With Adverse Cardiovascular Outcomes - A Meta Analysis
Link to Article:
https://www.abstractsonline.com/pp8/#!/9228/presentation/13693
Summary -
Background information:
The principal process by which macrophages remove cholesterol from atherosclerotic plaque is reverse cholesterol transport. A systematic literature review and meta-analysis were done to investigate the relationship between cholesterol efflux capacity (CEC), a measure of high-density lipoprotein (HDL) function, and poor cardiovascular (CV) events.
Methodologies:
A literature study was conducted to gather papers that looked at the link between CEC and CV outcomes. Adverse CV events, a composite of incident atherosclerotic CV disease (acute coronary syndrome, stroke/transient ischemic attack, revascularization, or new atherosclerotic plaque), or all-cause death, were the main outcomes.
The following are the outcomes:
Twenty investigations yielded a total of 25,132 individuals. High CEC levels were linked with a 37 percent decreased risk of the main outcome when compared to low CEC levels (RR=0.63; 95 percent CI, 0.52-0.76; P0.00001; Figure A). A 20 percent decreased risk of unfavorable CV events was related with every SD rise in CEC (HR=0.80; 95 percent CI, 0.66-0.97; P=0.02). After controlling for CV risk factors, medicines, and HDL concentration, the link remained significant (HR=0.76; 95 percent CI, 0.63-0.91; P=0.004). There was a 5% risk decrease in unfavorable CV events for every 0.1 unit rise in CEC (RR=0.95; 95 percent CI, 0.91-0.99; Figure B).
Final Thoughts:
Higher CEC is linked to less negative CV outcomes. These findings call for more research on CEC as a possible therapeutic target in order to enhance clinical outcomes.
Bart Meuris, prof. dr. from the University Hospitals Leuven Presentation on the HVS 2021 Abstract In-vivo Evaluation Of A Novel Surgical Heart Valve Prosthesis Designed To Be Durable, Anticoagulant-free And Silent.
Link to Abstract:
https://heartvalvesociety.org/meeting/abstracts/2021/A2.cgi
PURPOSE:
Reoperations of tissue valves or permanent anticoagulation of artificial valves are also drawbacks for heart valve prostheses. The Triflo valve, a tri-leaflet valve made of bio-inert materials with high resistance, was designed to overcome these limitations. In a chronic sheep model, we looked at protection and efficiency.
TECHNIQUES: The Triflo valve (size 21mm) was inserted in two models: in the aortic position for 90 days (n=7) and in the pulmonary position for 70 days (n=4). On-X valves (n=2) were used as a monitor in the pulmonary model. There was no more anticoagulant given after 7 days of low-molecular-weight heparin. Blood tests, echocardiography, acoustic measurements, fluoroscopy, and an autopsy were all performed.
END RESULTS:
The Triflo valve performed admirably during surgery. In the aortic analysis, there was one aborted surgery and one early death, all unrelated to the prosthesis. All of the other sheep (n=9) recovered well and continued in good clinical condition until they were slaughtered. We found low peak and mean gradients (8.1+/-2.7 and 4.8+/-1.9 mmHg, respectively), a large effective orifice area (2.3+/-0.2 cm2), no valvular regurgitation, and complete left ventricular activity in the aortic role. Both Triflo valves had a smooth surface at explantation, with no valve thrombosis. Thrombo-embolic (TE) damage was not found in any of the main organs. Both valve leaflet mobility was natural in the pulmonary role, and no TE-damage was observed in the lungs. Hematological parameters were stable, and no signs of hemolysis were present. In the pulmonary location, On-X valves performed well, but they produced slightly quieter acoustic signals (p0.05).
RECOMMENDATIONS:
In both the aortic and pulmonary positions, the Triflo valve proved to be safe and reliable. These promising in-vivo effects, which include excellent hemodynamic activity and long-term operation even without anticoagulants, show that this valve is ready for human trials.
Carol Chiung-Hui Peng, MD and Kashif Munir, MD, Medical Director Of The University Of Maryland Center For Diabetes And Endrocrinology, University of Maryland Medical Center Midtown Campus, University of Maryland School of Medicine speaks about Fracture Risks in Patients Treated With Different Oral Anticoagulants: A Systematic Review and Meta‐Analysis.
Link To Abstract:
https://www.ahajournals.org/doi/10.1161/JAHA.120.019618
Summary -
Background:
To evaluate the fracture risk associated with NOACs and warfarin, we performed a systematic review and meta-analysis.
Methods and Results:
From inception to May 19, 2020, we searched PubMed, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov. We included studies that recorded measurements for any fracture in NOAC and warfarin users (regardless of major, secondary, tertiary, or safety outcomes). Two or more reviewers worked together to screen relevant papers, extract data, and evaluate accuracy. To synthesize the pooled relative risk (RR) of fractures associated with NOACs versus warfarin, data were retrieved. For data synthesis, random-effects models were used. There were 388 209 patients in 29 studies (5 cohort studies and 24 randomized controlled trials). Patients taking NOACs had a lower risk of fracture than those taking warfarin (pooled RR, 0.84; 95 percent CI, 0.77–0.91; P0.001), and there was little variability (I2=38.9%). NOACs were also linked to a lower risk of hip fracture than warfarin (pooled risk ratio, 0.89; 95 percent confidence interval, 0.81–0.98; P=0.023). There was also a nonsignificant trend of NOAC users having a lower risk of vertebral fracture (pooled RR, 0.74; 95 percent CI, 0.54–1.01; P=0.061). Specific NOACs dabigatran, rivaroxaban, and apixaban were found to be significantly associated with lower fracture risks in subgroup analyses. Furthermore, the data synthesis results from randomized controlled trials and real-world cohort studies were remarkably consistent, suggesting the validity of our findings.
Conclusions:
NOACs are associated with a lower risk of bone fracture as compared to warfarin.
We discuss several aspects of cardio-oncology including screening protocols, specific chemotherapy related cardiotoxicities and management of cardiovascular disease among cancer patients and cancer survivors. Dr Sherry-Ann Brown is the director of Cardio-Oncology Medical College of Wisconsin, Milwaukee, WI.
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Milind Desai, MD, MBA of the Cleveland Clinic, speaks about Current Concepts in Diagnosis and Management of Hypertrophic Cardiomyopathy.
Link to what Hypertrophic Cardiomyopathy is -
https://www.ccjm.org/content/85/5/399/tab-figures-data
Link to Milind Desai, MD's Bio -
https://my.clevelandclinic.org/staff/6670-milind-desai#research-publications
Dr. Peter Block interviews presenter Dr. Ian Kronish on quality of life and cost-effectiveness after depression screening after ACS. Visit http://www.acc.org/ACC19 for full meeting coverage.
Prof. Dr. Henner Hanssen from the University of Basel, Switzerland speaks about How To Prevent And Treat High Blood Pressure With Exercise.
Link to Consensus Document:
https://academic.oup.com/eurjpc/article-lookup/doi/10.1093/eurjpc/zwaa141
Summary
Treatment of hypertension and its symptoms is still a huge health-care problem. Hypertension is now responsible for about 25% of heart attacks in Europe, and by 2025, up to 60% of the population may have hypertension. Hypertension has become more common as a result of inactivity, but patients who exercise or partake in physical activity have a lower chance of stroke, myocardial infarction, and cardiovascular mortality. As a result, existing international recommendations on cardiovascular disease prevention include general advice to improve physical activity, but physiological responses vary depending on blood pressure (BP) level, and more personalized advice could be able to achieve larger BP reductions over a population. We conducted a comprehensive analysis of meta-analyses to see if there was enough data to provide a scientific Consensus Document outlining how to exercise medication could be tailored for blood pressure regulation. The paper summarizes the results of 34 meta-analyses on the effects of aerobic fitness exercise, dynamic strength training, and isometric resistance training on blood pressure in adults with hypertension, high-average blood pressure, and people with normal blood pressure. The meta-review found enough data, based on the approximate spectrum of exercise-induced BP reduction, the number of randomized controlled trials, and the consistency ranking, to suggest that form of exercise should be recommended based on initial BP level, but there are still significant research gaps. As a result, this evidence-based Consensus Document recommends that more studies be done to promote and develop more regular use of individual exercise prescriptions in order to improve lifestyle treatments for the prevention and treatment of hypertension.
Sammy Zakaria, MD, MPH from Johns Hopkins University speaks about Acute Cardiac Effects of Severe Pre-Eclampsia.
Link to Article:
https://www.jacc.org/doi/10.1016/j.jacc.2018.04.048
Summary
Background: Pre-eclampsia with severe features (PEC) is a pregnancy-related condition marked by severe hypertension and end-organ dysfunction, as well as short-term adverse cardiovascular events such as heart failure, pulmonary edema, and stroke.
Objectives include:
The authors wanted to see how right ventricular (RV) systolic pressure (RVSP) and echocardiographic-derived diastolic, systolic, and speckle monitoring parameters changed over time in women with PEC.
Methodologies:
The authors enrolled 63 women with PEC and 36 pregnant control patients in this prospective retrospective study.
The following are the outcomes:
As compared to the control cohort, the PEC cohort had a higher RVSP (31.0 7.9 mm Hg vs. 22.5 6.1 mm Hg; p 0.001) and a lower global RV longitudinal systolic strain (RVLSS) (19.6 3.2 percent vs. 23.8 2.9 percent [p 0.0001]). There were significant differences (p 0.001) in mitral septal e′ velocity (9.6 2.4 cm/s vs. 11.6 1.9 cm/s), septal E/e′ ratio (10.8 2.8 vs. 7.4 1.6), left atrial area size (20.1 3.8 cm2 vs. 17.3 2.9 cm2), and posterior and septal wall thickness for left-sided cardiac parameters (median [interquartile range]: 1.0 cm [0.9 to 1.1 cm] vs. 0.8 cm [0.7 to 0.9 cm], and 1.0 cm [0.8 to 1.2 cm] vs. 0.8 cm [0.7 to 0.9 cm]). PEC was seen in eight women (12.7%) with grade II diastolic dysfunction and six women (9.5%) with peripartum pulmonary edema.
Final Thoughts:
When compared to healthy pregnant women, women with PEC have higher RVSP, higher rates of irregular diastolic activity, decreased global RVLSS, increased left-sided chamber remodeling, and higher rates of peripartum pulmonary edema.
B. Daan Westenbrink, MD, Ph.D., Senior Author and Cardiologist at the University of Groningen, UMCG Cardiology speaks about Ketone Supplementation: A Novel Intervention for CVD?
Link to Article:
https://www.medscape.com/viewarticle/946647?src=soc_lk_share
According to a recent study, regardless of the procedure used to increase ketone bodies' presence in the heart, they could have therapeutic benefits for patients with cardiovascular disease (CVD).
The authors examined the current body of experimental and clinical research on the potential function of ketone bodies in improving CVD and discovered that increasing circulating ketone levels can provide protective benefits in patients with the disease.
A ketogenic diet, which consists of a very low carbohydrate and high-fat intake, is a common way to induce ketosis; however, exogenous ketones could be a viable and superior alternative to the diet for increasing circulating ketone bodies, according to the researchers.
The study was published in the Journal of the American College of Cardiology on February 23.
This realization prompted Westenbrink and colleagues to conduct a clinical trial to examine the impact of exogenous ketones on exercise efficiency in patients with heart failure.
The aim of this review was to "summarize the existing literature from animal and human studies, in the hopes of facilitating more research into the benefits of ketones as therapeutic agents in CVD."
Beyond Fuel Efficiency
The authors have looked at the processes of ketone metabolism, such as ketogenesis and ketolysis, as well as cardiac metabolism in both healthy and diseased hearts.
The reactions that lead to the formation of the ketone bodies acetoacetate (AcAc), -hydroxybutyrate (OHB), and acetone are known as ketogenesis.
Fasting causes a reduction in the insulin-to-glucagon ratio, which mobilizes fatty acids, which the liver then converts into ketone bodies. They are then moved to peripheral tissues, where they go through a process known as "terminal oxidation."
The heart appears to "reprogram metabolism to increased dependence on ketone bodies as a fuel source" as heart failure progresses, according to the authors, with increased circulating ketone concentrations and cardiac ketone consumption.
Diabetes management is evolving and we discuss the role of cardiologists in improving cardio-metabolic care. Dr Muthiah Vaduganathan from Brigham and Women's Hospital & Harvard Medical School shares his expertise on the evidence for newer drugs and how cardiologists can get engaged in diabetes management. This is episode three of four in our Diabeto-Cardiology series. Listen, Like, Subscribe, Tweet and don't forget to give us a Rating!!
Ilya Danelich PharmD (Board Certified Cardiac Pharmacist) walks us through the different classes of drugs in diabetes today and discussed in greater detail the mechanism of action for the newer drugs. We also discuss how to prescribe the newer SGLT2 inhibitors and review different mechanisms for adverse effects and cardiovascular benefit. This is episode one of four in our Diabeto-cardiology series. Let's get to know the drugs first.
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Carol Chiung-Hui Peng, MD from the University of Maryland Medical Center Midtown Campus, and Kashif Munir, MD from the University of Maryland School of Medicine, associate professor, and Medical Director of the University of Maryland Center for Diabetes and Endocrinology speak about Non‐vitamin K antagonist oral anticoagulants vs. warfarin for AFib patients: What the latest research tells us.
Twitter -
@UMMC @umms @UMmedschool
Link to Abstract:
https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14243
Abstract
Comparison of the risk of developing diabetes in patients with non-vitamin K antagonist oral anticoagulants (NOACs) treated with atrial fibrillation (AF) and warfarin.
Materials and Methods
Using Taiwan's National Health Insurance Research Database, we carried out a nationwide retrospective cohort analysis. Adult new-onset AF patients treated with NOACs or warfarin between 2012 and 2016 have been included. The NOAC cohort was further categorized into classes of dabigatran, rivaroxaban, and apixaban. Incident diabetes requiring treatment with antidiabetic medications was the primary outcome. Subdistribution hazard models of Fine and Gray were used to estimate the adjusted hazard ratio (aHR). For each head-to-head analysis, propensity score matching was conducted.
Outcomes
Our analysis included a total of 10,746 new-onset AF patients. NOACs were associated with a lower risk of developing diabetes than warfarin during the mean 2.4-year follow-up (aHR = 0.80, 95 percent confidence interval [CI]: 0.68-0.94, P = .007). Analyses of the subgroup indicated that dabigatran, rivaroxaban, and apixaban each had a decreased risk of diabetes. Stratified studies found that the lower risk of NOAC-related diabetes was specific for patients 65 years of age or older (aHR = 0.74, 95% CI: 0.62-0.89, P = .002) and those with strong adherence to medication (aHR = 0.70, 95% CI: 0.58-0.84, P < .001).
Findings
In patients with AF, taking NOAC was associated with a lower risk of developing diabetes compared to taking warfarin.
David Conen, MD from the Population Health Research Institute and McMaster University, discusses Alcohol consumption, atrial fibrillation, and cardiovascular disease: finding the right balance.
Link To Study -
https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa955/6090247
Atrial fibrillation (AF) is associated with an increased risk of death and cardiovascular complications and has been described as one of the 21st century cardiovascular epidemics.1 AF pathogenesis is complex, but many risk factors for AF have been described previously, explaining the attributable risk of about 50 percent of the population.1-4 Enhancing our understanding of risk factors. Indeed, only oral anticoagulation has so far been undeniably shown to boost difficult results once AF.5 has been established by a patient.
Excessive alcohol intake is a significant modifiable risk factor that predisposes to AF. 6,7 The development of AF has been related to both acute and increased habitual drinking. As is apparent in the Holiday Heart Syndrome, acute alcohol intake has a direct impact on the heart, contributing to atrial tachyarrhythmias.8,9 Chronic alcohol consumption is also associated with an elevated risk of AF.6,7 In the Women's Health Study, women who drank > 2 alcoholic drinks per day had a 60% higher risk of AF incident after the multivariable change, while lower amounts did n.
In this issue of the Journal, in a very broad dataset, Csengeri et al.10 discussed the relationship between alcohol consumption and incident AF. Five prospective community-based cohorts totaling 107,845 individuals free of AF at baseline were combined by Csengeri et al.10, of whom 5854 developed new-onset AF over a median follow-up of 13.9 years. From patient self-report, alcohol intake was determined at baseline, while incident AF was determined from hospitalization data through ICD codes or comorbidities reported on death certificates. The median age was 47.8 years, 48.3 percent were men and 3 g/day was the median intake of alcohol. Consumption of 1 alcoholic beverage (defined as 12 g of alcohol) per day was correlated with a 16 percent increased risk of incident AF in Cox regression models stratified by sex and cohort [hazard ratio 1.16, 95 percent confidence interval (CI) 1.11–1.22, P < 0.001]. Importantly, at very low alcohol consumption levels, there was a substantial association between alcohol and increased AF risk. Even an average 3 g/day intake was closely correlated with the risk of AF (HR 1.04, 95% CI 1.02-1.05). Adjustment for other AF risk factors has not substantially attenuated this relationship. It is important to remember, while not mentioned in the manuscript, that the absolute risk of AF was likely low in participants who drank low to moderate amounts of alcohol.
The authors found a J-shaped association between alcohol intake and heart failure events, with the lowest risk reported at alcohol levels of up to 20 g per day. The relationship between alcohol- and time-dependent heart failure (HF) was not important when evaluating the intermediate function of incident heart failure in developing AF from alcohol intake. Finally, N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-I (hsTnI) were weakly associated with alcohol intake and the association between alcohol and AF for these biomarkers was not attenuated.
There are some strengths in the current study 10. Harmonization of the outcome and covariates across five cohorts allowed the authors to conduct standardized studies with very broad sample size and great power to define important associations between alcohol intake and AF, including the lower alcohol consumption range where the probability of AF incident is expected to be minimal. This research, therefore, offers strong evidence that even very low alcohol levels (i.e. < 1 drink per day) remain substantially correlated with an increased risk of new-onset AF.
There are drawbacks to the Csengeri et al.10 analysis. First, from hospitalization results, AF episodes were not adjudicated and relied on the international classification of diseases (ICD codes), which may have contributed to bias in misclassification. In addition, AF instances that did not result in hospital presentation or were listed on death certificates may not have been reported. Second, the link between binge drinking and incident AF could not be investigated in this review. Third, absolute risks of AF associated with low levels of alcohol intake were not reported in the study. This important problem must also be taken into account when considering the potentially beneficial associations with other cardiovascular outcomes of moderate alcohol intake.11-14 Finally, the research was not intended to shed more light on the mechanisms that link habitual alcohol consumption and AF production. Although the authors explored the potential role of NT-proBNP and hsTnI in this relationship, only a minority of patients had biomarker data available, and only at baseline. The effects of alcohol on atrial electrophysiology are likely to rely on many variables, including changes in atrial repolarization, vagal sound, and direct myocardial injury and fibrosis.9 More studies are required to investigate how alcohol affects atrial electrophysiology across these possible pathways.
In conclusion, the current Article10 makes a significant contribution to our understanding of the relationship between alcohol intake and AF incidence, especially with the lower alcohol consumption continuum. There was a substantial association between alcohol and AF, and even small amounts of alcohol were associated with an increased, albeit small, risk of AF incidence. Together with a recent randomized study showing that a decrease in alcohol intake resulted in a decrease in AF recurrence,15 these data indicate that reducing alcohol intake may be relevant for AF prevention and management. Importantly, any decrease in low-to-moderate alcohol consumption to potentially prevent AF needs to be balanced with the potentially beneficial association of low amounts of alcohol with other cardiovascular findings (Graphical abstract).11-14 More research is needed for the net clinical advantage of consuming low amounts of alcohol, preferably in adequately powered randomized studies. Until then, each person has to make their own best-educated decision as to whether it is worthwhile and healthy to consume up to 1 alcoholic drink per day.
ACC President Athena Poppas, MD, FACC, reflects on 2020 and shares her gratitude for how the global cardiovascular profession has come together to fight COVID-19, to stand against racism and violence, to promote diversity and inclusion in our workforce, and to address disparities in the health care system. “Together we have risen to every occasion in 2020 and together we will come out on the other side stronger and better prepared for future challenges,” she said. “I have never been prouder to be a part of the ACC and the larger cardiovascular community.” https://bit.ly/3m20ZOU
Drs. George Vetrovec, Mirvat Alasnag, and Peter Block discuss key takeaways for interventionalists from late-breaking clinical trials presented at TCT 2020, including PROSPECT ABSORB (2:05), Disrupt CAD III (5:20), REFLECT II and STS/ACC TVT Registry (8:14), and Bivalirudin vs Heparin in MI Patients (13:10).
Dr. Deepak Bhatt, Dr. Kim Eagle, and Dr. Gabriel Steg look back on Day 4 of the late-breaking science and featured clinical research from ESC Congress 2020, including THEMIS-PAD (0:32), BRACE CORONA (3:30), and REALITY (6:44). Visit https://www.acc.org/ESC2020 for full meeting coverage.
JACC: CardioOncology Editor-in-Chief Bonnie Ky is joined by Associate Editor Dr. Ron Witteles, Dr. Wilson Gonsalves, and Dr. Rola Khedraki in this insightful, informative two-part discussion on the topic of Amyloidosis. One of the Journal's most popular manuscripts to date, "AL Amyloidosis for the Cardiologist and Oncologist" is reviewed, with additional insights from recently published primers and clinical case challenges.
Explore papers referenced in Virtual Case Presentation Series on JACC.org: https://bit.ly/2AE18FI
A long-standing resource for busy cardiovascular professionals in need of key takeaways on top clinical trials released during Cardiology’s most relevant meetings, ACC Cardiology Hour is an expert roundtable hosted by JACC Editor-in-Chief Valentin Fuster, MD, PhD, MACC. In this installment, Dr. Fuster is joined by David H. Adams, MD, FACC; Roxana Mehran, MD, FACC; Vivek Y. Reddy, MD; and Anu Lala, MD, FACC, in trial-by-trial commentary on top Late-Breaking Clinical Trials released during ACC.20/WCC Virtual. Watch for expert perspectives and context on VICTORIA, VOYAGER PAD, POPular TAVI, PARTNER 3, PRONOMOS, SPYRAL HTN-OFF MED Pivotal, Radial Artery Versus Saphenous Vein for Coronary Bypass Surgery at Long-Term Follow-Up, PRECOMBAT, E3 and CIAO-ISCHEMIA.
VICTORIA: 2:20
VOYAGER PAD: 11:55
POPULAR-TAVI: 23:07
PARTNER: 31:55
PRONOMOS: 41:55
SPYRAL HTN-OFF Pivotal Trial: 47:49
PRECOMBAT: 59:10
Radial Artery Versus Saphenous Vein for Coronary Bypass Surgery at Long-Term Follow-Up: 1:10:45
E3: 1:16:31
CIAO-ISCHEMIA: 1:23:13
Cover the entire field of electrophysiology with EP SAP, developed in collaboration with the Heart Rhythm Society. Use it to identify your knowledge gaps, reinforce your existing knowledge and learn new information. . Watch this video and visit https://www.ACC.org/EPSAP to learn more.
Released at ACC.19, ACC/AHA primary prevention guideline provides a playbook for managing cardiovascular risk factors. Find out what the prevention guideline means for clinicians from Andrew Freeman, MD, FACC. Full ACC.19 coverage is available at https://www.ACC.org/ACC2019
Dr. Peter Block interviews presenter Dr. Henning Bundgaard regarding POET: Partial Oral Treatment of Left-Sided Infectious Endocarditis. Visit http://www.acc.org/ACC19 for full meeting coverage.
Join ACC Member Hub, a new way to help you connect, collaborate, and create with ACC's member network. Find a mentor, get answers to questions, share documents, collaborate on projects, and more. Join at https://memberhub.acc.org/home