Hypercholesterolemia is a major modifiable risk factor for coronary heart disease (CHD). Studies have consistently shown that atherosclerotic cardiovascular disease (ASCVD) risk is correlated to the levels of low-density lipoproteins (LDL) in the body. The lower the LDL levels, the lower the risk of ASCVD; but a key question remains to be answered, how low can you go without being unsafe? It has been several years since the 2013 American College of Cardiology and the American Heart Association (ACC/AHA) published updated guidelines for the management of hypercholesterolemia. The more current American College of Endocrinology (AACE) guidelines make an attempt to update clinicians on clinical profile-based management in 2017. One of the most striking differences between the 2013 ACC/AHA guidelines and the AACE/ESC/EAS guidelines is the latter’s focus on specific target LDL-C levels. While there is little doubt that higher statin intensity lowers ASCVD risk, a new meta-analysis has now shown based upon the IMPROVE-IT (Examining Outcomes in Subjects With Acute Coronary Syndrome: Vytorin vs Simvastatin), FOURIER (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk) and REVEAL trials that, lower is better when it comes to LDL-Cholesterol (LDL-C). Continue reading →

Antithrombotic therapy with vitamin K antagonist (VKA) and aspirin plus a P2Y12 inhibitor has been the cornerstone of medication regimen among stented patients with atrial fibrillation (AF) for decades. However, this traditional “triple therapy” (TAT) has been associated with a three to four-fold increased risk of bleeding. The ISAR Triple and WOEST Trial demonstrated that VKA in addition to one antiplatelet therapy was associated with a reduced risk of bleeding compared to the triple therapy. More recently, safety of non-Vitamin K oral anti-coagulant (NOAC)-based strategies, using a NOAC plus a P2Y₁₂ inhibitor, has been compared to vitamin K antagonist (VKA)-based triple therapy, in the PIONEER AF-PCI and REDUAL PCI randomized trials; both of which have demonstrated that NOAC-based strategies are safer and provide an attractive alternative to VKA-based triple therapy among AF patients who undergo percutaneous intervention (PCI). However, none of these randomized controlled trials was powered to assess the efficacy of dual anti-thrombotic (DAT) strategies. The higher safety associated with DAT has brought this fresh treatment modality into the limelight. Continue reading →

In a predictive model based substudy of the SPRINT trial published in the Journal of American College of Cardiology, Dr. Robert A. Phillips and his colleagues from Houston Methodist Hospital were able to show that patients with a higher 10-year cardiovascular disease (CVD) risk could achieve more benefit than harm from intensive blood pressure control, with a set target of systolic blood pressure (SBP) of < 130mm Hg. Continue reading →

A new multi-center prospective randomized trial published in the American Heart Journal was able to show that a video presentation may be better at helping patients to understand the procedure and risks associated with percutaneous coronary intervention (PCI) compared to standard patient education pamphlets. Continue reading →