High-Sensitivity Troponin I Can Predict Mortality in Stable Patients Suspected to Have CAD The biomarker was more sensitive compared with other conventional troponin assays and predicted near-term MACE in low-risk patients.

Heightened levels of high sensitivity troponin I (hsTnI) can predict the near-term risk of death, acute myocardial infarction (MI), and hospitalization for unstable angina in stable symptomatic patients suspected to have coronary artery disease (CAD), according to a new study published in the Journal of American College of Cardiology. Continue reading →

2018: Cardiology News at A Glance Most important trials published in 2018

COAPT trial

This prospective, multicenter, open-label, randomized trial aimed to assess the use of transcatheter mitral valve repair in heart failure (HF) patients with mitral regurgitation due to left ventricular dysfunction. A total of 614 patients were randomized to either receiving guideline-directed medical therapy (GDMT) alone or GDMT in addition to transcatheter mitral-valve repair. The primary efficacy endpoint was all hospitalizations due to heart failure at 24 months of follow-up, while the primary safety endpoint was freedom from device-related complications at 12 months of follow-up. The study showed that the device group had a lower risk of hospitalization for HF (HR 0.53, 95% CI 0.4-0.7) and all-cause mortality (HR 0.62, 95% CI 0.46-0.82) at 24 months. Moreover, the rate of freedom from device complications at 12 months was 96.6% which exceeded the prespecified safety threshold. Continue reading →

Novel Target for STEMI Patients: Cholesterol Efflux Capacity Inversely Associated with All-Cause Mortality Population-based cohort study shows patients with a higher serum cholesterol efflux capacity have a significantly marked decrease in all-cause mortality

A population-based cohort study has shown that patients with a higher serum cholesterol efflux capacity, the capacity of HDL particles to mediate cholesterol efflux from macrophages, have a marked decrease in all-cause mortality as compared to patients with a lower serum cholesterol efflux capacity. Continue reading →

Workplace Bullying and Violence Might be New, Potentially Modifiable Cardiovascular Risk Factors A multi-cohort study

A European study has revealed that bullying and violence are common at workplaces and those exposed to such stressors are at higher risk of cardiovascular disease (CVD). Psychosocial cardiovascular risk factors such as depression, subclinical depressive symptoms, vital exhaustion, anger, and personality traits such as hostility have been demonstrated as independent predictors of incident cardiovascular disease (CVD). Additionally, social factors associated with increased CVD risk include low socio-economic status, social isolation, low social support, and stress at work or in family life. Psychological and social factors are strongly inter-related and tend to cluster in certain individuals. In the recent most issue of the European Heart Journal, Xu et al. aimed to provide evidence for yet another psychosocial factor involved in CVD risk. Continue reading →

Saphenous Vein Graft Harvesting for CABG: Endoscopic Vs Open Technique Results from the REGROUP trial

A new study published in the New England Journal of Medicine showed no significant difference in the risk of major adverse cardiac events (MACE) between patients undergoing endoscopic and open harvest of the saphenous vein grafts for coronary artery bypass grafting (CABG). Continue reading →

Does a Low Salt Diet Improve Heart Failure Prognosis? Reduced Salt Intake for Heart Failure: A Systematic Review

A systematic review conducted by Kamal R. Mahtani et al in JAMA looked into the evidence of salt restriction recommendation on heart failure prognosis. The investigators evaluated previous trials but could not find a conclusive relationship between salt consumption and heart failure prognosis. Continue reading →

Cardiogenic Shock in Takotsubo Syndrome: Incidence, Predictors, and Outcomes Results from the RETAKO registery

Cardiogenic shock (CS) is not a rare complication in patients with Takotsubo syndrome (TTS). Moreover, it is associated with an increased risk of adverse outcomes in the short- and long-term follow-up, according to a new study published in the Journal of the American College of Cardiology. Continue reading →

Unrecognized Myocardial Infarctions Have a 10-Year Mortality Rate Comparable to Clinically-Recognized Infarctions Results form the ICELAND MI study

According to a new study published in the Journal of American Medical Association, unrecognized myocardial infarction (UMI) detected by cardiac magnetic resonance (CMR) was associated with equivalent all-cause mortality as compared to recognized myocardial infarction (RMI) at 10 years of follow-up. Individuals with UMI also had a higher risk of nonfatal MI, heart failure, and death than those without any evidence of MI. Continue reading →

From Barbershops to Churches: Are Community-Based Interventions the Best Way to Engage Vulnerable Populations? Cluster Randomized Clinical Trial of FAITH (Faith-Based Approaches in the Treatment of Hypertension) in Blacks

The FAITH study (Faith-Based Approaches in the Treatment of Hypertension) has portrayed how a community-based lifestyle intervention delivered in churches can lead to a significantly greater reduction in systolic BP in hypertensive blacks in comparison with Health Education (HE) alone. The results were published online in Circulation. Continue reading →

Highlights of TCT 2018

The results of many interesting trials were presented at the TCT conference 2018 held in San Diego, California. Continue reading →

ESC at a Glance: The Trials Were Largely Negative, The Science Was Positive

The Canadian SCAD Study

The Canadian SCAD study investigated the risk factors and outcomes of spontaneous coronary artery dissection (SCAD). This prospective observational study enrolled 750 non-atherosclerotic SCAD patients from 22 cardiac centers in North America. Continue reading →

Aspirin Vs Placebo In Cardiovascular Event Reduction In Diabetes ESC 2018: ASCEND trial

A randomized 15,480 patient strong UK based trial comparing Aspirin (ASA) versus placebo in diabetics has shown that the absolute reduction in cardiovascular events from aspirin is offset by a similar absolute increase in major bleeding. Continue reading →

Antithrombotic therapy post TAVR: A double edged sword? ESC 2018: Insights from the French TAVI registry

A multicenter, prospective nation-wide French registry evaluated whether oral anticoagulation therapy was an independent correlate of long-term survival and early bioprosthetic valve dysfunction (BVD) in patients who underwent successful Transcatheter Valve Implantation (TAVI). The French registry was launched in 2007 and involved 11,469 patients with a mean duration follow-up was 495±3.5 days. This registry contained 11 years of data and analyzed patients from January 1, 2013, and December 31, 2015. Continue reading →

Conservative Management Should be First Line Therapy for SCAD ESC 2018: Canadian SCAD study

Spontaneous coronary artery dissection (SCAD) is an underdiagnosed, poorly misunderstood condition. The predisposing causes and management of this condition are still unclear. To throw light on this, the CANADIAN SCAD cohort study was a large, prospective, multicenter, observational, natural history study that enrolled 750 non-atherosclerotic SCAD patients from 22 centers (20 from Canada and 2 from the US). The key study objective was the analysis of cardiovascular outcomes within the hospital and long-term. Secondary outcomes included the assessment of clinical and angiographic characteristics of patients presenting with SCAD. Continue reading →

‘Lowest is best’ when it comes to blood LDL cholesterol levels A meta-analysis shows lower blood LDL cholesterol levels may be efficacious and safe

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 →

Modifiable risk factor control can eliminate excess cardiovascular risk in Type 2 Diabetes

A Swedish study has found that type 2 diabetics who have five risk-factor variables within the target ranges have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. Assessment of risk is based on the presence of five modifiable risk factors: smoking, elevated glycated hemoglobin, elevated low-density lipoprotein cholesterol level, elevated blood pressure and albuminuria. Continue reading →

Renal Denervation Is Promising for Resistant Hypertension in a Sham Controlled Trial SPYRAL HTN-ON MED Study

A recent study published on The LANCET demonstrated that renal denervation, targeting the sympathetic nervous system, significantly reduced systolic blood pressure among patients with uncontrolled hypertension who were taking antihypertensive medications.

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Low Dose Rivaroxaban Plus Aspirin Reduces Major Adverse Limb Events in COMPASS A COMPASS subgroup analysis

According to a new subgroup analysis of the COMPASS trial published in the Journal of the American College of Cardiology, the prevention of Major Adverse Limb Events (MALE) is of utmost importance in patients with lower extremity Peripheral Arterial Disease (PAD) due to its poor prognosis. Additionally, it has been found that the aspirin and rivaroxaban 2.5mg twice daily combination leads to a significant reduction of Major Adverse Limb Events (MALE) in these patients.