This Week In Cardiology

Health and income, high BP in the hospital, and more on subclinical AF and when to use anticoagulants are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic   I. Health and Income  A Cash Giveaway to Improve Health https://www.medscape.com/viewarticle/cash-giveaway-improve-health-2024a1000dhf?form=fpf JAMA RCT https://jamanetwork.com/journals/jama/fullarticle/2821454 NBER RCT https://www.nber.org/papers/w32711 Have We Missed the Hidden Cause of Medical Overuse? https://www.medscape.com/viewarticle/908309 Mar 17, 2023 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/989775 Other References  Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status https://jamanetwork.com/journals/jamacardiology/article-abstract/2793120 Rand Link https://www.rand.org/pubs

Vulnerable plaque and scientific method; industry payments to trainees; tirzepatide or semaglutide; trial interpretation; and PFA are the topics John Mandrola, MD, covers in today’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Non-invasive Imaging for Vulnerable Plaque   PET Imaging Finds Vulnerable Plaques That Cause MI https://www.medscape.com/viewarticle/pet-imaging-finds-vulnerable-plaques-cause-mi-2024a1000cm2 JACC paper https://doi.org/10.1016/j.jacc.2024.03.419 Original JAMA-Card paper https://jamanetwork.com/journals/jamacardiology/fullarticle/2806690 II. Industry Payments to Fellows JAMA Network Letter https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2821267 III. GLP-1a Class Effect? Semaglutide Significantly Improves Chronic Kidney Disease https://www.medscape.com/viewarticle/semaglutide-significantly-improves-chronic-kidney-disease-2024a10009w9 Mounjaro Beats Ozemp

Venous closure devices, GLP1-s linked to blindness and cancer, resisting the urge to do an ECG, and transcatheter edge-to-edge repair (TEER) for secondary mitral regurgitation are the topics discussed this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study https://doi.org/10.1093/europace/euae105 II GLP1-s and Blindness Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2820255 Locke Twitter  https://x.com/doc_BLocke/status/1808972226655629610 When to Start a Statin Is a Preference-Sensitive Decision https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.029808 III GLP1-s and Cancer Glucagon-Like Peptide 1 Receptor Agonists and 13 Obesity-Associated Cancers in Patients W

Screening echo, multivitamins, wasteful research, another PA sensor for HF, vascular closure devices, and GLP-1 marketing as science research are the topics John Mandrola, MD, discusses this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Screening for Valvular HD in the Elderly EHJ-CV Imaging Paper https://doi.org/10.1093/ehjci/jeae127 II. Vitamins and Wasteful Research Is Red Meat Healthy? Multiverse Analysis Has Lessons Beyond Meat   https:// www.medscape.com/viewarticle/red-meat-healthy-multiverse-analysis-has-lessons-beyond-meat-2024a10008qv May 10, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1000772 Multivitamin Paper https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820369 Physicians Health Study II https://jamanetwork.com/journals/jama/fullarticle/1389615 III. FDA Has Approved Another PA Sensor Link to slides https://c212.net/c/link/?t=0&l=en&o=4

MRAs in HF with renal dysfunction, coronary autoregulation, the hubris of US doctors, NSTEMI in older patients, survival after STEMI, and new leaders at JACC are discussed by John Mandrola, MD. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Combined analysis (Matsumoto) II Coronary artery autoregulation with increasing stenosis NEJM Paper https://www.nejm.org/doi/full/10.1056/NEJMc2402216 III RECOVER IV Trial Gregg Stone, MD Tweet https://x.com/GreggWStone/status/1803583552354742416 DANGER-Shock Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659 IV NSTEMI Elderly Main Paper Datamethods https://discourse.datamethods.org/t/random-vs-fixed-effects-meta-analysis/7361 O’Fee Paper https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2785560 V MI Survival Danish Pap

Listener feedback, statin eligibility and Yogi Berra, evidence-based medicine and heterogenous treatment effects, and MRAs in HF are the topics John Mandrola, MD, discusses in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Listener Feedback ASPIRE AF https://classic.clinicaltrials.gov/ct2/show/NCT03968393 Butala paper: Stroke After TAVR With and Without EPD https://www.ahajournals.org/doi/abs/10.1161/CIRCINTERVENTIONS.123.013697 PROTECTED TAVR Heuts meta-analysis: EPD During TAVR https://heart.bmj.com/content/110/11/757 II. Statin Eligibility JAMA-IM: Data Analytic Choices and Predicting Vascular Events https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2819821 Zeraatker Specification Analysis Paper https://doi.org/10.1016/j.jclinepi.2024.111278 PCE https://www.mdcalc.com/calc/3398/ascvd-atherosclerotic-cardiovascular-disease-2013-risk-calculator-aha-acc III. Heterogenous Tr

Cannabis and CV outcomes, post-CABG AF, embolic protection devices, emulation of randomization, and a preview heterogenous treatment effects are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Cannabis It Sure Looks Like Cannabis Is Bad for the Heart, Doesn't It? https://www.medscape.com/viewarticle/1000250 Cannabis Use Tied to Increased Cardiovascular Risk https://www.medscape.com/viewarticle/cannabis-use-tied-increased-cardiovascular-risk-2024a10003yr Medical Cannabis for Chronic Pain Tied to Arrhythmia Risk https://www.medscape.com/viewarticle/medical-cannabis-chronic-pain-tied-arrhythmia-risk-2024a10000sc Cannabis for Chronic Pain and CV Safety https://doi.org/10.1093/eurheartj/ehad834 Editorial  https://academic.oup.com/eurheartj/article/45/6/485/7500073 Response to Letter  https://doi.org/10.1093/eurheartj/ehae314 UCLA paper https://jamanetwork.com/journals/

The FLOW trial of semaglutide, the DANCAVAS CV screening trial, non-invasive tests for chest pain, and conflicts of interest on social media are the topics John Mandrola, MD, discusses this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Semaglutide for CKD Semaglutide Significantly Improves Chronic Kidney Disease https://www.medscape.com/viewarticle/semaglutide-significantly-improves-chronic-kidney-disease-2024a10009w9 FLOW Trial II. CV Screening Judicious CVD Screening May Work in Men: DANCAVAS https://www.medscape.com/viewarticle/980153 DANCAVAS 6-Year Outcomes https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004403 DANCAVAS Main Trial NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2208681 III. Non-invasive Cardiac Testing in Chest Pain Circulation Outcomes Paper https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010457 Scot Heart https://www.nejm.org/doi/full/10.10

Clues in SCAF, a DOAC antidote trial, another negative lytic trial in stroke, JAMA changes to observational studies, and BP in stroke care are the topics John Mandrola, MD, covers in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. ARTESIA Substudy Sadly, ARTESIA Doesn't Answer a Common Question in Cardiology  https://www.medscape.com/viewarticle/998215 ARTESIA Substudy NOAH https://www.nejm.org/doi/full/10.1056/NEJMoa2303062 ARTESIA https://www.nejm.org/doi/10.1056/NEJMoa2310234 II. DOAC Reversal ANNEXA-1 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2313040 III. Lytic Therapy in Acute Stroke Thrombolysis Offers No Benefit for Mild Stroke https://www.medscape.com/viewarticle/iv-thrombolysis-offers-no-benefit-mild-stroke-2024a10009p7 TEMPO-2 Trial https://doi.org/10.1016/S0140-6736(24)00921-8 The Case Against Thrombolytic Therapy in Stroke IV. Observational Research JAMA Special Comm

An Impella update, another TAVI vs SAVR trial, two studies on angina and PCI, another null substudy from REVIVED-BCIS, and semaglutide are the topics John Mandrola, MD, covers in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Impella Update CHRIP BCIS 3 https://classic.clinicaltrials.gov/ct2/show/NCT05003817 Danger-Shock Podcast https://www.medscape.com/viewarticle/1000675 II. TAVI vs SAVR Notion 2 Trial EHJ https://doi.org/10.1093/eurheartj/ehae331 DEDICATE-DZHK6 III. Angina and PCI Orbita 2 Sub-analysis Orbita Star https://www.jacc.org/doi/10.1016/j.jacc.2024.04.001 IV. Complete Revascularization Main REVIVED trial https://www.nejm.org/doi/full/10.1056/NEJMoa2206606 JACC Substudy https://www.jacc.org/doi/10.1016/j.jacc.2024.04.043 V. Semaglutide Semaglutide CV Benefits Irrespective of Weight Loss: 4-Year SELECT Data https://www.medscape.com/viewarticle/semaglutide-cv-benefits-irresp

Inclisiran, sodium-channel blocker safety, analytic flexibility, the work-up of patients with HF, and BP in older patients are the topics John Mandrola, MD, covers in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Inclisiran Update ORION 4 https://classic.clinicaltrials.gov/ct2/show/NCT03705234 II. Sodium-Channel AADs UPenn Paper https://doi.org/10.1016/j.jacep.2024.01.021 Three Questions Editorial https://www.ahajournals.org/doi/full/10.1161/circoutcomes.110.957381 EAST Post-hoc Review https://doi.org/10.1093/europace/euae121 III. Analytic Flexibility   Is Red Meat Healthy? Multiverse Analysis Has Lessons Beyond Meat https://www.medscape.com/viewarticle/red-meat-healthy-multiverse-analysis-has-lessons-beyond-meat-2024a10008qv Specification Curve Analysis of Red Meat Data https://doi.org/10.1016/j.jclinepi.2024.111278 IV. The Work-up of Patients With HF Durstenfeld and colleagues, UCSF

The DEDICATE trial of TAVR vs SAVR, more on renal denervation, inclisiran, and marketing disguised as science are the topics John Mandrola, MD, discusses in today’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. TAVR vs SAVR TAVI Comparable With SAVR in Lower-Risk Aortic Stenosis https://www.medscape.com/viewarticle/tavi-comparable-savr-lower-risk-aortic-stenosis-2024a100074o?form=fpf DEDICATE https://www.nejm.org/doi/full/10.1056/NEJMoa2400685 Partner 3 https://www.nejm.org/doi/full/10.1056/NEJMoa1814052 Evolut Low Risk https://www.nejm.org/doi/full/10.1056/NEJMoa1816885 Barili meta-analysis https://doi.org/10.1093/ejcts/ezab516 II. Renal Denervation Alcohol-Mediated Renal Denervation Promising in Hypertension https://www.medscape.com/viewarticle/alcohol-mediated-renal-denervation-promising-hypertension-2024a10007eg TARGET 1 https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069291 III. Inc

A listener defends colored boxes in guidelines; mysteries of non-culprit coronary lesions during PCI, and of AF ablation; and surrogate markers are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Mystery of What to Do in the Cath Lab after Fixing the Culprit Lesion – The FULL REVASC Trial Complete Revascularization Not Superior to Culprit-Only PCI After MI https://www.medscape.com/viewarticle/complete-revascularization-not-superior-culprit-only-pci-2024a10007ik FULL REVASC Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2314149 FIRE Trial https://www.nejm.org/doi/10.1056/NEJMoa2300468 COMPLETE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1907775 Cohen Tweet on FULL REVASC https://x.com/djc795/status/1781361606238085532 II. AF Ablation Mysteries New Expert Consensus on Ablation Strategies for AF https://www.medscape.com/viewarticle/new-expert-co

ACC Part 2: The TACT2 trial of chelation, inter-atrial shunts for HF, and triglyceride lowering; plus diltiazem and Factor Xa anticoagulants are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. TACT 2 Chelation Therapy Provides No Benefit Post-MI https://www.medscape.com/viewarticle/chelation-therapy-provides-no-benefit-post-mi-2024a10006l5 Chelation Therapy and CV Risk: Why TACT2 Showed No Benefit https://www.medscape.com/viewarticle/chelation-therapy-and-cv-risk-why-tact2-showed-no-benefit-2024a1000761?src= JAMA TACT 1 paper https://jamanetwork.com/journals/jama/fullarticle/1672238 Diabetes Subgroup paper https://pubmed.ncbi.nlm.nih.gov/24254885/ A New Look at P-values https://evidence.nejm.org/doi/abs/10.1056/EVIDoa2300003 PARAGON HF https://www.nejm.org/doi/full/10.1056/NEJMoa1908655 II. Interatrial Shunts for HF No Net HF Benefit for Interarterial Shunt Device

ACC Recap #1: DanGer Shock (plus a sobering JAMA research letter on Impella use), REDUCE-AMI, PREVENT, and EMPACT-MI are the topics John Mandrola, MD, covers in this week’s podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. DanGer-Shock Trial Impella CP Improves Survival in STEMI, Cardiogenic Shock https://www.medscape.com/viewarticle/impella-cp-improves-survival-stemi-cardiogenic-shock-2024a10006kz Impella Saves Lives in Cardiogenic Shock, but Patient Selection Key https://www.medscape.com/viewarticle/1000659 Published DanGer Shock Study  https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 JAMA Research letter https://jamanetwork.com/journals/jama/article-abstract/2817457 II. REDUCE-AMI Trial New Data Question Beta-Blockers Post-MI With Preserved EF https://www.medscape.com/viewarticle/new-data-question-beta-blockers-post-mi-preserved-ef-2024a10006y8 Beta-Blockers Post-MI Past Their Expiration Date: REDUCE

Statins and diabetes, AAD in patients with heart disease, tricuspid valve interventions, and an ACC preview are the topics John Mandrola, MD, discusses in this week’s podcast.This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Statins and Diabetes Meta-analysis in Lancet-Diabetes https://doi.org/10.1016/S2213-8587(24)00040-8 Editorial https://doi.org/10.1016/S2213-8587(24)00059-7 NEJM Paper on Gene Variants and DM https://www.nejm.org/doi/full/10.1056/nejmoa1604304 JAMA Paper on Gene Variants and DM https://jamanetwork.com/journals/jama/fullarticle/2565289 II. Anti-arrhythmic Drugs in Patients With Serious Heart Disease UPenn Paper on AADs for PVC Suppression https://doi.org/10.1016/j.jacep.2024.01.021 Three Questions for Evidence-Based Cardiac EP https://www.ahajournals.org/doi/full/10.1161/circoutcomes.110.957381 CAST trial https://www.nejm.org/doi/full/10.1056/NEJM199103213241201 III. Tricuspid Valve Interventio

Intermittent fasting, anticoagulation decisions, heterogenous treatment effects, frailty in HF, the importance of the ECG, and industry conflicts are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Intermittent Fasting No, Intermittent Fasting Won't Kill You https://www.medscape.com/viewarticle/1000544 NEJM Paper on Time-Restricted Eating  https://www.nejm.org/doi/full/10.1056/NEJMoa2114833 JAMA TREAT Clinical Trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2771095 II. Stroke Prevention with OAC Shah Meta analysis of Vitamin K Agonists in AF https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.123.010269 III. Heterogenous Treatment Effects in Trials Pivotal CV Trials May Not Apply to Complex Patients https://www.medscape.com/viewarticle/989129 Analysis of 8 Trials of Multimorbidity and Treatment Response https://doi.org/10.1016/j.amjm

p>Obesity drugs as ASCVD-modifiers, HR monitors, when journals publish obvious facts, and effect scores and sorting out signals from RCTs are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Denmark Notes II. FDA approval of Semaglutide FDA Approves Semaglutide for Cardiovascular Risk Reduction https://www.medscape.com/viewarticle/fda-approves-semaglutide-cardiovascular-risk-reduction-2024a10004ix Select Trial III. PPG Monitor Accuracy Research Letter https://doi.org/10.1016/j.jacc.2024.01.024 IV. AAD and Bradycardia Anti-arrhythmic Drugs Linked to Bradycardia in Patients With AF https://www.medscape.com/viewarticle/anti-arrhythmic-drugs-linked-bradycardia-patients-af-2024a10004vw JACC paper on AAD Adverse Effects https://doi.org/10.1016/j.jacc.2024.01.013 V. Finding Signals in RCTs   JAMA paper on Treatment Effects of Oxygen Targets DANISH trial

Plastics and heart disease, MINT trial letters-to-the-editor and Bayes theorem, and Brugada syndrome are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Plastics and Heart Disease Plastic Particles in Carotid Plaques Linked to CV Events https://www.medscape.com/viewarticle/plastic-particles-carotid-plaques-linked-cv-events-2024a10004ge Plastics and ASCVD Study https://www.nejm.org/doi/full/10.1056/NEJMoa2309822 Review https://www.nejm.org/doi/full/10.1056/NEJMra2300476 Editorial https://www.nejm.org/doi/full/10.1056/NEJMe2400683 II. MINT trial LTE and Bayes Theorem In MI With Anemia, Results May Favor Liberal Transfusion: MINT https://www.medscape.com/viewarticle/998376 The MINT Study https://www.nejm.org/doi/full/10.1056/NEJMoa2307983 Letter-to-the-Editor https://www.nejm.org/doi/full/10.1056/NEJMc2400982 Likelihood Ratio https://www.cebm.ox.ac.uk

The Western AF meeting, aspirin, cannabis use, LVEF in athletes, and shared decision making before ICD implantation are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. ASA in Primary Prevention Campbell Meta-analysis https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.065420 Swedish Observational study https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.117.028321 ASPREE https://www.nejm.org/doi/full/10.1056/NEJMoa1805819 II. Cannabis Cannabis Use Tied to Increased Cardiovascular Risk https://www.medscape.com/viewarticle/cannabis-use-tied-increased-cardiovascular-risk-2024a10003yr It Sure Looks Like Cannabis Is Bad for the Heart, Doesn’t It? https://www.medscape.com/viewarticle/1000250 Journal of the AHA Observational Study https://www.ahajournals.org/doi/full/10.1161/JAHA.123.030178 III. Low EF in Athletes Reduced Ejection Fraction in