Podcasts about ascvd

Welcome to HCPLive's 5 Stories in Under 5—your quick, must-know recap of the top 5 healthcare stories from the past week, all in under 5 minutes. Stay informed, stay ahead, and let's dive into the latest updates impacting clinicians and healthcare providers like you! Interested in a more traditional, text rundown? Check out the HCPFive! Top 5 Healthcare Headlines for May 12-18, 2025. FDA Approves Once-Daily Roflumilast (ZORYVE) Foam 0.3% for Scalp and Body Psoriasis The FDA approved once-daily roflumilast (Zoryve) foam 0.3% for treating plaque psoriasis on the scalp and body in patients aged 12 and older. This marks the fifth overall indication for roflumilast, adding to its existing approvals in psoriasis and atopic dermatitis. FDA Warns About Rare, Severe Itching After Stopping Cetirizine or Levocetirizine The FDA issued a warning about severe pruritus that can occur after stopping long-term cetirizine or levocetirizine use. Manufacturers will be required to add a label warning noting that symptoms may improve if the medications are restarted. FDA Approves Susvimo for Treatment of Diabetic Retinopathy The FDA approved Genentech's Susvimo, a ranibizumab delivery system, as the first continuous refillable treatment for diabetic retinopathy. Susvimo offers sustained vision maintenance with refills needed only once every nine months. Olezarsen Cuts Triglyceride Levels at 6 Months in Essence Study The Essence study showed olezarsen significantly reduced triglyceride levels in patients with moderate hypertriglyceridemia at ASCVD risk. Monthly doses achieved about 60% reductions, with most patients reaching normal triglyceride levels after six months. Ruxoprubart Shows Efficacy for PNH in Interim Phase 2 Trial Results Interim Phase 2 results showed ruxoprubart met all primary efficacy endpoints in adults with paroxysmal nocturnal hemoglobinuria. The therapy led to transfusion avoidance, improved hemoglobin, reduced LDH, and increased PNH clone size at 12 weeks.

Welcome to HCPLive's 5 Stories in Under 5—your quick, must-know recap of the top 5 healthcare stories from the past week, all in under 5 minutes. Stay informed, stay ahead, and let's dive into the latest updates impacting clinicians and healthcare providers like you! Interested in a more traditional, text rundown? Check out the HCPFive! Top 5 Healthcare Headlines for April 28-May 4, 2025: Obicetrapib Achieves Robust LDL-C Reductions in Phase 3 ASCVD Trials Obicetrapib significantly reduced LDL-C as monotherapy and in combination with ezetimibe in ASCVD patients inadequately controlled by statins, according to Phase 3 data presented at EAS 2025. MAR001 Cuts Remnant Cholesterol, Triglycerides by 50% in Phase 2a Trial MAR001, a novel ANGPTL4-targeting monoclonal antibody, reduced remnant cholesterol and triglycerides by over 50% in high-risk patients, suggesting a promising new cardiovascular intervention strategy. Oral Zervimesine Reduces Geographic Atrophy Lesion Growth in Phase 2 Trial Zervimesine (CT1812) slowed lesion progression in geographic atrophy secondary to AMD in Phase 2 MAGNIFY trial results, offering a potential oral treatment option. UBX1325 Matches Aflibercept in Vision Gains for DME at 36 Weeks UBX1325 demonstrated noninferiority to aflibercept in visual acuity gains in patients with diabetic macular edema over 36 weeks in the Phase 2b ASPIRE study. Roflumilast Foam 0.3% for Scalp, Body Psoriasis Effective, Safe for Patients Roflumilast foam 0.3% achieved significant efficacy and rapid symptom control in scalp and body psoriasis, with an FDA decision expected by late May 2025.

The SOUL trial

Video Version Only on HCPLive! In this episode, hosts Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, explored two key trial updates in type 2 diabetes (T2D) care at the American College of Cardiology (ACC) 2025 Annual Scientific Sessions. SOUL Trial SOUL, a double-blind, placebo-controlled, event-driven trial, was designed to assess the cardiovascular effects of oral semaglutide (Rybelsus) in patients with T2D and atherosclerotic cardiovascular disease (ASCVD) and/or chronic kidney disease (CKD). A total of 9650 patients aged ≥50 years were enrolled across 450 centers in 44 countries. Analyses showed oral semaglutide (Rybelsus) was linked to a 14% reduction in major adverse cardiovascular events (MACE) in high-risk patients with T2D. This reduction included the incidence of cardiovascular (CV) death, myocardial infarction (MI), or stroke compared to placebo (HR, 0.86; 95% CI, 0.77 to 0.96; P = .006) over a median follow-up of 47.5 months. A 26% reduction in non-fatal MI was the primary driver of benefit, while safety findings identified gastrointestinal adverse events as more common with oral semaglutide. Based on these results, Novo Nordisk announced plans to pursue regulatory approval for a label expansion of oral semaglutide to include MACE risk reduction in adults with T2D and established CV disease. STRIDE Trial STRIDE, a double-blind, randomized, placebo-controlled trial initiated in 2020, assessed the effects of semaglutide 1.0 mg (Ozempic) on functional outcomes, including walking distance, in patients with T2D and peripheral artery disease (PAD). Conducted across 112 sites in 20 countries, the trial randomized 792 patients to receive semaglutide or placebo for 52 weeks. Analyses showed semaglutide use was associated with improvements in maximal walking distance, quality of life, and ankle-brachial index (ABI). SOUL met its primary endpoint, with semaglutide favoring the ratio from baseline in maximum walking distance at 52 weeks (1.21 [interquartile range, 0.95–1.55] vs 1.08 [0.86–1.36]), with an estimated treatment ratio (ETR) of 1.13 (95% CI, 1.06–1.21; P = .0004). At week 57, the improvement in walking distance was higher with semaglutide (ETR, 1.08; P = .038). Quality-of-life scores (VascuQoL-6) at week 52 were significantly higher in the semaglutide group (median difference, 1.00; P = .011), as were improvements in pain-free walking distance (ETR, 1.11; P = .0046). Relevant disclosures for Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. Editor's Note: In this episode, there was an error in the discussion about the new dosing for Rybelsus in the SOUL trial. The corrected information is that the 14 mg dose is now 9 mg with the new formulation, due to improved absorption. The full corrected statement is: “Instead of 3 mg, the new dose is 1.5 mg; instead of 7 mg, it's 4 mg; and instead of 14 mg, it's 9 mg.”

In this on-site episode of Don't Miss a Beat from the American College of Cardiology (ACC) 2025 Annual Scientific Sessions, hosts Muthiah Vaduganathan, MD, MPH, and Steve Greene, MD, break down a pair of trials from the meeting: STRIDE and SOUL. STRIDE Trial The STRIDE trial, funded by Novo Nordisk, was a double-blind, randomized, placebo-controlled study initiated in 2020 to evaluate the effects of semaglutide 1.0 mg (Ozempic) on walking distance in patients with type 2 diabetes (T2D) and peripheral artery disease (PAD). Conducted across 112 sites in 20 countries, the trial enrolled 792 patients, who were randomized 1:1 to receive semaglutide or placebo for 52 weeks. Participants assigned to semaglutide received an escalating dose regimen (0.25 mg to 1.0 mg). The primary endpoint, the ratio from baseline in maximum walking distance at 52 weeks, favored semaglutide (1.21 [interquartile range, 0.95–1.55] vs 1.08 [0.86–1.36]), with an estimated treatment ratio (ETR) of 1.13 (95% CI, 1.06–1.21; P = .0004). Secondary outcomes further supported semaglutide's benefit. At week 57, the improvement in walking distance was greater with semaglutide (ETR, 1.08; P = .038). Quality-of-life scores (VascuQoL-6) at week 52 were significantly higher in the semaglutide group (median difference, 1.00; P = .011). Pain-free walking distance also improved more with semaglutide than with placebo (ETR, 1.11; P = .0046). SOUL Trial The SOUL trial was a double-blind, placebo-controlled, event-driven study designed to assess the cardiovascular effects of oral semaglutide (Rybelsus) in patients with T2D and atherosclerotic cardiovascular disease (ASCVD) and/or chronic kidney disease (CKD). The trial enrolled 9650 patients aged ≥50 years and was conducted across 450 centers in 44 countries. Participants were randomized 1:1 to receive semaglutide or placebo, with a mean follow-up of 47.5 months. Primary outcome events occurred in 12.0% of participants receiving semaglutide (3.1 events per 100 person-years) compared with 13.8% in the placebo group (3.7 events per 100 person-years), resulting in a hazard ratio (HR) of 0.86 (95% CI, 0.77–0.96; P = .006). The primary driver of benefit was a 26% reduction in nonfatal myocardial infarction, with additional reductions in nonfatal stroke (12%) and cardiovascular death (7%). No significant improvements in kidney function were observed. Serious adverse events occurred slightly less frequently in the semaglutide group compared with placebo (47.9% vs 50.3%; P = .02). However, gastrointestinal adverse events, including nausea, diarrhea, constipation, and flatulence, were more common in the semaglutide group (5.0% vs 4.4%). Benefits were consistent across subgroups, including participants receiving sodium-glucose cotransporter-2 inhibitors. Relevant disclosures for Vaduganathan include Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, Lexicon, and others. Relevant disclosures for Greene include Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, and others. Chapters 00:00 - Intro 00:50 - STRIDE Background 02:50 - STRIDE Results 08:19 - SOUL Background 10:40 - SOUL Results

CardioNerds co-founders Dr. Daniel Ambinder and Dr. Amit Goyal are joined by Dr. Spencer Weintraub, Chief Resident of Internal Medicine at Northwell Health, Dr. Michael Albosta, third-year Internal Medicine resident at the University of Miami, and Anna Biggins, Registered Dietitian Nutritionist at the Georgia Heart Institute. Expert commentary is provided by Dr. Zahid Ahmad, Associate Professor in the Division of Endocrinology at the University of Texas Southwestern. Together, they discuss a fascinating case involving a patient with a new diagnosis of hypertriglyceridemia. Episode audio was edited by CardioNerds Intern Student Dr. Pacey Wetstein. A woman in her 30s with type 2 diabetes, HIV, and polycystic ovarian syndrome presented with one day of sharp epigastric pain, non-bloody vomiting, and a new lower extremity rash. She was diagnosed with hypertriglyceridemia-induced pancreatitis, necessitating insulin infusion and plasmapheresis.   The CardioNerds discuss the pathophysiology of hypertriglyceridemia-induced pancreatitis, potential organic and iatrogenic causes, and the cardiovascular implications of triglyceride disorders. We explore differential diagnoses for cardiac and non-cardiac causes of epigastric pain, review acute and long-term management of hypertriglyceridemia, and discuss strategies for the management of the chylomicronemia syndrome, focusing on lifestyle changes and pharmacotherapy.  This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Hypertriglyceridemia Cardiac sarcoidosis can present with a variety of symptoms, including arrhythmias, heart block, heart failure, or sudden cardiac death. The acute management of hypertriglyceridemia-induced pancreatitis involves prompt recognition and initiation of therapy to lower triglyceride levels using either plasmapheresis or intravenous insulin infusion +/- heparin infusion. Insulin infusion is used more commonly, while plasmapheresis is preferred in pregnancy.   Medications such as fibrates and omega-3 fatty acids can be used to maintain long-term triglyceride reduction to prevent the recurrence of pancreatitis, especially in patients with persistent triglyceride elevation despite lifestyle modifications. Statins can be used in patients for ASCVD reduction in patients with a 10-year ASCVD risk > 5%, age > 40 years old, and diabetes or diabetes with end-organ damage or known atherosclerosis. Consider preferential use of icosapent ethyl as an omega-3 fatty acid for triglyceride lowering if the patients fit the populations that appeared to benefit in the REDUCE IT trial.   Apply targeted dietary interventions within the context of an overall healthy dietary pattern, such as a Mediterranean or DASH diet. Limit full-fat dairy, fatty meats, refined starches, added sugars, and alcohol. Encourage high-fiber vegetables, whole fruits, low-fat or fat-free dairy, plant proteins, lean poultry, and fish. Pay special attention to the cooking oils to ensure the patient is not using palm oil, coconut oil, or butter when cooking. Instead, use liquid non-tropical plant oils. Initiate a very low-fat diet (< 5% of total daily calories from fat) for 1-4 weeks when TG levels are > 750 mg/dL.  Recommend and encourage patients to exercise regularly, with a minimum goal of 150 minutes/week of moderate-intensity aerobic activity. If weight loss is required, aim for more than >225 - 250 minutes/week.   Develop patient-centered and multidisciplinary stra...

New RNA Therapies for Treatment of ASCVD, Prevention, and Dyslipidemia   Guest: R. Scott Wright, M.D. Host: Stephen L. Kopecky, M.D.   RNA therapies are growing in number as targeted treatments for dyslipidemia including LDL-c, Lp(a) and Triglycerides. The podcast will explore the science behind these therapies, the evidence for safety and how clinicians can utilize them in their practices.    Topics Discussed: What are the new RNA therapies available or soon to be available? How are RNA based therapies being used? How do they compare to the COVID-19 vaccine? What is their effectiveness and side effect profile? Are there side effects or concerns?   Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.

Welcome to The HCPFive, your go-to roundup for the latest healthcare news and breakthroughs, curated specifically for busy healthcare professionals. Each week, we highlight 5 key developments or headlines from healthcare that you need to know—whether it's a cutting-edge treatment, regulatory updates, or innovations shaping the future of medicine. This week's top stories included the US Food and Drug Administration's (FDA) acceptance of a Biologics License Application (BLA) for a cholesterol-lowering drug, long-term data on a dermatologic treatment for hidradenitis suppurativa, an expanded dosing label for a blinding eye disease treatment, and more! With The HCPFive, you'll get the essential takeaways to stay informed and ahead of the curve. Here's your quick dive into the top stories for the week of February 09, 2025—let's jump in! Interested in oncology news? Check out The OncFive, from our sister publication OncLive. Top News for Healthcare Providers from the Week of 02/09 1. FDA Accepts Lerodalcibep BLA for LDL-C Reduction in High-Risk Patients The FDA accepted the BLA for lerodalcibep, targeting reductions in low-density lipoprotein cholesterol (LDL-C) levels in patients with or at high risk for atherosclerotic cardiovascular disease (ASCVD) and primary hyperlipidemia. The agency set a Prescription Drug User Fee Act (PDUFA) action date of December 12, 2025, and announced no plans to hold an advisory committee meeting. 2. Travere Therapeutics Plans FSGS Submission for Sparsentan Travere Therapeutics announced its intent to submit a supplemental New Drug Application (sNDA) for sparsentan (Filspari) with the FDA for the treatment of focal segmental glomerulosclerosis (FSGS) at the end of Q1. The announcement arrived soon after the completion of a Type C meeting with the FDA, with the sNDA based on existing data from the Phase 3 DUPLEX and Phase 2 DUET studies. 3. Bimekizumab Long-Term Hidradenitis Suppurativa Data Support Efficacy, Safety Profile Bimekizumab (Bimzelx) was associated with sustained disease control for up to 2 years in patients with hidradenitis suppurativa (HS), according to presentation of long-term data from the BE HEARD trials. Presented at the 14th Conference of the European Hidradenitis Suppurativa Foundation (EHSF), bimekizumab reduced the symptoms of HS, achieved a low rate of flares, and improved health-related quality of life. 4. Rosnilimab Demonstrates Historic Responses for Rheumatoid Arthritis Rosnilimab achieved historic American College of Rheumatology (ACR) and clinical disease activity index (CDAI) low disease activity (LDA) responses in patients with rheumatoid arthritis (RA), according to new Phase 2b findings. A depleter and agonist of PD-1+ T cells, rosnilimab was evaluated in the global 424-patient RENOIR trial for efficacy, safety, tolerability, pharmacokinetics, and pharmacodynamics in patients with moderate-to-severe RA on background conventional disease-modifying antirheumatic drugs (cDMARDs). 5. FDA Expands Dosing Label for Avacincaptad Pegol for Geographic Atrophy The FDA approved an expanded label for avacincaptad pegol intravitreal solution (IZERVAY) for geographic atrophy (GA), extending the approved dosing beyond 12 months. Announced by Astellas Pharma, the decision comes after the company resubmitted its supplemental New Drug Application (nDA) in December 2024, based on feedback received from the FDA. The company received a Complete Response Letter (CRL) the month prior. See you next week! Editor's note: this was created with the assistance of AI tools. 

  Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. Traditional lipid-lowering therapies have minimal impact on Lp(a), necessitating novel treatments. Zerlasiran, a small-interfering RNA (siRNA), significantly reduces Lp(a) (~85%) by inhibiting hepatic apolipoprotein(a) synthesis via subcutaneous injection. Muvalaplin, an oral small-molecule inhibitor, prevents Lp(a) particle formation, reducing levels by up to 85.8%. Both drugs were well-tolerated in Phase 2 trials, with further studies needed to evaluate cardiovascular event reduction.

Heart disease is often thought of as a "man's disease," but the reality is that it affects women just as much—if not more. The problem? Women aren't getting the information they need to take control of their heart health. Did you know that heart disease is the leading killer of women, yet so many of us remain unaware of the risks? We sit down with the brilliant Dr. Martha Gulati, a leading expert in preventative cardiology, to uncover the real facts about heart health. From debunking myths about hormone replacement therapy (HRT) to explaining how women can take proactive steps to protect their hearts, this conversation is packed with game-changing insights. Whether you're in your 30s, 40s, or beyond, understanding your heart health now could save your life in the future. Don't miss this essential episode—your heart will thank you! What You'll Learn in This Episode: The Truth About Heart Disease in Women – Why it's often overlooked and why it's crucial to start screening early. Hormone Replacement Therapy (HRT) & Heart Health – Does it actually help prevent heart disease? Dr. Gulati sets the record straight. How to Assess Your Own Risk – Learn about risk scores like the ASCVD and the new PREVENT score to better understand your heart health. The Role of Lifestyle in Prevention – Small changes can have a big impact! Discover how diet, exercise, and stress management play a role in keeping your heart strong. Coronary Calcium Scoring & Advanced Testing – Who should consider getting additional tests for heart disease risk? The Importance of Knowing Your Numbers – Why you should get tested for LP(a), ApoB, cholesterol, and blood pressure levels. Connect with Us: Please sign up for our SUBSTACK so you can forward this information to all your friends inboxes! For more episodes, merch, or to send us direct messages: Website: https://yourdoctorfriendspodcast.com Email: yourdoctorfriendspodcast@gmail.com Socials: Follow @your_doctor_friends on Instagram, TikTok, and YouTube. DM or send us a voice memo—we might feature it on the show! Resources & Links: ASCVD Risk Calculator – Find your heart disease risk score here Your Doctor Friends Podcast Website – www.yourdoctorfriendspodcast.com Email Us Your Questions! – yourdoctorfriendspodcast@gmail.com Follow Dr. Martha Gulati – [Twitter | Instagram | Website] Support the Show! If you found this episode helpful, please take a moment to rate Your Doctor Friends on Apple Podcasts and Spotify. A five-star review helps us reach more listeners and spread life-saving health information. Don't forget to share this episode with a friend—because when it comes to heart health, knowledge is power! Join the Conversation! Have a question about heart health? Leave us a voicemail on our website, and we might feature your question in an upcoming episode! Thanks for tuning in to another episode of Your Doctor Friends! Stay heart-smart, and we'll see you next time.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. Additionally, he covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, and the vital role of cholesterol in brain health, including how cholesterol is synthesized and managed in the brain, how it differs from cholesterol regulation in the rest of the body, and how pharmacological interventions can influence brain cholesterol metabolism. We discuss: Defining atherosclerotic cardiovascular disease (ASCVD): development, risks, and physiological impact [2:45]; The pathogenesis of ASCVD: the silent development over decades, and the importance of early detection for prevention of adverse outcomes [10:45]; Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis [17:30]; How hyperinsulinemia elevates cardiovascular risk [24:00]; How apoB-containing lipoproteins contribute to atherosclerosis, and why measuring apoB is a superior indicator of cardiovascular risk compared to LDL cholesterol [29:45]; The challenges of detecting early-stage atherosclerosis before calcification appears [46:15]; Lp(a): structure, genetic basis, and significant risks associated with elevated Lp(a) [55:30]; How aging and lifestyle factors contribute to rising apoB and LDL cholesterol levels, and the lifestyle changes that can lower it [59:45]; How elevated triglycerides, driven by insulin resistance, increase apoB particle concentration and promote atherosclerosis [1:08:00]; How LDL particle size, remnant lipoproteins, Lp(a), and non-HDL cholesterol contribute to cardiovascular risk beyond apoB levels [1:21:45]; The limitations of using HDL cholesterol as a marker for heart health [1:29:00]; The critical role of cholesterol in brain function and how the brain manages its cholesterol supply [1:36:30]; The impact of ApoE genotype on brain health and Alzheimer's disease risk [1:46:00]; How the brain manages cholesterol through specialized pathways, and biomarkers to track cholesterol health of the brain [1:50:30]; How statins might affect brain cholesterol synthesis and cognitive function, and alternative lipid-lowering strategies for high-risk individuals [1:57:30]; Exciting advancements in therapeutics, diagnostics, and biomarkers coming in the next few years [2:09:30]; Recent consensus statements on apoB and Lp(a) from the National Lipid Association (NLA) [2:12:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

Host: Keith C. Ferdinand, MD, FACC, FAHA , FASPC, FNLA, FPCNA A concerning number of patients with atherosclerotic cardiovascular disease (ASCVD) reached suboptimal LDL-C levels between 2021 and 2022. Even with new strategies that can help lower LDL-C, an analysis of over 3 million ASCVD patients in the Family Heart Database shows that these treatments are not being properly utilized. Join Dr. Keith C. Ferdinand as he delves into an analysis of management trends among these patients, which he presented at the 2024 Family Heart Foundation Global Summit. Dr. Ferdinand is a Professor of Medicine and the Gerald S. Berenson Endowed Chair in Preventative Cardiology at the Tulane University School of Medicine in New Orleans, Louisiana.

JACC Associate Editor Muthiah Vaduganathan, MD speaks with author Ambarish Pandey, MD about the LookAHEAD trial published in JACC and presented at AHA. Among adults with T2D and overweight/obesity in the Look Action for Health in Diabetes (AHEAD) trial, an intensive lifestyle intervention targeting weight loss led to sustained reductions in hs-cTnT at 1- and 4-year follow-up, and a rise in NT-proBNP at 1 year that attenuated at 4 years. After accounting for baseline biomarker levels and baseline and changes in risk factors, longitudinal increase in NT-proBNP was associated with higher risk of ASCVD and incident HF. In contrast, increase in hs-cTnT was significantly associated with ASCVD but not incident HF.

Elevated lipoprotein(a) levels increase the risk of atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. Cleveland Clinic's Steven E. Nissen, MD, speaks with JAMA Executive Editor Gregory Curfman, MD, about how zerlasiran produced more than 80% reductions in time-averaged lipoprotein(a) concentration. Related Content: Zerlasiran—A Small-Interfering RNA Targeting Lipoprotein(a)

In this episode, CardioNerds Dr. Gurleen Kaur and Dr. Akiva Rosenzveig are joined by Cardio-Rheumatology experts, Dr. Brittany Weber and Dr. Michael Garshick to discuss treating inflammation, delving into the pathophysiology behind the inflammatory hypothesis of atherosclerotic cardiovascular disease and the evolving data on anti-inflammatory therapies for reducing ASCVD risk, with insights on real-world implementation. Show notes were drafted by. Dr. Akiva Rosenzveig. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Lexicon Pharmaceuticals. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Treating Inflammation Our understanding of the pathophysiology of atherosclerosis has undergone a few iterations from the incrustation hypothesis to the lipid hypothesis to the response-to-injury hypothesis and culminating with our current understanding of the inflammation hypothesis. Both the adaptive and innate immune systems play instrumental roles in the pathogenesis of atherosclerosis. After adequately controlling classic modifiable risk factors such as blood pressure, dyslipidemia, glucose intolerance, and obesity, systemic inflammation as assessed by CRP can be ascertained as CRP is associated with ~1.8-fold increased risk of cardiovascular events Although the most common side effect of colchicine is gastrointestinal intolerance, colchicine can induce lactose intolerance, so a lactose free diet may help ameliorate colchicine-induced GI symptoms. Anti-inflammatory therapeutics have shown promise in reducing cardiovascular risk but much more is to be learned with ongoing and future basic, translational, and clinical research. Show notes - Treating Inflammation What are the origins of the inflammatory hypothesis? The first hypothesis as to the pathogenesis of atherosclerosis was the incrustation hypothesis by Carl Von Rokitansky in 1852. He suggested that atherosclerosis begins in the intima with thrombus deposition.In 1856, Rudolf Virchow suggested the lipid hypothesis whereby high levels of cholesterol in the blood lead to atherosclerosis. He observed inflammatory changes in the arterial walls associated with atherosclerotic plaque growth, called endo-arteritis chronica deformans.In 1977, Russell Ross suggested the response-to-injury hypothesis, that atherosclerosis develops from injury to the arterial wall.In the 1990's the role of inflammation in ASCVD became more recognized. Both the adaptive and innate immune system are critical in atherosclerosis. Lipids and inflammation are synergistic in that lipid exposure is required but they translocate through damaged endothelium which occurs by way of inflammatory cytokines, namely within the NLRP3 inflammasome (IL-1, IL-6 etc.).Smooth muscle cells are also involved. They migrate to the endothelial region and secrete collagen to create the fibrous cap. They can also transform into macrophage-like cells to take up lipids and become foam cells. T, B, and K cells are also part of this milieu. In fact, neutrophils, macrophages and monocytes make up only a small portion of the cells involved in the atherosclerotic process. What are ways to individually optimize one's ASCVD risk?Ensure the patient is on appropriate antiplatelet therapy, lipid lowering therapy, blood pressure is well controlled, and the Hemoglobin A1c is well controlled. Smoking cessation is pivotal.If the patient has an elevated Lipoprotein (a), pursue more aggressive lipid lowering therapy. Targeted therapies may become available in the future. Assess the patient's systemic inflammatory risk as measured by C-Reactive Protein (CRP)

People with kidney disease are at an increased risk for atherosclerotic cardiovascular disease, or ASCVD, and cardiovascular disease is the leading cause of death in people with kidney disease. In this episode of the Kidney Commute our interprofessional panel of experts discusses what ASCVD is, how patients can be evaluated for their ASCVD risk, and strategies for managing and reducing this risk. We cover risk calculators, pharmaceutical options, communication strategies, and areas where we can all work together to educate patients about risk. Thank you for joining us on this ride of The Kidney Commute!   Click here to claim CE Credit. 

A 72-year-old woman with a 20-year history of hypertension and dyslipidemia-- both at EBP goals with appropriate drug therapy, as well as a remote history of peptic ulcer disease-- presents for follow up. She is a nonsmoker, drinks about 1- 2 glasses of wine per week and denies the use of other substances. Her daily routine includes a 2- 3 mile walk and she denies history of acute coronary syndrome or other ASCVD related conditions. She mentions that one of her friends takes an aspirin a day to “prevent a heart attack or a stroke”, and further states, “I live alone, and I need to maintain my independence.” According to the latest recommendations from US Preventative Services Task Force, which of the following is the most appropriate advice regarding low dose aspirin use in this patient?A. Start low dose aspirin therapy 81 mg daily as the vascular benefits outweigh the risk.B. Best evidence for primary prevention of ASCBT event is with higher dose aspirin at 325 mg a day.C. The risks associated with aspirin therapy in this patient outweigh the potential benefits.D. Start aspirin therapy only if the patient has a family history of heart disease and 1st degree relatives.---YouTube: https://www.youtube.com/watch?v=9uK3CINTFOg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=91Visit fhea.com to learn more!

Elevated LDL-C is directly associated with the development of ASCVD. Learn about current treatments, barriers in applying guideline-directed therapies, strategies for prioritizing LDL-C in clinical practice, combatting misinformation, and utilizing shared decision-making from guests Kim Prado, DNP, AGPCNP-BC, and Binu Koirala, PhD, MGS, RN, FAAN, FPCNA.2018 Guideline for the Management of Blood Cholesterol: https://www.ahajournals.org/doi/10.1161/cir.0000000000000625 2022 ACC Expert Consensus Decision Pathway on Role of Nonstatin Therapies for LDL-C Lowering in the Management of ASCVD Risk: https://www.jacc.org/doi/10.1016/j.jacc.2022.07.006Evolving Management of LDL-C: https://www.ahajournals.org/doi/10.1161/JAHA.122.028892 Shared Decision-Making and Cardiovascular Health: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001162 JUPITER Trial: https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.109.868299 ASTEROID Trial: https://jamanetwork.com/journals/jama/fullarticle/202629 See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

CardioNerds Dan Ambinder and Dr. Devesh Rai join cardiology fellows and National Lipid Association lipid scholars Dr. Jelani Grant from Johns Hopkins University and Dr. Alexander Razavi from Emory University. They discuss a case involving a patient with familial hypercholesterolemia. Dr. Archna Bajaj from University of Pennsylvania provides expert commentary. Drs. Jelani Grant and Alexander Razavi drafted notes. CardioNerds Intern Pacey Wetstein engineered episode audio. This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. A classic finding in patients with familial hypercholesterolemia is the presence of markedly elevated levels of total and low-density lipoprotein cholesterol (LDL-C) with an LDL-C concentration of 190 mg/dL or greater. However, severe hypercholesterolemia is not inevitably present, and many patients who carry this diagnosis may have lower LDL-C levels. This case history describes a young woman whose mother and brother met clinical and genetic criteria for heterozygous familial hypercholesterolemia but who had only a mild elevation in LDL-C, falling to 130 mg/dL after dietary intervention. Despite this finding, genetic testing revealed the presence of the same genetic variants as were noted in her mother and brother. In addition, a second genetic variant predisposing them to cholesterol gallstone formation was identified in all three family members. If genetic testing had not been performed, the diagnosis may have been missed or delayed, resulting in an increased risk for vascular complications associated with familial hypercholesterolemia. This case supports the value of genetic testing of family members of those with familial hypercholesterolemia, even when LDL-C levels are not severely elevated. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Exposing an Unusual Presentation of Familial Hypercholesterolemia – National Lipid Association Familial hypercholesterolemia (FH) is among the most common autosomal co-dominant genetic conditions (approximately 1:200 to 1:300 for HeFH, 1:160,000 to 1:300,000 for HoFH). Genetic testing has a role for all first-degree relatives when a family history of FH is strongly suggestive, regardless of LDL-C level. Heterogeneity in ASCVD risk among individuals with FH is derived from background polygenic risk, clinical risk factors (e.g., timing of lipid-lowering initiation and adjacent risk factors), as well as subclinical atherosclerosis burden. In clinical or genetically confirmed FH, an LDL-C goal of 55 mg/dL is recommended. Beyond statins, FDA-approved non-statin therapies for FH include ezetimibe, PCSK9 mAb, bempedoic acid, inclisiran, evolocumab (only HoFH), lomitapide (only HoFH), and LDL apheresis. Notes - Exposing an Unusual Presentation of Familial Hypercholesterolemia – National Lipid Association What are the diagnostic criteria for FH? Dutch Lipid Clinic Network1 Variables: family history, clinical history, physical exam, LDL-C level, DNA (LDLR, APOB, PCSK9) Simon-Broome1 Variables: total or LDL-C, physical exam, DNA (LDLR, APOB, PCSK9), family history Emphasis on clinical history and physical exam reduces sensitivity U.S. Make Early Diagnosis Prevent Early Death (MEDPED) 1 Only one of the three where no genetic testing is required, may work well in cascade screening Variables: age, total cholesterol, family relative (and degree) with FH Definite, probable, possible, unlikely Emphasis on clinical history and physical exam reduces sensitivity

For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/courses/tackling-residual-risk-in-ascvd-and-ckd-9653SummaryInflammation plays a pivotal role in both cardiovascular and chronic kidney disease, making it a crucial target for reducing patient risk. In this focused 15-minute podcast, our experts break down the latest insights into how inflammation drives these conditions and explore innovative approaches to managing it.Listen to Dr. Ridker as he will delve into the critical role of inflammation in cardiovascular and chronic kidney disease, with a focus on the predictive value of hsCRP as a biomarker for ASCVD and CKD risk. Dr. Ridker explores emerging strategies to address inflammation, and how these advancements could potentially reduce cardiovascular risk and improve patient outcomes.Learning ObjectiveAt the conclusion of this activity, participants should be better able to:Recognize the role of hsCRP as a biomarker in evaluating the risk of ASCVD and CKDIdentify the role of current and emerging agents, based on their mechanism of action, to target inflammation and potentially reduce cardiovascular riskThis activity is accredited for CME/CE CreditAssociation of Black Cardiologists, Inc. (ABC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.Association of Black Cardiologists, Inc. designates this enduring material for a maximum of 0.50 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners® (AANP) through the joint providership of the National Association for Continuing Education (NACE) and ABC. NACE is accredited by the AANP as an approved provider of nurse practitioner continuing education. Provider number 121222. This activity is approved for 0.50 contact hours (which includes 0.25 hours of pharmacology).For additional information about the accreditation of this program, please contact NACE at info@naceonline.com.Summary of Individual DisclosuresPlease review faculty and planner disclosures here.Disclosure of Commercial SupportThis educational activity is supported by an independent medical educational grant from Novo Nordisk.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

In this CCO Nephrology podcast episode, hear from cardiologist Erin D. Michos, MD, MHS, FACC, FAHA, FASE, FASPC, and nephrologist Mark J. Sarnak, MD, MS, as they explore the pathophysiology and novel therapeutic strategies to target residual inflammatory risk associated with ASCVD and CKD.    Episode outline:   Moving beyond lipid lowering to address residual inflammatory riskNovel anti-inflammatory targets for ASCVD To learn more about targeting residual risk associated with systemic inflammation, find more educational activities and resources with the links below:   CME-certified text module with animated pathophysiology video and faculty voice audio clipsClinicalThought commentariesPodcast episode 1, discussing residual risk associated with systemic inflammation and the role of cardiologists and nephrologists in mitigating risk in ASCVD and CKD Podcast episode 3, featuring faculty discussion of new and emerging therapies to target inflammatory risk in patients with ASCVD and CKD 

In this CCO Nephrology podcast episode, hear from cardiologist Erin D. Michos, MD, MHS, FACC, FAHA, FASE, FASPC, and nephrologist Mark J. Sarnak, MD, MS, as they explore new and emerging strategies to target residual risk associated with systemic inflammation in patients with ASCVD and CKD.    Episode outline:   The relationship among systemic inflammation, ASCVD, and CKD The role of cardiologists and nephrologists in screening and mitigating systemic inflammation To learn more about targeting residual risk associated with systemic inflammation, find more educational activities and resources with the links below:   CME-certified text module with animated pathophysiology video and faculty voice audio clips ClinicalThought commentaries Podcast episode 2, discussing novel therapeutic approaches to address residual inflammatory risks in patients with ASCVD and CKD Podcast episode 3, featuring faculty discussion of new and emerging therapies to target inflammatory risk in patients with ASCVD and CKD 

In this CCO Nephrology podcast episode, hear from cardiologist Erin D. Michos, MD, MHS, FACC, FAHA, FASE, FASPC, and nephrologist Mark J. Sarnak, MD, MS, as they discuss new and emerging therapies designed to target residual inflammatory risk associated with ASCVD and CKD.    Episode outline:   Colchicine: inhibition of NLRP3 inflammasome assembly/activationCanakinumab (anti–IL-1β monoclonal antibody)Ziltivekimab (anti–IL-6 monoclonal antibody)Other emerging targets/therapies To learn more about targeting residual risk associated with systemic inflammation, find more educational activities and resources with the links below:   CME-certified text module with animated pathophysiology video and faculty voice audio clips ClinicalThought commentaries Podcast episode 1, discussing residual risk associated with systemic inflammation and the role of cardiologists and nephrologists in mitigating risk in ASCVD and CKD Podcast episode 2, discussing novel therapeutic approaches to address residual inflammatory risks in patients with ASCVD and CKD 

CardioNerds Dan Ambinder and Dr. Devesh Rai join cardiology fellows and National Lipid Association lipid scholars Dr. Oby Ibe from Temple University and Dr. Elizabeth Epstein from Scripps Clinic. They discuss a case involving a patient with elevated Lp(a). Dr. Jessica Pena provides expert commentary. Drs. Oby Ibe and Elizabeth Epstein drafted notes. CardioNerds Intern Christiana Dangas engineered episode audio. This episode is part of a case reports series developed in collaboration with the National Lipid Association and their Lipid Scholarship Program, with mentorship from Dr. Daniel Soffer and Dr. Eugenia Gianos. This is a 63-year-old man with hypertension, hyperlipidemia, and active tobacco smoking who presented with acute dyspnea. He was tachycardic but otherwise initially hemodynamically stable. The physical exam demonstrated warm extremities with no murmurs or peripheral edema. Chest X-ray revealed diffuse pulmonary edema, and the ECG showed sinus tachycardia with T-wave inversions in the inferior leads. A bedside echocardiogram revealed a flail anterior mitral valve leaflet. The patient was taken for cardiac catheterization that revealed nonobstructive mid-RCA atheroma with a distal RCA occlusion, which was felt to reflect embolic occlusion from recanalized plaque. PCI was not performed. Right heart catheterization then demonstrated a low cardiac index as well as elevated PCWP and PA pressures. An intra-aortic balloon pump was placed at that time. A TEE was performed soon after which showed the posteromedial papillary muscle was ruptured with flail segments of the anterior mitral leaflet as well as severe posteriorly directed mitral regurgitation. The patient ultimately underwent a successful tissue mitral valve replacement and CABG. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Little (a), Big Deal – National Lipid Association You are never too young to see a preventive cardiologist! The field of preventive cardiology is shifting focus towards the identification of early upstream risk and intervention before the development of clinical ASCVD (1,5). Patients who have a strong family history of cardiovascular disease, a personal history of CVD at an early age, multiple risk factors, or genetic disorders such as familial hypercholesterolemia especially benefit from early cardiovascular risk assessment and reduction. Female-specific risk factors to incorporate into a young woman's cardiovascular risk assessment include polycystic ovarian syndrome, hormone contraceptive use, early menarche (age 5 pregnancies), early menopause (age

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity. We discuss: Key points about starting exercise as an older adult [2:45]; Overview of episode topics and structure [1:45]; How Peter defines longevity [3:45]; Why healthspan is a crucial component of longevity [11:15]; The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30]; Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00]; Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15]; Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30]; The spectrum of metabolic diseases [43:15]; Why it's never too late to start thinking about longevity [44:15]; The 5 components of the longevity toolkit [46:30]; Peter's framework for exercise—The Centenarian Decathlon [47:45]; Peter's nutritional framework: energy balance, protein intake, and more [58:45]; Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30]; Drugs and supplements: Peter's framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30]; Why emotional health is a key component of longevity [1:17:00]; Advice for newcomers on where to start on their longevity journey [1:19:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

For more information regarding this CME/CE activity and to complete the CME/CE requirements and claim credit for this activity, visit:https://www.mycme.com/courses/answering-your-questions-on-lipids-and-risk-9498SummaryThere's no shortage of information on the management of lipids for the prevention of cardiovascular disease:2018 Guideline on the Management of Blood Cholesterol.2022 ACC Expert Consensus Decision Pathway.CLEAR Outcomes, CVOT studies, Risk Calculators.Helping sort these and other topics out, Dr. James Underberg and Dr. Jessica Pena discuss the top 5 learner submitted questions/topics from the recent programs on non-statin lipid management in primary prevention of ASCVD.This activity is accredited for CME/CE CreditAssociation of Black Cardiologists, Inc. (ABC) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.Association of Black Cardiologists, Inc. designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners® (AANP) through the joint providership of the National Association for Continuing Education (NACE) and ABC. NACE is accredited by the AANP as an approved provider of nurse practitioner continuing education. Provider number 121222. This activity is approved for 0.25 contact hours (which includes 0 hours of pharmacology).For additional information about the accreditation of this program, please contact NACE at info@naceonline.com.Summary of Individual DisclosuresPlease review faculty and planner disclosures here.Disclosure of Commercial SupportThis educational activity is supported in part by an educational grant from Esperion Therapeutics, Inc. and an independent educational grant from Novartis Pharmaceuticals Corporation.Please visit http://naceonline.com to engage in more live and on demand CME/CE content.

CardioNerds (Amit Goyal and Dan Ambinder), Dr. Jaya Kanduri, and Dr. Jason Feinman discuss foundations of cardiovascular prevention with Dr. Stephen Kopecky. In this episode, the CardioNerds and topic expert Dr. Stephen Kopecky tackle cardiovascular prevention. They focus on how to identify patients at risk for cardiovascular disease by using the pooled cohort equation and discuss how to incorporate additional risk-enhancing factors in risk estimation. Later, they discuss the role of non-invasive imaging and testing for further patient risk stratification. Last, they discuss the appropriate pharmacologic interventions for patient care, how to determine what LDL-c to target for each patient, and how to modify your treatment modalities in response to side effects or the need for further lipid-lowering therapies. Notes were drafted by Dr. Jason Feinman. Audio was engineered by CardioNerds Intern Christiana Dangas. The CardioNerds Beyond the Boards Series was inspired by the Mayo Clinic Cardiovascular Board Review Course and designed in collaboration with the course directors Dr. Amy Pollak, Dr. Jeffrey Geske, and Dr. Michael Cullen. CardioNerds Beyond the Boards SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Foundations of Cardiovascular Prevention The 2018 cardiovascular prevention guidelines indicate that a single equation, like the pooled risk equation, does not fit everyone. There are additional risk enhancers that are not factored into the pooled risk equation that can impact an individual's risk These factors are often conditions that increase inflammation but can also include family history, ethnicity, chronic kidney disease, metabolic syndrome, premature menopause or gestational diabetes, and rheumatologic conditions Data from Get With The Guidelines demonstrates that the average LDL at the time of the first myocardial infarction is 105 mg/dL. Coronary artery calcium scores or a carotid ultrasound can be used to further risk stratify patients. However, CAC is likely to be negative in young women. A CAC of zero can be used to “de-risk” some patients but should not be used to guide therapy in the setting of tobacco usage, diabetes mellitus, or familial hypercholesterolemia. Strategies to mitigate risk include healthy lifestyle habits and selectively targeting key risk factors including LDL, hypertriglyceridemia, inflammation, and the GLP1-pathway. Upcoming medications may address elevated Lp(a). Notes - Foundations of Cardiovascular Prevention Notes: Notes drafted by Dr. Jason Feinman. How do you assess an individual's risk for cardiovascular disease? The paramount role of primary prevention is the assessment and mitigation of an individual's risk for ASCVD event.1 The 10-year ASCVD risk calculator is a commonly used tool to assess an individual's risk and to guide shared decision-making conversations and recommendations.2 Individuals can be characterized as having low (less than 5%), borderline (5%-7.5%), intermediate (7.5%-20%), or high (greater than 20%) risk.2 The 10-year ASCVD risk calculator has varying validation in ethnic minorities, and other risk calculators, such as the Framingham CVD risk score, may be considered in those groups.3-5 Additional risk enhancers may be used to guide recommendations for individuals at borderline or intermediate risk.1 What additional imaging testing may be beneficial in the assessment of an individual's risk? Individuals with intermediate or borderline risk may benefit from further non-invasive imaging to help guide therapeutic recommendations.2 Coronary artery calcification is a marker of underlying atherosclerosis, which can help to reclassify patients to be at higher risk for ASCVD events and support interventions to help lower t...

This three part series consists of 3 cases that illustrate important concepts in managing patients with familial hypercholesterolemia, patients with hyperlipidemia and cardiometabolic comorbidities, and patient with South Asian descent with increased risk of ASCVD and a history of percutaneous Intervention. The cases are designed to be quick and offer high-level takeaways and pearls.   In this podcast, experts will discuss the following case: A 54-Year-Old South Asian Male with a History of Cardiac Percutaneous Intervention

This three part series consists of 3 cases that illustrate important concepts in managing patients with familial hypercholesterolemia, patients with hyperlipidemia and cardiometabolic comorbidities, and patient with South Asian descent with increased risk of ASCVD and a history of percutaneous Intervention. The cases are designed to be quick and offer high-level takeaways and pearls.   In this podcast, experts will discuss the following case: A 62-Year-Old Diabetic Woman with an LDL-C of 53 mg/dL 

This three part series consists of 3 cases that illustrate important concepts in managing patients with familial hypercholesterolemia, patients with hyperlipidemia and cardiometabolic comorbidities, and patient with South Asian descent with increased risk of ASCVD and a history of percutaneous Intervention. The cases are designed to be quick and offer high-level takeaways and pearls.   In this podcast, experts will discuss the following case: A 34-Year-Old Woman with Severe Heterozygous Familial Hypercholesterolemia (HeFH)

CardioNerds (Drs. Gurleen Kaur and Richard Ferraro) and episode FIT Lead Dr. Spencer Carter (Cardiology Fellow at UT Southwestern) discuss the clinical implementation of GLP-1 receptor agonists with Dr. Neha Pagidapati (Faculty at Duke University School of Medicine). In this episode of the CardioNerds Cardiovascular Prevention Series, we discuss the clinical implementation of glucagon-like peptide-1 (GLP-1) receptor agonists. We cover the clinical indications, metabolic and cardiovascular benefits, and potential limitations of these emerging and exciting therapies. Show notes were drafted by Dr. Spencer Carter. Audio editing was performed by CardioNerds Academy Intern, student Dr. Pacey Wetstein. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit. Claim CME for this episode HERE. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Clinical Implementation of GLP-1 Receptor Agonists GLP-1 agonists work through a variety of mechanisms to counteract metabolic disease. They increase insulin secretion, inhibit glucagon secretion, slow gastric motility, and increase satiety to limit excess energy intake. Patients with type II diabetes and an elevated risk for atherosclerotic cardiovascular disease should be considered for GLP-1 agonist therapy regardless of hemoglobin A1c. GLP-1 agonists offer significant ASCVD risk reduction even in the absence of diabetes. Newer data suggest a significant reduction in cardiovascular events with GLP-1 agonist therapy in patients who are overweight or obese and have a prior history of heart disease. GLP-1 agonists should generally be avoided in patients with a history of medullary thyroid cancer or MEN2. As these medications slow gastric emptying, relative contraindications include history of recurrent pancreatitis and gastroparesis. GLP-1 agonists should be initially prescribed at the lowest dose and slowly uptitrated to avoid gastrointestinal side effects. Show notes - Clinical Implementation of GLP-1 Receptor Agonists What were the groundbreaking findings of the STEP1 and SURMOUNT-1 trials and how these impact cardiovascular wellness? The STEP1 and SURMOUNT trials demonstrated sustained clinically relevant reduction in body weight with semaglutide and tripeptide, respectively, in patients with overweight and obesity. As obesity is an important risk factor for the development of cardiovascular disease, weight reduction meaningfully contributes to cardiovascular wellness. What were the findings of the LEADER trial and their implications for patients with type II diabetes and high cardiovascular risk? The LEADER trial demonstrated a significant reduction in the rate of cardiovascular death, nonfatal MI, or nonfatal stroke in patients with type II diabetes treated with liraglutide. GLP-1 receptor agonist therapy should be considered in all patients with type II diabetes and elevated ASCVD risk regardless of A1c or current hyperglycemic therapy. What are current indications for GLP1 agonists in the context of cardiometabolic disease. GLP-1 receptor agonists should be considered in patients with type II diabetes and high ASCVD risk OR patients without diabetes who are overweight/obese and have a history of cardiovascular disease. What are important side effects or contraindications to GLP1 agents when used for cardiovascular risk reduction and wellness? GLP-1 receptor agonists should be avoided in patients with a history of medullary thyroid cancer or MEN2. Relative contraindications include recurrent pancreatitis, gastroparesis,

In this groundbreaking interview we discuss the causes of atherosclerosis from a first principles. We cover the critical role of endothelial glycocalx, exclusion zone (EZ) water, nitric oxide (NO), sunlight, whether or not the heart is truly a pump, statins as mitochondrial toxins, coronary calcium and much more.Michael Twyman, MD is the worlds leading decentralized cardiologist specializing in the prevention of aetheroscelortic cardiovascular disease (ASCVD). He practices in St  Louis, Missouri.--------------------------------------------------------------LEARN how to GET HEALTHY SUN EXPOSURE  - PRESALE Offer !✅ Dr Max's Solar Callus Course

Dr. Vyvyane Loh returns to STEM-Talk for her second appearance to talk about atherosclerotic heart disease. Also known as ASCVD, the disease has been reported to affect 26 million people in the U.S., and annually leads two million hospitalizations and more than 400,000 deaths. Vyvyane is a board-certified physician in obesity and internal medicine. In episode 142 of STEM-Talk, we talked to Vyvyane about her Boston-based preventative-care practice that specializes in weight management and the treatment of chronic metabolic diseases such as diabetes, hypertension and dyslipidemia. In today's podcast, Vyvyane and host Dr. Ken Ford talk about ASCVD as well as recent research that has shown substantial individual variability in the response to statin therapy as a way to lower cardiovascular risk. Vyvyane and Ken also discuss how the current knowledge base informing clinical practice in medicine today is far behind advances in the biological sciences, especially in the field of ASCVD. Show notes:  [00:03:15] Ken welcomes Vyvyane back to STEM-Talk and encourages listeners to check out Vyvyane's first interview, episode 142. Ken goes on to mention that atherosclerotic heart disease has been reported to affect 26 million people in the U.S. and that despite the wide use of statins as a primary prevention of atherosclerotic heart disease, the effects of this treatment have been variable with regards to major adverse cardiac events. Ken asks Vyvyane for her thoughts. [00:05:32] Ken asks Vyvyane about recent developments in atherosclerotic heart disease research, specifically in regard to the anatomical aspects of the disease-model itself. [00:08:43] Ken follows up asking Vyvyane how the knowledge we have of glycocalyces, and the endothelial lining of the blood vessels, could affect clinical practice. [00:12:19] Ken asks if there are any other recent updates to the anatomical model of atherosclerotic disease that people should be aware of. [00:13:09] Ken asks Vyvyane how she would characterize the significance of the tunica intima of the coronary artery. [00:15:25] Ken asks about the third recent anatomical highlight to blood vessels relevant to the discussion. [00:19:19] Ken follows up, asking if this is how the vasa vasorum contributes to our understanding of the development of atherosclerosis. [00:21:05] Ken asks Vyvyane to explain what endothelial dysfunction is and what are its downstream effects. [00:26:09] Ken asks Vyvyane to expound on the link between atherosclerotic disease and auto-immunity. [00:31:01] Ken asks, given the link to inflammation, if there have been any therapeutic developments made in the treatment of atherosclerotic disease. [00:34:54] Ken asks about the vaccine that is being developed for atherosclerosis. [00:37:53] Ken mentions that another recent development in the field is the growing appreciation for clonal hematopoiesis in atherosclerosis. Ken asks Vyvyane to explain what clonal hematopoiesis is. [00:39:55] Ken asks Vyvyane what some actionable takeaways are from our discussion on atherosclerosis that listeners can take home with them. [00:43:17] Ken asks Vyvyane about her passion for dance, and how much time she invests in that area of her life. [00:48:11] Ken follows up asking Vyvyane what drives her to pursue dance so passionately. [00:53:34] In closing the interview, Ken encourages listeners to check out Vyvyane's podcast as well as her website. Links: Vyvyane Loh website Vlmdrounds.com Learn more about IHMC STEM-Talk homepage Ken Ford bio Ken Ford Wikipedia page  

Prepare to have your mind expanded by Dr. Michael Koren's insights straight from the American College of Cardiology meeting in Atlanta, where he's sparking excitement with new research on heart health and cholesterol management. As Dr. Koren talks about the new drug Inclisiran that's revolutionizing cholesterol treatment with its vaccine-like qualities, you'll understand why this biannual injection could be a game-changer in the fight against heart disease.This episode isn't just about groundbreaking treatments; it's an eye-opener to the power of clinical research and how it propels medical advancements. Dr. Koren intricately explains how participation in clinical trials with organizations like ENCORE Research Center is critical—and can lead to substantial global health improvements.  Join us for a session that isn't merely informative but could also be the impetus for you to contribute to a healthier future.Recording Date: April 8, 2024Comparison of an “Inclisiran First” Strategy With Usual Care in Patients With Atherosclerotic Cardiovascular Disease - VICTORION-INITIATEInclisiran First Strategy Safe, Effective for LDL-C Control in ASCVD PatientsBe a part of advancing science by participating in clinical researchShare with a friend. Rate, Review, and Subscribe to the MedEvidence! podcast to be notified when new episodes are released.Follow us on Social Media:FacebookInstagramTwitterLinkedInWant to learn more checkout our entire library of podcasts, videos, articles and presentations at www.MedEvidence.com Powered by ENCORE Research GroupMusic: Storyblocks - Corporate InspiredThank you for listening!

In this episode, we review the pharmacology, indications, adverse effects, monitoring, and unique drug characteristics of HMG CoA reductase inhibitors (“statins”). Key Concepts Statins reduce LDL cholesterol by 20-60% (depending on the dose and statin potency). They have modest favorable effects on HDL and triglycerides. Clinically, statins reduce the risk of major adverse cardiac events by about 30% depending on the statin potency. There are four main groups of patients who are indicated for a statin: LDL >= 190 mg/dL, diabetes with age 40-75 years with LDL 70-189 mg/dL, those with an elevated 10-year ASCVD risk of > 7.5% (or possibly > 5%), and those who have had an ASCVD event (“secondary prevention”). Atorvastatin, lovastatin, and simvastatin heavily rely on CYP 3A4 metabolism and tend to be most susceptible to drug interactions compared to the other statins. When a statin is started, baseline lipid panel and liver function tests should be obtained. After 4-12 weeks, a lipid panel should be repeated. Liver function and creatine kinase testing should only be done if a patient has a symptom (e.g. jaundice, right upper quadrant pain, muscle pain or weakness, dark urine, etc.) References Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25):e1082-e1143. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625

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 https://www.nejm.org/doi/full/10.1056/nejmoa1608029 LAFFLIN et al. Scoring System to Assess Generalizability of Trial Results https://doi.org/10.1177/2047487318815967 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Links: Go to episode page Subscribe to Premium See recommended resources Receive the Sigma email newsletter About This Episode: The question of whether dietary fat quality causally affects atherosclerosis risk has been a subject of extensive research and debate within the field of nutrition and cardiovascular health. Atherosclerosis, the build-up of plaque in arteries, is a key factor in the development of cardiovascular diseases, including heart attacks and strokes. Traditionally, dietary fat has been implicated in contributing to atherosclerosis, with a focus on reducing overall fat intake. However, recent studies have shifted the focus towards the quality of dietary fats rather than their quantity. Not all fats are created equal, and researchers are now paying closer attention to the types of fats consumed in the diet. Saturated fats, commonly found in animal products and some tropical oils, have long been associated with increased cholesterol levels and atherosclerosis. On the other hand, unsaturated fats, including monounsaturated and polyunsaturated fats found in olive oil, nuts, and fish, have been linked to potential cardiovascular benefits. Research suggests that replacing saturated fats with unsaturated fats may have a positive impact on blood lipid profiles and reduce the risk of atherosclerosis. Additionally, genetic factors and individual responses to different fats may play a role in how dietary fats impact atherosclerosis risk. In this episode, Dr. Jacob Christensen discusses the research in this area and some conclusions about whether we can say dietary fat quality causally increases atherosclerotic cardiovascular disease (ASCVD) risk. This includes looking at the relationship between low-density lipoprotein (LDL) particles and ASCVD, the link between dietary fat quality and LDL particles, and then finally the relationship between dietary fat quality, LDL particles, and ASCVD. About the Guest: Jacob J. Christensen is a clinical dietitian and researcher at University of Oslo. His research interests include cardiovascular diseases, lipid metabolism, nutrition, genomics and data science.

Welcome back to the CardioNerds Cardiovascular Prevention Series, where we are continuing our discussion of Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs). This class of medications is becoming a household name, not only for their implications for weight loss but also for their effect on cardiovascular disease. CardioNerds Dr. Ty Sweeney (CardioNerds Academy Faculty Member and incoming Cardiology Fellow at Boston Medical Center), Dr. Rick Ferraro (CardioNerds Academy House Faculty and Cardiology Fellow at Johns Hopkins Hospital), and special guest Dr. Franck Azobou (Cardiology Fellow at UT Southwestern) sat down with Dr. Darren McGuire (Cardiologist at UT Southwestern and Senior Editor of Diabetes and Vascular Disease Research) to discuss important trial data on GLP-1 RAs in patients with heart disease, as well as recent professional society guidelines on their use. Show notes were drafted by Dr. Ty Sweeney. Audio editing was performed by CardioNerds Intern student Dr. Diane Masket. If you haven't already, be sure to check out CardioNerds episode #350 where we discuss the basics and mechanism of action of GLP-1 RAs with Dr. Dennis Bruemmer. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit. Claim CME for this episode HERE. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - GLP-1 Agonists: Diving into the Data Patients with diabetes and clinical atherosclerotic cardiovascular disease (ASCVD) or who are at high risk of ASCVD benefit from treatment with a GLP-1 RA. For persons with sufficient ASCVD risk and type 2 diabetes, GLP-1 RAs and SGLT2 inhibitors can, and often should, be used in combination. "Just like we don't consider ‘and/or' for the four pillars of guideline-directed medical therapy for heart failure with reduced ejection fraction, we shouldn't parcel out these two therapeutic options...it should be both.” Setting expectations with your patients regarding injection practices, side effects, and expected benefits can go a long way toward improving the patient experience with GLP-1 RAs. Utilize a multidisciplinary approach when caring for patients on GLP-1 RAs. Build a team with your patient's primary care provider, endocrinologist, clinical pharmacist, and nurse. “This is really a cardiologist issue. These are no longer endocrinology or primary care drugs. We need to be prescribing them ourselves just like we did back in the nineties when we took over the statin prescriptions from the endocrinology domain...we need to lead the way.” Show notes - GLP-1 Agonists: Diving into the Data For which patients are GLP-1 RAs recommended to reduce the risk of major cardiac events? For patients with type 2 diabetes and ASCVD, starting a GLP-1 RA carries a Class 1, Level of Evidence A recommendation in the most recent ESC and ACC guidelines. For patients without diabetes or clinical ASCVD with an estimated 10-year risk of CVD exceeding 10%, consideration of starting a GLP-1 RA carries a Class 2b, Level of Evidence C recommendation to reduce CV risk. The STEP-HFpEF trial showed that among patients with obesity and HFpEF, once-weekly semaglutide may be beneficial in terms of weight loss and quality of life. The results of the FIGHT and LIVE trials question the utility and safety of liraglutide in treating patients with advanced HFrEF. Of the over 17,000 patients enrolled in the SELECT trial, about 25% had heart failure, of which about one-third had HFrEF. Stay tuned for sub-analyses from that trial for more info! Can we still prescribe GLP-1 Ras in patients with well-controlled T2DM?

Dr. Mark Houston is a thinker and researcher into the root causes of cardiovascular disease and metabolism. He graduated from Rhodes College in Memphis, Tennessee summa cum laude in Chemistry before graduating with honors from Vanderbilt Medical School. He completed his medical internship and residency at the University of California, San Francisco, then returned to Vanderbilt Medical Center where he was chief resident in medicine and served on the full- time faculty until 2012. He is the current director of the hypertension Institute where he and his team develop novel approaches to hypertension and ASCVD by attending to root biological causes of disease. He also has a Master's degree in Human Nutrition from the University of Bridgeport, Connecticut, and a Masters of Science degree in Functional and Metabolic Medicine from the University of South Florida in Tampa Florida. He has written hundreds of papers, books and chapters on cardiovascular disease. He is one of the top researchers in the preventative cardiology space and he is here today to share his wisdom. His book credits: Handbook of Antihypertensive Therapy Vascular Biology for the Clinician What Your Doctor May Not Tell You About Hypertension Hypertension Handbook for Students and Clinicians The Hypertension Handbook What Your Doctor May Not Tell You About Heart Disease. Please enjoy my conversation with Dr. Mark Houston, Dr. M Hypertension Institute

Drawing on historical, anthropological and current scientific evidence, Dr Anthony Chaffee & I discuss the logical flaws of blaming red meat and animal-derived fats for modern chronic diseases. We also cover the true underlying causes of heart attacks (atherosclerotic cardiovascular disease (ASCVD)), with specific reference to thrombogenic hypothesis & the flawed approaches of plant-based influencers and centralized cardiology in reducing LDL cholesterol/ApoB with lipid lowering therapy for primary prevention. -------------------------------------------------------------Download my FREE Guide to the Carnivore Diet

Download the 9-Page "Cognitive Enhancement Blueprint" Discover my premium podcast The Aliquot Show notes are available by clicking here Peter Attia, MD is a highly respected expert in preventive medicine, focused on the crucial subject of longevity and cardiovascular health. He's also the author of the NY Times best selling book Outlive - which I highly recommend if you have not read it already. Peter's philosophy transcends the conventional goal of merely extending lifespan; it's about enriching the quality of every year, ensuring that each stage of life is lived with optimal health and vitality. In this episode, we discuss: (00:07:36) Defining cardiovascular disease (00:09:43) Coronary plaque and fatality risk (00:11:09) What is cholesterol? (00:13:34) How ApoB predicts heart disease (00:21:34) Factors elevating ApoB (00:25:24) ApoB reference range explained (00:27:23) Does high ApoB cause cardiovascular disease (00:37:01) ApoB thresholds for ASCVD prevention (00:40:27) Dietary factors raising ApoB (00:39:33) Genetics of ApoB and LDL (00:53:24) Does low LDL increase cancer? (00:56:19) Cholesterol-lowering drugs (00:59:59) Statins, uses, and side effects (01:03:12) Are statins toxic to mitochondria? (01:09:56) Ubiquinol for statin-induced muscle soreness (01:11:09) How to train in zone 2 (01:17:09) Statins and neurodegenerative disease risk (01:21:54) Cholesterol synthesis in the brain (desmosterol role) (01:25:58) Statin alternatives – pros and cons (01:27:30) Ezetimibe (01:31:01) Bempedoic acid (01:36:49) Berberine for CVD Risk Reduction? (01:39:36) Muscle as a glucose sink (01:45:58) Chronic glucose toxicity and vascular impact (01:51:38) Hemoglobin A1C Levels and Mortality Data (01:55:35) 80/20 Zone 2/VO2 Max Training Protocol (02:02:12) Insights from VO2 max testing data (02:12:17) How obesity increases cancer risk (02:15:03) Cancer screening benefits and risks (02:20:47) Dr. Attia's recommended cancer screening age (02:28:54) Liquid biopsies for detecting cancer (02:34:48) CT scans, mammograms and radiation concerns (02:40:32) Menopause – hormonal shifts and health effects (02:45:13) Hormone replacement therapy (HRT) (02:58:57) Perimenopause diagnosis with hormone levels (03:02:04) HRT's impact on dementia, cancer, and heart disease risk (03:04:49) Estrogen's role in bone density (03:07:42) Vitamin D (03:16:24) Testosterone replacement for women's sexual function (03:18:47) HRT safety 10 years post-menopause (03:23:05) Treating low testosterone in men (03:29:53) TRT side effects and risks (03:32:33) Ways to reduce blood pressure (03:39:33) How to measure blood pressure (03:45:30) Peter's longevity optimization routines Become a FoundMyFitness premium member to get access to exclusive episodes, emails, live Q+A's with Rhonda and more: https://www.foundmyfitness.com/premium

Calling all those with a passion for cardiovascular prevention! In this episode of the CardioNerds Cardiovascular Prevention Series, we take a deep dive into the world of glucagon-like peptide-1 (GLP-1) receptor agonists. Along the way, you'll hear about the biology of the GLP-1 molecule and its related peptides, learn more about how GLP-1 agonists promote glycemic control, weight loss, and cardiometabolic health, and explore the current body of literature supporting the individualized application of these medications to patients with diabetes, obesity, and/or ASCVD. Join Dr. Christian Faaborg-Andersen (CardioNerds Academy Fellow and Internal Medicine Resident at MGH), Dr. Gurleen Kaur (Director of the CardioNerds Internship, Chief of House Einthoven, and Internal Medicine resident at BWH), and Dr. Rick Ferraro (CardioNerds Academy House Faculty and Cardiology Fellow at JHH) for a wide-ranging discussion on GLP-1 and GIP agonists with Dr. Dennis Bruemmer (Cardiologist and Director of the Center for Cardiometabolic Health in the section of Preventive Cardiology at the Cleveland Clinic). Show notes were drafted by Dr. Christian Faaborg-Andersen. Audio editing was performed by CardioNerds Academy Intern, student Dr. Tina Reddy. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Novo Nordisk. See below for continuing medical education credit. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - GLP-1 Agonists: Mechanisms to Applications The selection and dosing of GLP-1 and GIP agonists (GLP-1s and GIPs) depends on their intended use as an anti-glycemic or anti-obesity agent. The cardiovascular benefits of GLP-1s and GIPs may be independent of improvements in glycemic control, and in part be driven by reduction in inflammation, a key driver of arterial plaque formation. In patients with comorbid coronary artery disease, obesity, and diabetes, GLP-1 agonists and SGLT-2 inhibitors should be used as first-line agents, over metformin. Tirzepatide is a dual agonist that activates GIP and GLP-1 receptors. GIP is highly expressed in the brain, which may mediate satiety, promote energy expenditure, and enhance peripheral glucose metabolism. Caution should be used with GLP-1 agonists in patients with long-standing diabetes complicated by gastroparesis, as well as incompletely treated diabetic retinopathy. GI upset is not uncommon with GLP-1/GIP agonists, and switching to a different agonist is unlikely to help.  Show notes - GLP-1 Agonists: Mechanisms to Applications What are the mechanisms of action by which GLP-1 and GIP controls blood sugar and body weight? Glucagon-like peptide-1 (GLP-1) is an endogenous hormone that is secreted in response to an oral glucose load. It promotes insulin release, inhibits glucagon secretion, and slows gastric emptying via the brain-intestine axis, leading to satiety. GLP-1 agonists are medications that mimic the effect of this hormone and, on average, lower hemoglobin A1C by 0.8% to 1.5%. These medications include semaglutide, liraglutide, and dulaglutide. Glucose-dependent insulinotropic polypeptide (GIP) is also an endogenous hormone, similarly secreted by the body in response to an oral glucose load such as a meal. GIP is highly expressed in the arcuate nucleus and hypothalamus, which may mediate satiety, promote energy expenditure, and enhance peripheral glucose metabolism. Tirzepatide is a dual GLP-1/GIP agonist. What is the role of GLP-1/GIP agonists in patients with overweight/obesity and/or type 2 diabetes? How does the dosing of GLP-1/GIP medications change with their intended disease target?

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this special episode of The Drive, Peter discusses a variety of topics, breaking away from the typical deep-dive format to explore a wide range of common questions submitted by listeners. Peter tackles subjects like the viability of living to 120 and beyond, addressing some of the optimistic theories regarding achievement of this remarkable feat. Peter then shares his drug and supplement regimen while emphasizing how individualized these protocols need to be. The conversation also touches on lowering apoB, the long-term use of statins, the myth of good vs. bad cholesterol, the complexities of nutrition research, the quest for the ideal diet, and Peter's strategies for hitting daily protein goals. Peter finishes with a discussion about his favorite health-tracking wearables, the role of CGM in non-diabetics, and more. We discuss: Overview of topics and previous episodes of a similar format [2:45]; The viability of living to 120 and beyond: some optimistic theories [4:45]; The potential of mTOR inhibition as a mid-life intervention, and longevity potential for the next generation [13:30]; A framework for thinking about geroprotective drugs and supplements in the context of a lack of aging biomarkers [17:00]; Supplements Peter takes and how his regimen has changed in the last year [26:15]; Pharmacologic strategies to lower ASCVD risk, the limitations of statins, nutritional interventions, and more [36:15]; Misnomers about cholesterol [48:00]; Why nutritional research is so challenging, some general principles of nutrition, and why Peter stopped doing prolonged fasts [50:45]; Optimizing protein intake [59:45]; Wearables for sleep and exercise, continuous glucose monitors (CGM), and a continuous blood pressure monitor on the horizon [1:04:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube