Podcasts about cardiovascular prevention

Does a new low-cost home screening evaluation for cognitive impairment pass the smell test? It's never too late to build social networks that prevent dementia; Study yields surprise findings on marriage's impact on cognitive decline; Senate hearing calls for reinstatement of full-fat milk in school lunches—as science overturns assumption dairy's saturated fat promotes cardiovascular disease; Top cardiologist explains how novel supplement (Vitality) incorporates 7 key cardioprotective nutraceuticals.

In this episode of "Ditch the Lab Coat," Dr. Mark Bonta welcomes Dr. Behnam Banihashemi, a cardiologist specializing in cardiovascular prevention, wellness, and longevity. Dr. Banihashemi discusses the concept of Medicine 2.0, which includes advancements in pharmaceuticals and interventions that have extended life expectancy in the Western world, along with a focus on improving lifestyle choices to further enhance longevity. However, he emphasizes that the real key to living a longer, healthier life lies in addressing lifestyle factors such as fitness, nutrition, sleep, and mental health.Dr. Banihashemi explains that although cardiac procedures like stents can be life-saving during heart attacks, they do not necessarily improve life expectancy for those with stable angina. Instead, lifestyle changes have a more significant impact. He highlights the influence of pharmaceutical funding on medical research and practice, leading to an emphasis on treatments rather than preventive care.The conversation also covers the limitations of the Canadian healthcare system, which does not incentivize primary prevention, and the potential benefits of certain quick fixes like metformin or supplements like protein and creatine. Dr. Banihashemi stresses that small, consistent actions, despite not being marketable, are essential for longevity and that the healthcare system often focuses more on managing diseases than preventing them. Ultimately, individuals hold the power to take charge of their health through day-by-day lifestyle decisions, adding life to their years, not just years to their lives.Get Dr. Banihashemi's 8 Steps to Conquer Chronic Pain: A Doctor's Guide to Lifelong Relief : https://www.amazon.ca/Steps-Conquer-Chronic-Pain-Lifelong/dp/0778807118 Episode Highlights:Longevity Myths Debunked: Dr. Ben sheds light on the widespread misconception that a magic pill exists for living longer. Spoiler alert: it doesn't! Discover the habits that truly make a difference in extending not only your lifespan but also your health span.Four Pillars of Health: Learn about the core areas that Dr. Ben advocates for—Fitness, Nutrition, Sleep, and Mental Health—and how these simple, intentional choices can vastly improve your quality of life.Real Talk on Medical Interventions: Are cardiac stents the ultimate fix? Dr. Ben discusses the harsh realities of current medical practices focused on quick fixes and how lifestyle changes offer more significant benefits.The Canadian Healthcare Perspective: Ever wondered how the Canadian healthcare system affects patient care? Dr. Ben gives an insider's look into the challenges doctors face and how his new venture, the Cardiac Longevity Clinic, is pioneering a shift towards proactive, personalized healthcare.00:00 - Cardiologist Ben's Holistic Heart Health06:00 - Longevity trends in the Western world.09:08 - Impact of non-chronic mortality factors.12:04 - Cardiac stents save lives in heart attacks.16:53 - Biased pharmaceutical research investments.18:49 - Cardiology's focus: Band-Aids over causes.21:13 - Research bias in health studies.27:03 - Primary prevention system failures.28:43 - The Four Pillars for Longevity.34:43 - Integrative health consultation process.37:42 - Sustainable change through consistency.40:46 - Longevity drugs: Metformin vs. Rapamycin.45:28 - Red wine popularity: Study misinterpretations.47:00 - Wine, longevity, and confounding factors.51:13 - Patient responsibility in medication adherence.53:22 - Reflecting on longevity and lifestyle.DISCLAMER >>>>>>    The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions.   >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests.       Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. 

Dr. Hoffman continues his conversation with Jim LaValle, a Clinical Pharmacist, Author, Board Certified Clinical Nutritionist, and Heart Health Expert. 

Comprehensive Cardiovascular Health and Prevention with Jim LaValle: In this episode of the Intelligent Medicine Podcast, Jim LaValle, a clinical pharmacist and heart health expert discusses various aspects of cardiovascular health in honor of Heart Health Month. The discussion covers risk factors for heart disease, including metabolic health markers and lifestyle influences. They examine the pros and cons of statins, their impact on brain health, and the role of natural supplements like Kyolic Aged Garlic Extract in cardiovascular prevention. Specific criteria for an ideal cardiovascular risk assessment are provided, and practical advice on exercise and maintaining a balanced diet is shared. 

In today's special episode of The Root Cause Medicine Podcast, we're unwrapping the most transformative health insights from five extraordinary physicians who are redefining wellness. You'll hear us discuss: 1. How to reverse your biological age and prevent chronic disease 2. The profound connection between gut health and overall wellness 3. The hidden impacts of menopause on inflammation and immunity 4. Advanced approaches to preventing heart attacks 5. Revolutionary solutions for ADHD, anxiety, and insomnia Join us for this curated collection of powerful conversations with Dr. Kara Fitzgerald, Dr. Vincent Pedre, Dr. Bridget Briggs, Dr. Sanjay Bhojraj, and Dr. Romie Mushtaq as they share their groundbreaking approaches to health and healing. Order tests through Rupa Health, the BEST place to order functional medicine lab tests from 30+ labs - https://www.rupahealth.com/reference-guide

Dr. Hoffman continues his conversation with Jim LaValle, co-author of "Peptide Handbook: A Professional's Guide to Peptide Therapeutics."

Jim LaValle, an internationally recognized clinical pharmacist, author, and lecturer, details the emerging field of peptide therapeutics. He discusses the basics of peptides, their roles in various bodily functions, and their therapeutic potentials, including weight loss, immune support, and injury recovery. Jim also shares insights on individualized dosage for GLP-1 drugs, regulatory challenges, the future of peptides in medicine, and exercise tips for seniors. Additionally, Dr. Hoffman explores Jim's role in spearheading the MIORA Longevity Program at Lifetime Gyms, aiming to make gyms not just places for workouts but comprehensive wellness centers focused on longevity and health optimization.

In this episode Dr. Paul Ridker discusses the pivotal role of high-sensitivity C-reactive protein (hsCRP), a biomarker for inflammation, in cardiovascular prevention and treatment. He explains how inflammation and cholesterol together drive atherosclerosis, the significance of hsCRP testing, and the latest clinical trial findings. Dr. Ridker also highlights the importance of primary prevention strategies and the potential of targeted anti-inflammatory therapies to revolutionize cardiovascular care.

 Chronic inflammation from diabetes, obesitity and other long term illnesses play a bigger role in heart disease than we realize.  Dr. Andrew Freeman, the Director of Cardiovascular Prevention and Wellness at National Jewish Health in Denver, says changing your lifestyle is much more cost effective than surviving a heart attack or dying from one.  Dr. Freeman says a plant based diet, brisk exercise everyday, reducing stress, at least 7-hours of sleep each night and have a good support system around you.  ALL five of these tips -- along with not smoking are the best way to reduce your risk of a heart attack.  Go to CVDInflammation.com for more information.  You can follow this show on Instagram and Facebook.  And to see what Heather does when she's not talking money, go to her personal X (Twitter) page. Be sure to email Heather your questions and request topics you'd like her to cover here.  

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...

Shownotes and Transcript Ivor Cummins, maybe better known to many of us as The Fat Emperor, has challenged the Covid narrative from the very beginning.   He joins us today to discuss a new tyranny happening not only in Ireland but across the whole of Europe. Compelled speech.  Ireland's new "Incitement to Violence or Hatred and Hate Offences" Bill has been waiting for approval in the Senate since the summer.  This biggest curtailment of free speech was set to quickly pass until scrutiny from free speech champions stalled it.  Ivor goes through the bill and the expected consequences.  Ivor Cummins BE(Chem) CEng MIEI  completed a Biochemical Engineering degree in 1990. He has since spent 30 years in corporate technical leadership positions. His career specialty has been leading large worldwide teams in complex problem-solving activity.   Since 2012 Ivor has been intensively researching the root causes of modern chronic disease. A particular focus has been on cardiovascular disease, diabetes and obesity. He shares his research insights at public speaking engagements around the world, revealing the key nutritional and lifestyle interventions which will deliver excellent health and personal productivity. He has recently presented at the British Association of Cardiovascular Prevention and Rehabilitation (BACPR) and also at the Irish National Institute of Preventative Cardiology (NIPC) annual conferences.  Ivor's 2018 book “Eat Rich, Live Long” (co-authored with preventative medicine expert Jeffry Gerber MD, FAAFP), details the conclusions of their shared research: https://www.amazon.com/Eat-Rich-Live-Long-Mastering/dp/1628602732/ Interview recorded 12.12.23  Connect with Ivor... X                           https://x.com/FatEmperor?s=20 WEBSITE              https://thefatemperor.com/ PODCASTS          https://thefatemperor.com/podcasts/ Connect with Hearts of Oak... WEBSITE              https://heartsofoak.org/ PODCASTS          https://heartsofoak.podbean.com/ SOCIAL MEDIA    https://heartsofoak.org/connect/ TRANSCRIPTS    https://heartsofoak.substack.com/ Support Hearts of Oak by purchasing one of our fancy T-Shirts....  SHOP                  https://heartsofoak.org/shop/  *Special thanks to Bosch Fawstin for recording our intro/outro on this podcast. Check out his art https://theboschfawstinstore.blogspot.com/ and follow him on GETTR https://gettr.com/user/BoschFawstin and X https://twitter.com/TheBoschFawstin?s=20  Transcript (Hearts of Oak) Today, I'm delighted to have Ivor Cummins with us, The Fat Emperor. Ivor, thanks so much for your time today. (Ivor Cummins) No worries, Peter. Always good to chat about real truth and accuracy and avoid misinformation, shall we say. Which is fast and thick and furious and being thrown at us from every angle. I have thoroughly enjoyed watching your different videos. I know recently you've done Dr Pierre Kory, who we had on, you've obviously been on TNT Radio, I saw I think recently with Darren Denslow who's been on with us quite a number of times and I think your title on that was Technical Manager, Biochemical Engineer and Technologist and obviously you've got your background in biochemical engineering and probably over the last couple of years you've been very vocal on pushing back against the COVID tyranny and then it's much wider. I think from 2012 you've been researching the root causes of modern chronic disease, focusing on cardiovascular and I'm sure that over the last three years a lot has been added to that, that you weren't expecting. But maybe you just take a moment and introduce yourself before we get on to what is happening in Ireland and the criminalization of speech. Yeah absolutely, so briefly I did biochemical engineering, I graduated in 1990, I spent five years in medical device and development of dialysis units and all that kind of stuff. So I got a lot of medical exposure there at the time, but then the next 20 years, plus I was on the high volume kind of, uh, electro fluidic devices. And it was great because it's extremely complex when you have around 10 sites around the whole world, making products, uh, billions, ultimately of complex devices, the slightest problem or the most subtle problems, it can become huge, you can lose millions of dollars overnight. So I was the master problem solver. Ultimately, I ran large teams on the most complex problems, multi factor. And I did that for 10 or 15 years, 20 years. And I was also a manager as well of teams of up to 20 engineers, directly people managing them, that was great experience. So, I just got this vast experience in complex problem solving and people management and essentially a form of politics, corporate politics, which was also very useful. And what we're seeing since COVID started, coming ultimately from Rockefeller Brothers Fund in the 50s, right through Club of Rome, Trilateral Commission, Council of Foreign Relations, UN, the EU, I'm beginning to view those as a complex problem solver as almost synonymous. So they're all so interconnected and countless NGOs and corporates and the World Economic Forum that people find it hard to believe. Well, how could this be orchestrated? Who could possibly organize it? And it's actually quite simple. It's a long game plan for a global governance structure. And it's funded by the people at the top and the most powerful political people and the US State Department has an interest. And they're all working for around half century or more since the Second World War towards a very tight, well-controlled global government. And yeah, it's not that hard to orchestrate, because all the right people are doing it. And they're doing it like we did things, corporate style. It's very structured. It's full of lovely language. It's got lovely goals that sound great. It's obviously highly sinister under the hood. But yeah, it's not that complex. But most people don't have the corporate experience to be able to decode something like this, find all the players and just see the whole picture. And that's the problem. Just like people have no knowledge of virology or epidemiology, you know, or immunology. So you can fool the people with ease. And that's the challenge we've been seeing. And that's what I jumped into in March, 2020, because I could see pretty quickly, I have five children, I could see where it was going, it wasn't hard. And I just knew that this is kind of the battle of our generation, there's no question about that. And if we lose, we'll have a China-style society in the West, and that's pretty much the outcome. Yeah, and I respect those views. I think Naomi Wolf actually mentioned that from day one, whenever it was announced shutting down Broadway, then her and her husband left New York immediately. Others has taken a little bit longer to see through. You're hoping for the best in institutions, in society, in media. I think we've realized there is no best there. But what has been then your last three and a half year because that's a world away from a background in the biochemistry, the research. What you're doing now is so different. So I mean let us know that change and what that has been like for you personally. Yes, it's certainly been interesting, but you live in interesting times. So 2012, 13 up to 2020, when COVID hit, I was deeply involved in biomedical and metabolic research, and I was going all over the world speaking. A wealthy Irish entrepreneur was funding me to travel all over the world to conferences, medical and nutritional, and to explain to people how what caused heart disease, Alzheimer's, most of the solid tumour cancers that cause the most death, and all of these modern chronic diseases go back to the devil's triad. So very simple, I named it that. It's sugar, refined grains, refined carbohydrates, and vegetable oils, seed oils. And that's what makes up most processed foods, which is around 60% of everyone's calories. So essentially, were poisoning the population for nearly a century now. So I was lecturing on all of that and on insulin resistance, which is the big thing you measure, because that's the target you have to get down low, and then you're pretty much okay. But then when COVID hit, I had been so involved in the corruption of the statin kind of industry, the cholesterol-lowering nonsense. I'd been involved in a lot of drug corruption, and also back in the 90s, I'd actually been directly involved, not personally doing things, but older engineers were doing things completely against the rules. And it was common practice, you know, in biomedical manufacture. And I'm sure that never changed. So I had all this experience in the corporate corruption. I had all the experience in my own corporate roles in the last 15 years, again, in the corporate politics and corruption. And I had all the medical and biomedical knowledge now and metabolic. So when COVID hit, I was on stage in Denver, big room and giving a talk and then I came down and Trump was shutting down the country and I said what the hell is going on? And my wife had said previously, she had said should we get masks? Now she's a first class honours engineer and she's aware of a lot of my work but she assumed COVID was a big deal and I just smiled and this was early March I think and I said not at all sure. I saw the Diamond Princess data and you could see from who died and who didn't that it was going to be a bad flu equivalent. I mean, there's no question about that. The ship had shared AC. They were crammed together. They got 25% positivity. It was an extreme maximiser of infection. So you see the end result. And a few people in their late 70s and late 80s passed away. That was it. So we knew. But when they shut the airports, I said okay they're gonna pull a swine flu and they're gonna pull a big swine flu, a scam. And got back to Ireland and after that I just started interviewing immunologists, virologists, epidemiologist because when I will call something constantly I check with my massive network and my massive network of specialist in all the medical fields grew rapidly because a lot of people out there who are seeing that this is crazy. And so within a few months, I knew not only everything you needed to know about COVID, the mortality impact, the lockdown ineffectiveness, mask ineffectiveness, seasonality, I cracked the whole lot with the help of my network. And I began to explain it in layperson's terms. And that's when I began to get smashed, put in the newspapers, and censored. Even though I didn't talk any anti-vax, any crazy stuff, everything I said was referenced to government data. I was very careful. But in September, my viral video shot up to millions of views, half an hour, just me with slides, just explaining all the factors in COVID, just what it was. And the New York Times did a half-page article on me. It's like, whoa, a half-page hit piece on an Irish engineer. But at that stage, I knew that this was a total orchestrated scam. There was no question. So it didn't actually surprise me that the New York Times devoted half a page to an Irish engineer because the system and the media particularly were owned. And my video had corporate CEOs. They actually said it in the article. A leader in the COVID scam in the US, I forget his name, said, I have people from major companies, CEOs, coming to me asking, is this Irish guy right? So it shocked them. Just truth. Just truth. That's all it was. Well I think we learned people are hungry for information and that information is becoming, can be more difficult to access. But I want to go, I mean, I'd love to pick you up on that, on the. Fascinating. I know your book, Eat Rich Live Long, is available. Links are in the description and people can get a hold of that. And that health is a hot topic, but I want to talk to you about Ireland and the restrictions on speech. I mean Ireland has had incitement to hatred, hate speech laws for I think it was 89 or 90 was introduced, the UK has had it across Europe, but what is happening in Ireland at the moment with this new piece of legislation has really woken a lot of people up. I mean I saw an article in Newsweek magazine a couple of days ago and they were saying this cannot go ahead, this is Orwellian hate speech. Do you want to just let us know what exactly has been proposed in Ireland? Yeah, well, for sure, you're absolutely right, Peter, to refer to the 1989 Hate Speech Act, because that was actually very good legislation. It is still 100% perfect legislation for what they claim may be a problem, because it is quite powerful. It's been used, I believe, 50 times plus. And if you go out and make hate speech that could cause injury or cause hatred towards people or minorities, yada, yada, yada, they can go after you. No problem. So the law is there. It's perfectly functional. Needs no upgrade. What they brought out, it seems to be, I don't know, a Soros, an NGO coming down from the UN, maybe using Ireland as a test case for the most extreme madness that they're willing to try out in the test bed of Ireland. But what's in it is just lunatic. Now, people listening, they know it's terrible and it's great to hear Newsweek featured it. And it is, of course, Orwellian. But the extent to which it's insane, I can't even believe the bad guys want this or wrote this. So essentially, there's layers of madness. One is that they don't define hate speech really at all. And Michael McDowell, the former Attorney General in Ireland, was fantastic in the Irish Parliament questioning the Justice Minister on this point, it's not defined. And he said, I've heard the reason discussed for not defining hate speech was it could make it more difficult to convict people. And he said, that's the point. It should be difficult to convict in these kinds of matters, so it should be defined, so you get the right guy. So that's one point, It's not defined. There's around 10 groups, arbitrary, that they've listed out, like traveling people, and trans, and sexual, and gender, all this nonsense, none of whom has a problem anymore with hate speech. There is no far right in Ireland worth a toss. None of these groups have any real issue, right? So that's the other layer, not defining. And the other thing is that they've put in that a single guard, based on someone whispering in his ear, can get a local, very low-level court warrant and come into your house and take everything, anything and everything. It's like, wow. It can be diaries, it can be phones, it can be computers. They could take them for weeks, I would guess. And if you don't give a PIN number, that's also listed as an offence. If you say, I don't know the PIN for that, it's an old phone, that's an offence with six months in prison potentially and a big fine. That's another insanity. And when they take it, if they find anything under the undefined hate speech kind of thing, right, they can say, well, okay, that's private. You wrote this down. You could write a diary and you could say, oh, I hate this group and I don't like that group and I think they should be thrown out. Whatever you want, which you're entitled to. Of course, you're entitled to write that stuff. I wouldn't agree with it, but if you believe that, go ahead. Keep it to yourself. It is up to you to prove to a judge that you would never in the future have shared that. So it's guilty until proven innocent has been put in this. It is thought crime. It is 1984. It is minority report. Remember the movie with Tom Cruise? They see that you will commit a crime in the future using futuristic technology and they come and arrest you. It's like that but much worse because your private writings, memes, God knows what's on your computer from stuff you've downloaded or had sent to you. You have to prove you would not in the future share that. I mean, it is just beyond notes, hopefully, you know, well, you know already. It's just insane. I keep using the word insane for this because I'm blown away, even me after three years of COVID. People need to understand that. It is insane. There's no other word. Has this come in, I mean, the UK have obviously got the online safety bill. That's another issue. And then the EU passed a bill, proposed a bill, which now passed just days later. But this, you're right, it's difficult to understand when legislation exists to tackle a so-called crime or injustice. And that's already there and everyone says that can be used and there's no issue with it being used. And then something else is brought in place, supposedly to correct a problem that isn't addressed and yet it is. And it is this confusion, I guess, and of course, we don't have the media reporting this or asking why. It's simply, well, are you for hate? I'm not for hate, therefore you want this bill. I mean, talk to us about the pushback on this and has it been scrutinized at all? Yeah, there's no scrutiny at all. I mean, basically, we know now, and it's not even controversial, I think, recently a TD or an MEP, an Irish MEP was asked, oh, what do you think of coming back to Ireland, back to Irish politics and the Dáil? And he said, well, no, and he casually let a cat out of the bag. And he said in the interview on record, he said people don't realize that over 70% of legislation comes from Europe, down to Ireland. So he said, to be honest, I'm better off over here, because that's where the control is. He didn't say control, but he said the first piece. And that's it. So essentially, I would say this is the simple way to view it now. Over the last couple of decades, increasingly, and now it's largely complete, when people go into politics, first of all, people got to remember the skill that brings you into politics is the opposite of technical, mathematical, logical. You go in there with so-called people skills. You know the type, right? So they go in there and they're kind of useless technically. Anyone can fool them, even though they're cunning. Anyone can fool them technically. And with legal matters, will fool them. So the people that go into politics now, especially in Ireland, we're like a vassal state of EU, UN, WEF. You know, we're really bad. That's why we had the longest lockdown in Europe. So they go in anyway and they quickly find out, political people find out where the power is. Like a lady said years ago about Washington, when you go into the Senate in Washington, an old guy said to her, you got to lean to the green. And he didn't mean environmentalism, he meant the dollar, you got to lean to the big guys, the money, the lobbyists, if you want to be successful. So in Ireland, they go in, they quickly find out it's all about the EU and keeping the big boys happy, and the UN and the WEF. And if you get invited to Davos, oh my God, that's the pinnacle of Irish political success. So you get the idea. So when it came to the Dáil, this legislation, they all just said, oh yeah, yeah, great. Oh, hate, love. Oh, we're all lovey-dovey. Oh, trans, you know, Ukraine, all this stuff. So all the politicians just signed it off. Didn't even read it. If they read page 10 and 11 and they had a brain, they'd say, oh my god, but they didn't. You know they didn't read it. They were all told it's great and they all signed it. And then when it was coming up to the Senate and then it would go to the President, then people began to get wind of it and began to talk about it. And then it became a problem. And then Elon Musk began to talk about it and said, what the hell's going on in Ireland? And then they started and saying, oh, he's right wing, he's an anti-Semite. There are politicians judging Elon Musk. It's like an ant judging God. It's just crazy. So also, I think it was someone connected to Trump, not Trump himself, made comments on how crazy it was. And then he did a big article, oh, Trump. Trump doesn't want it, because they know people think Trump's bad. It was propaganda to the power of 10, because they wanted it true and the media wanted it true. You know, the media all wanted it true. So luckily the Senate actually, it didn't go past and it got delayed. You know, that's all they could do. They delayed it. And then shockingly based on the stabbings of some poor children, actually migrant children, I believe. They used the anger in the public from the gross, excessive, uncontrolled migration in the last year or two. There's anger. 75% of Irish people or more in a Red Sea official poll said immigration has gone way too far, uncontrolled. It needs to be pulled back in control. So the majority in the country believes that. But the anger that's there in the country, smaller percentage of people are very angry. and a bunch of hoodlums caused a riot. They smashed windows, burned buses. They didn't beat anyone up and they didn't go after any migrants. They did a smash and grab spree on the back of public sentiment. And with the children being stabbed, it was an opportunity, it's happened before. Nothing to do with far right, nothing to do with political ideology. It was opportunistic from a bunch of hoodlums in hoodies. And the video showed that. and the government actually used that problem that they caused, right? They then tried to flip truth upside down and use the problem to ram the insane law through. You couldn't make it up unless you knew how loathsome, low-life's our politicians are and how utterly controlled they are from the NGOs and all the other groups up top. It is just shocking, right? Well, I want to go down the Irish politics side, but you need a catalyst in the UK, the catalyst for the online safety bill was the stabbing and murder of David Amess MP and that immediately everyone came out and said we need this online safety bill. Even with that individual was possibly radicalised in his local mosque but that's a conversation you weren't allowed to have so we'll just focus on. We've seen the issue there in Ireland and the government have not wasted the opportunity to jump on that. I was even looking at that and thinking, is this contrived? I mean, governments need a catalyst to push forward. And if something happens, they can point and say, look, we told you so. This is why it's needed. And everyone comes together. I mean, what were your thoughts on how that happened? And has that been the main catalyst or have other things happened to push it forward? Yeah, there was talk of, you know, there's always talk of kind of false flag and don't get me wrong, there's a ton of false flag and there's a ton of Hegelian kind of mechanisms that have been used since all of human history, problem, reaction, solution. You create a problem, essentially, you then use propaganda to get a big reaction to it. And then you come in with your pre ordained solution and everyone goes, yeah, we'll take it. So COVID's a classic example of that. A lab created gain-of-function virus. It comes out. They see that it's got a little bit of pathology to it or pathological effect. It's going to kill older people mainly. And they big it up. And then they say they have a solution, the vaccine. So there's a lot of that. This one here, I really think, because I'm a logic and data guy and I go on probabilities. That's the centre of my universe. The overwhelming probability, I would say, that guy has not worked, I believe, in 20 years since he came here, the person who did the stabbing, and probably has all kinds of issues. And I think they've even referred in some articles to some of that indirectly. They don't want to identify him. I think that was just a happening. And we saw it earlier, a girl was stabbed by, again, a migrant who had issues. And even locally in my area, a similar thing occurred a few years ago, a very tragic case with a family. So these things happen, you know, when migrants come to places, sometimes they're under pressure, they don't have the language, they develop issues. So I think that just did kind of happen. But the exploiting of it, well, like I said, is just criminal. And the reason it blew up, if that was a very rare occurrence and it just happened, and it wasn't after a year or two of increasing public discomfort, like the poll said, they know that the towns around Ireland, little towns, are getting stuffed with migrants. And they can see they're young males mainly. They're not women and children from Ukraine, come on. I mean, down in South East Wexford, there was a nursing home being built for a community of 1,200. And a couple of weeks ago, it transpired that suddenly it's not being built. It's being built in a different direction for 170 young male migrants, young male migrants, unmarried. And they're looking at bringing it up to 400 over time. Now, a thousand people marched and of course the media all sniffed and sneered at them like they're far right. It's their community. It's insane. I mean, the numbers that came in in the last six or 12 months is like 100k and the graph of the numbers coming in went through the roof. And O'Gorman, I think the minister last year, he did this, it's on the record, sent out a tweet, not in Ukrainian. In Ukrainian, Georgian, and African languages. And he basically said, Ireland's open. You'll have a house within four months. We get you a phone. We get you loads of money. Whatever. I don't know what was in it. But it was translated into all African languages and everything. So he's on the record. They want to flood the zone. And the reasons for that go back to the Pan-European Union in the 30s and speeches in 2009, I think, by, who was that CEO of Goldman Sachs who became a big UN guy, not Robinson, forget his name, an Irish guy originally. He gave a huge speech and he said it outright. We have to destroy nationalism. We have to destroy sovereignty in the EU countries. We have to break it down. And the mechanism, the best mechanism for that, besides pouring US junk television in, right? And phones, you know, the best thing is flood in very different people, ideally young males, and blend the country into a blob so we can get a big blob in Europe without any national identities. So they're actually destroying diversity because we had all these countries that you could freely travel to and see their culture. and then you come back home and you talk about it, that's actually diversity. They're all peaceful, all lovely, but they want to end diversity. They just want to make a blob because a blob can easily be translated into a super state or a China-style society. Very hard to do it when you've got identifiable nationalities in Europe. It's so simple, isn't it? This is a hundred-year-old brainstorm strategy that's clearly being deployed recently. Big scale. That's it, no racism. In fact, last thing I'll say, sorry I'm on a rant here, it's morning time, but Peter, the last thing I'd say, and this is so important for people to know and understand, The people who are using minorities from other countries as cattle, literally using them as pawns in their chess game to get their globalist Europe and globalist West, they are the ultimate racists because they have absolute scorn and contempt for poor people from all over the world that they're forcing into countries and creating difficult situations where there may be, you know, certain amounts of racism stoked and provoked, you know, like a hornet's nest, keep shoving in people, they don't have accommodation, our homeless can't get accommodation, they've ignored them for decades, and now they're shoving in hundreds of thousands with, we already have an accommodation problem, what's going to happen? But the people driving this, they are the racists. I am the opposite of racist, my record is clear, they'd love to call me one, but they can't because I have a full record on social media and forever. Absolutely the opposite. In fact, I've often shared anti-racial movies and films on my Twitter, like Kenneth Branagh, 2001 conspiracy, it's called, about Wannsee in Germany in 1942 or three. I'm clearly an anti-racist. They hate that. But that said, I know racists when I see them and the people driving the policy are racists. And of course there's nothing you can say or push back if you're called names which is this legislation about offending and finding offense and if someone has been offended you cannot prove that in a court that, you cannot prove your feelings in court and of course when someone calls you whatever, racist, xenophobe, Islamophobe, the list goes on, you can argue and you can push back but it's already been decided by whatever individual has said. They have decided and therefore you are because they have spoken. And that declaration of speech, you know, truth goes out the window. It's the issue on pronouns. If someone wants to use a pronoun then they define that person who is a man, is a woman and that must be true. And that kind of removal of truth, not only in this legislation but I guess across Europe for all the hate speech which is simply if someone finds offense then it is decided that a crime has been committed. It's beyond absurdity but also it's very malign and clever. So the people I refer to are driving this as a geopolitical crucial strategy this is not small stuff, that's why it's getting so much funding and backing. it's very important for broader globalist. Kind of government desires and to make ultimately, we won't get into detail, the intention is to translate the UN into the world government or for the West. The UN is being built and built and built and we can see the insanity coming from Guterres, the head of the UN. We're now global boiling. We're no longer warming, all nonsense. The UN is being teed up. So there's a lot put into this thing and hate speech because it is important because free speech increasingly could cause a real problem for basically plans that have been grown beautifully for 70 or 80 years since post-World War II. So, you know, too big to fail. They can't let all of the plans of geopolitical, you know, structure and infrastructure that have been built for a half century, they can't let it fail because people all start becoming aware of it and talking about it, that's why there's this extreme kind of insane zeal to get in the laws, because they're important, and people need to realize that. And you say you can call. Yeah, once you call someone a racist, the judge is going to roll over. That's the sick thing. We saw in COVID, several people brought very good cases, and they assigned a lower-level judge to check if the cases were appropriate to bring forward in the system. I didn't realize they could do this. They did. So there were mask challenges and other challenges. This judge, she went in and looked at everyone. No, I don't think that's, no, that's not required. One judge threw them all out before they even got in the system. So you know what will happen. If the government don't like someone, they'll try to nail them on this law, and the judge will be in the pocket. The judges now are no longer really independent. We saw that in COVID. They know where the wind's blowing, and they do their job. A lot of them are appointed. So that's institutional corruption gone crazy. And another one I just thought when you were talking, Peter, there was a communist activist, a very significant person. I can't remember his name, but back in America before the McCarthy era, when America was big, there were a lot of activists who wanted America to go communisto or fascististo. And one of them was caught with, not emails at that time, but circulars to all their activists. And he said to them, and he was right, very clever. he said always call our detractors, our opponents, always call them a fascist. Now he said be careful, don't call someone a fascist if it can blow back on you. In other words, don't always do it, but whenever you can, call them a fascist. And he said if we keep repeating this on an individual, after a while the people will largely just come to believe it's true. And he said, it's the most dirty word and the dirty label you can put in someone right now. So use it. And you can see now that that advice was excellent, but it turned out it all failed in America until recently. Now they've got Biden and all the rest. They're getting, they're getting to communism. But yeah, exactly that. They know that racism is powerful. if you can make it even stick a bit and get your media to keep repeating it, people will assume, well that's the racist guy. I mean, it's shocking, it's criminal, but this is the game they play. Yeah, you talked about the 70 year. I mean, I'm still blown away having grown up in Dublin, Limerick, first like nine years of my life. It was rough, but actually it was conservative as a country. You had Fianna Gael, Fianna Fáil, polar opposites in theory. Now they're all together, the union party. Has this been sped up simply with the bailout after the financial crash, with Europe then calling the shots? Because if you look at Italy and Greece, they've kind of held on to their identity. And Ireland has always been known for a strong identity. That seems to have gone out the window. Obviously, COVID has sped things up, and that's part of it. But is it the crash? Is it that Ireland is now beholden to Europe because of that or talk to us about that because the collapse in Irish society has been unbelievable. Yeah, I think it's not so much the bailout more as the symptom of the problem. I mean the fact that Ireland kowtowed and the EU, the EU flooded the zone with money. They told Ireland flood the zone and the little Irish went off and they flooded the zone for the EU overlords and it suited them because there's money everywhere and everyone was happy. And then the piper came to be paid, and they went with cap in hand, and they gave away all our money to the bondholders. So I think Ireland back then was just a biatch, really. It wasn't that they got them then, they'd already got them. So I think it's been many decades, Ireland, maybe partially because of the history of the British rule, the Irish became culturally doff the cap to the big man. They might grumble, but they doff the cap. So Ireland, over the last 30 or 40 years, we saw it with all the referendums. They were rammed through or run several times to get through. The Irish intelligentsia, politicos, Europe was the big boy. And they dropped to their knees for Europe all the way. And then they took in the corporations, did the double dutch, the tax thing. They're allowing them to get away with 1% effective tax rate. So they played the kind of beggar to the American corporations. And I think over 50% of our GDP now is biotech and pharma. So we're just kind of biatches for the pharma sector. So you can see Ireland has made itself into a kind of a rent boy on the global market. Let's be honest. It's sad, but that's the way it is. But people are waking up to that and begin to realize, my God, our whole echelon of politicians are actually, by definition, essentially traitors. Because we're voting for them and they're immediately giving their allegiance straight up the chain to forces outside the country. So they're actually technically traitors. So I think that's kind of what happened to Ireland and it showed in the longest lockdown in Europe, it shows in the hate speech laws, a test bed for this craziness. It shows in every interview when you see these goons we have up the top. It's just disgusting, like, right? And was that the total question about why Ireland? Did I miss something there?  No, it's just, I find it curious, having grown up there, first nine, ten years of my life, and just seeing that collapse, and you kind of think, that's not the Ireland that I knew growing up, and then you realise it's not. It's changed beyond all recognition, with no media pushback, no political pushback, And then if you don't have Fine Gael or Fianna fail, you've got Sinn Féin, you're thinking, hmm, could this thing get worse? Okay, I'll tell you something about Sinn Féin. I mean, Sinn Féin during COVID, the government did the most insane, crazy-ass, unscientific, damaging, nonsensical measures, the worst in Europe almost. And Sinn Féin were screaming at them to do more. I mean, I'm not joking. They were literally screaming at the government, saying, you're not keeping us safe. And it was the same in all the issues. So Sinn Féin are an unmitigated disaster. They're the opposite of opposition. So they play this pantomime. And I think there's a hashtag, politics is panto. And it's so true nowadays. It's a fricking pantomime. And Sinn Féin go up and argue with the government, and the government argue back with Sinn Féin. It's all a joke. It's all a club. At the end of the day, they are all aligned with each other, really, at the Dáil bar and behind the scenes. And the reason that they're all aligned, this is the important thing, I've said it already, they all understand there's big power structures in the world, and we kow tow to them. Therefore, there's no point arguing amongst each other except as a pantomime for our voters. That's it. I mean, it sounds kind of conspiracy theory. It's basic geopolitics. Now that we have a world structure of World Economic Forum, UN, EU, and I mean, recently Professor Werner, who invented quantitative easing in 95, I interviewed him. He's an expert in central banking and all the political. He worked for the Japanese government during their financial challenges as a direct advisor, chief advisor. Learned Japanese, fluent German, fluent English, master's, PhDs from Oxford. Brilliant man. But he told me something that I actually didn't realize. He said, you know the European Parliament has no real power. It's a talk shop. The European Commission decides the laws, the Commission. And the Commission are essentially not elected. And he said, you know what other region in the last 100 years had that exact structure, and they've almost taken it from them? Soviet Union. They have a parliament, people aren't too aware, and they have a Politburo, a commission, and it's the same structure. The parliament, you let them all talk and pretend that they've got some control, but the party decides. He said, essentially, and he said, one or two or a couple of Russian historians, have noted this in the early 2000s, academically, that fascinatingly, Europe is recreating the Soviet model. And people don't know that. And of course, under that model, the EU Commission, who are diplomatic immunity, no army or police can enter their grounds under any condition, a bit like central banks, they decide, the parliament then, And blah, blah, blah, blah, blah, everyone, blah, blah, gets very high salaries, tax-free. All the people from the countries go over there and suck on the teat of Europe. They have a great time, meals for everyone, best of steaks. And they go, blah, blah, blah, blah, blah, blah. And that's that. And then the countries, of course, they just doff the cap increasingly. You look at Hungary, they say, we don't want to do this. And if you go against Europe, they take the whole European media, and they feckin' bury you. They bury you in accusations of far-right, nationalistic. They take away all the EU money. They cause you pain. So this is what we have. We have a new Soviet structure that wants to become a Chinese social credit-style full totalitarian structure. It's just what it wants. The organism of the geopolitical top strata in Europe, they want the full power. It's just natural, it's in the DNA now of the whole structure, it's not any one individual or one bad guy. Yeah, it's driven primarily from the late 50s by Rockefeller Brothers Fund and all the other bad guys and NGOs and CFR and all these groups and the Club of Rome, they're all pushing one way and that's it, it's simple guys, it's not a big conspiracy theory, it's just geopolitics has gone the wrong way for us. And a lot of bad guys have ended at the top. That's all. Happened in Rome. Jesus!  Yeah, and you see pushback across Europe with the rise of populist parties. Ireland and the UK sadly are sitting on their backsides with now, but that's a whole lot. I just want to just finish off on where you think this, the bill will go. It's been, what my understanding was, been in the Senate since maybe July, so and it was passed up. It's been sitting there now with more scrutiny. Where does it go? Because the police obviously will have to be sent out to police all these tweets which I thought they could do under the legislation but this is darker. Is there a way of turning it around so we just accuse everyone on the left of hurtful comments and the police must investigate? I mean is there requirement for an investigation. I'm just thinking of how you push back because this is going to pass through. I can't see any way it stopped. Yeah, I'm not entirely sure, Peter. Yes, they say we need a true by Christmas and all this talk, but they're not divulging what's actually happening. So I'm not sure what's actually happening on the ground mind you a very senior politician secretly met with me and a team of doctors, surgeons and businessmen back in September 2020. Very senior I obviously won't name in private and pretty much told us that most the politicians knew most of what I was sharing about COVID but he said, no everyone knows you don't talk about it and you support the narrative. So there's that level of institutional corruption, and I'm sure now there's similar stuff going on. A lot of the senators will have found out from their bloody daughters from social media how insane this is, but they'll know, shit, this is important. It comes from the big boys up top. We can't let them down. So I don't know exactly what's going on. I'm still hoping absolutely that with the focus on it, that they'll have to hold back their nonsense about these riots being a reason to bring in this insane law. I presume they're thinking, hmm, that's not washing. So I hope it's not inevitable. If it does happen, we got a massive problem. There's no question about that, because once it's in, it is a tool for tyranny waiting there like a nuclear weapon. sitting there on the statute of books with no place there, a criminal law, criminal in its very drafting. Criminal in its drafting, that's how bad it is. It's bad, but I guess, yeah, possibly be able to use it against itself. But you know, the judiciary and all of these bent politicians will be striving to throw out any cases involving it for leftists or nut jobs. And they'll be hyper trying to influence judges and police to use it on the people the government doesn't like. God, it's very sinister, isn't it? It's literally a tool of government to suppress people who don't agree with the government, which is treason in my mind. I mean, it might not be the exact definition. I don't care. It's treason. Well, we're all following this closely and praying and hoping that actually it is stopped. Ivor, great to have you on. Obviously, people can find you @FatEmperor on Twitter and thefatemperor.com. They can see all the videos, interviews up there on the website. Really appreciate your time today. Thanks so much for joining us. Thanks so much, Peter. And if people are wondering, I'm down south in an undisclosed location, but that's me fox there. I picked it up. It's from an old country estate in Wexford that was stripped. Guy had it for 10 years, got it for 200 euro. Beautiful case, probably 100 years old plus. So anyway, bit of trivia.  That's probably a hate crime against foxes. But anyway, we'll leave it there. Thanks, Ivor. Good luck, Peter. Bye now.

Join our experts to hear about imaging strategies to determine cardiovascular (CV) risk and optimum preventive strategies.    Credit available for this activity expires: 12/5/2024 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/998954?ecd=bdc_podcast_libsyn_mscpedu

Joining us on Well Said is Dr. Eugenia Gianos, Professor of Cardiology at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, System Director for Cardiovascular Prevention with Northwell Health and Director of both the Women's Heart Program at Lenox Hill Hospital and the Western Region for the Katz Institute Women's Heart Program. She will be talking about the dangers of high cholesterol and how cholesterol awareness and cholesterol management have become a crucial public health issue.

Dr. Reza Malekzadeh gives an overview of the results of his article "Fixed-Dose Combination Therapy for Prevention of Cardiovascular Diseases in CKD: An Individual Participant Data Meta-Analysis," on behalf of his colleagues.

The following question refers to Section 4.9 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by UCSD fellow Dr. Patrick Azcarate, and then by expert faculty Dr. Melissa Tracy. Dr. Tracy is a preventive cardiologist, former Director of the Echocardiography Lab, Director of Cardiac Rehabilitation, and solid organ transplant cardiologist at Rush University. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #35 In patients with a low risk of cardiovascular disease, which of the following is true?AAspirin does not affect the risk of ischemic strokeBAspirin increases the risk of fatal bleeding.CAspirin reduces the risk of non-fatal MI.DAspirin reduces cardiovascular mortality Answer #35 ExplanationIn 2019, an updated meta-analysis of aspirin for primary prevention of cardiovascular events found that patients with a low risk of CVD taking aspirin did not have a reduction in all-cause or cardiovascular mortality. There was a lower risk of non-fatal MI (RR 0.82) and ischemic stroke (RR 0.87). However, aspirin was also associated with a  higher risk of major bleeding (RR 1.50), intracranial bleeding (RR 1.32), and major GI bleeding (RR 1.52). There was no difference in the risk of fatal bleeding (RR 1.09).Accordingly, the ESC does not recommend antiplatelet therapy in individuals with low/moderate CV risk due to the increased risk of major bleeding (Class III, LOE A).Although aspirin should not be given routinely to patients without established ASCVD, we cannot exclude that in some patients at high or very high CVD risk, the benefits may outweigh the risks.Main TakeawayIn patients with low/moderate risk of CVD, aspirin for primary prevention is not recommended due to the higher risk of bleeding. For those at higher risk of CVD, low-dose aspirin may be considered for prevention in the absence of contraindications.Guideline Loc.Section 4.9.1, Page 3291 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

The following question refers to Section 4.7 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Shivani Reddy, answered first by NP Carol Patrick, and then by expert faculty Dr. Eileen Handberg.Dr. Handberg is an Adult Nurse Practitioner, Professor of Medicine, and Director of the Cardiovascular Clinical Trials Program in the Division of Cardiovascular Medicine at the University of Florida. She has served as Chair of the Cardiovascular Team Section and the Board of Trustees with the ACC and is the President Elect for the PCNA.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #34 Ms. BW presents after her best friend was diagnosed with hypertension and is interested in measuring her own blood pressure. According to the ESC Guidelines, what BP screening approach is recommended for making a diagnosis of hypertension? ARepeated measurements in one visitBA single measurement in a single visitCRepeated measurements in more than one visit  DReported patient history  Answer #34 Explanation The correct answer is C – Repeated measurements in more than one visit.It is recommended to base the diagnosis of hypertension on repeated office BP measurements on more than one visit except when hypertension is severe (e.g., Grade 3—defined as SBP > 180 and/ or DBP >110mmHg—and especially in high-risk patients) (Class I, LOE C). In addition to recommending repeat measurements across visits, the guidelines provide a number of considerations for appropriately measuring blood pressure, such as taking measurements when seated in a quiet environment for 5 minutes and measuring in both arms at the first visit and using the higher-level value arm for visits thereafter (see Table 14 on page 3283).Additionally, home blood pressure monitoring is recommended as an alternative to repeated office measurements. Blood pressure measurements are taken with a semiautomated, validated cuff for 3 consecutive days – and 6-7 days being preferred – in the morning and at night, averaged over that period. Notably, home blood pressure thresholds for the diagnosis of hypertension are lower than for that of in-office measurements, with a daytime systolic of 135mmHg or diastolic of 85mmHg given as the level at which hypertension is diagnosed, as opposed to 140mmHg and 90mmHg for systolic and diastolic levels, respectively, given for in-office diagnosis.Main TakeawayWith the exception of those with severely elevated blood pressures, the diagnosis of hypertension requires repeated measurements across multiple office visits.Guideline Loc.Sections 4.7.1 and 4.7.2, Table 13 and 14, Figure 14 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

The following question refers to Section 4.5 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Maryam Barkhordarian, answered first by pharmacy resident Dr. Anushka Tandon, and then by expert faculty Dr. Noreen Nazir. Dr. Nazir is Assistant Professor of Clinical Medicine at the University of Illinois at Chicago, where she is the director of cardiac MRI and the preventive cardiology program. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #33 Mr. V is a 37-year-old man who presents to clinic after a recent admission for anterior STEMI and is status-post emergent percutaneous intervention to the proximal LAD. He has mixed hyperlipidemia and a 10 pack-year history of (current) tobacco smoking. Which of the following points related to tobacco use is LEAST appropriate for today's visit? A Providing assessment and encouragement for smoking cessation, even if for only a 30-second “very brief advice” intervention. B Reviewing and offering pharmacotherapy support options for smoking cessation if Mr. V expresses readiness to quit today. C Recommending a switch from traditional cigarettes to e-cigarettes as a first step towards cessation, as e-cigarettes are safer for use. D Discussing that smoking cessation is strongly recommended for all patients, regardless of potential weight gain. Answer #33 Explanation Answer C is LEAST appropriate and therefore is the correct answer. Answer C is not appropriate. Although e-cigarettes may be more effective than nicotine replacement therapy (NRT) for smoking cessation, the long-term effects of e-cigarettes on cardiovascular and pulmonary health are unknown. According to the 2019 ACC/AHA prevention guidelines, e-cigarettes may increase the risk of CV and pulmonary diseases; their use has been reportedly associated with arrhythmias and hypertension. Therefore, neither the ESC nor ACC/AHA suggest clinicians recommend e-cigarettes over traditional cigarettes to patients. Answer A: Smoking cessation is one of the most effective CVD risk-lowering preventive measures, with significant reductions in (repeat) myocardial infarctions or death. ESC guidelines emphasize the importance of encouraging smoking cessation even in settings where time is limited. “Very brief advice” on smoking is a proven 30-second clinical intervention, developed in the UK, which identifies smokers, advises them on the best method of quitting, and supports subsequent quit attempts. While ESC does not explicitly suggest a frequency of assessment, the 2019 ACC/AHA guidelines specifically recommend that “all adults should be assessed at every healthcare visit for tobacco use and their tobacco use status recorded as a vital sign to facilitate tobacco cessation.” Answer B: The ESC suggests (class 2) that offering follow-up support, nicotine replacement therapy, varenicline, and bupropion individually or in combination should be considered in smokers. A meta-analysis of RCTs in patients with ASCVD reflects that varenicline (RR 2.6), bupropion (RR 1.4), telephone therapy (RR 1.5), and individual counselling (RR 1.6) all increased quit rates versus placebo; NRT therapies were well-tolerated but had inconclusive effects on quit rates (RR 1.22 with 95% CI 0.72-2.06). The 2019 ACC/AHA recommendation to combine behavioral and pharmacotherapy interventions to maximize quit rates is a class 1 recommendation. Answer D: The ESC gives a class 1 recommendation to recommending smoking cessation regardless of weight grain. Smokers who quit may expect an average weight gain of 5 kg, but the health benefits of tobacco cessation (both CVD and non-CVD related) consistently outweigh risks from weight...

Who should get aspirin for primary prevention? Drs Cannon and Vega share their perspectives in this fast-paced program. Credit available for this activity expires: 8/21/24 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/995627?ecd=bdc_podcast_libsyn_mscpedu

The following question refers to Section 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Adriana Mares, answered first by early career preventive cardiologist Dr. Dipika Gopal, and then by expert faculty Dr. Michael Wesley Milks.Dr. Milks is a staff cardiologist and assistant professor of clinical medicine at the Ohio State University Wexner Medical Center, where he serves as the Director of Cardiac Rehabilitation and an associate program director of the cardiovascular fellowship. He specializes in preventive cardiology and is a member of the American College of Cardiology's Cardiovascular Disease Prevention Leadership Council.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #32 Mr. Daniel Collins is a 58-year-old man with hypertension, chronic kidney disease (CKD), and obesity who presents to your clinic for a routine physical examination. Vitals are as follows: BP 143/79 mmHg, HR 89 bpm, O2 99% on room air, weight 106 kg, BMI 34.5 kg/m2. Recent laboratory testing revealed: creatinine 1.24 mg/dL, total cholesterol 203 mg/dL, HDL 39 mg/dL, LDL 112 mg/dL, TG 262 mg/dL. His current medications include lisinopril and rosuvastatin. You recommend increasing the dose of lisinopril to treat uncontrolled hypertension. What additional step(s) are indicated at this visit? A Order urine albumin-to-creatinine ratio B Ask the patient how often they have been bothered by trouble falling or staying asleep, or sleeping too much C Perform depression screening D All of the above Answer #32 Explanation The correct answer is D – all of the above.Answer A is correct. The ESC gives a Class I (LOE C) indication that all CKD patients, with or without diabetes, should undergo appropriate screening for ASCVD and kidney disease progression, including monitoring for changes in albuminuria. Cardiovascular disease is the leading cause of morbidity and death among patients with CKD. Even after adjusting for risk factors, including diabetes and hypertension, there is a linear increase in CV mortality with decreasing GFR below ~60-75 mm/min/1.73m2. Specific CKD-related risk factors include uremia-mediated inflammation, oxidative stress, and vascular calcification.Answer choice B is also correct. In patients with ASCVD, obesity, and hypertension, the ESC gives a Class I (LOE C) indication to regularly screen for non-restorative sleep by asking the question related to sleep quality as follows: “‘How often have you been bothered by trouble falling or staying asleep or sleeping too much?”. Additionally, if there are significant sleep problems that are not responding within four weeks to improving sleep hygiene, referral to a specialist is recommended (Class I, LOE C). However, despite the strong association of OSA with CVD, including hypertension, stroke, heart failure, CAD, and atrial fibrillation, treatment of OSA with CPAP has failed to improve hard CVD outcomes in patients with established CVD. Interventions that focus on risk factor modification, including reduction of obesity, alcohol intake, stress, and improvement of sleep hygiene, are important.Answer choice C is also correct. The ESC gives a Class I (LOE C) recommendation that mental health disorders with either significant functional impairment or decreased use of healthcare systems be considered as influencing total CVD risk. All mental disorders are associated with the development of CVD and reduced life expectancy. Additionally, the onset of CVD is associated with an approximately 2-3x increased risk of mental health disorders compared to a ...

The following question refers to Figures 6-8 from Sections 3.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Hirsh Elhence, answered first by Ohio State University Cardiology Fellow Dr. Alli Bigeh, and then by expert faculty Dr. Eugene Yang.Dr. Yang is Professor of Medicine at the University of Washington where he is also the Medical Director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and as well as former Chair of the ACC Prevention of CVD Section.  The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #31 The 2021 ESC CV Prevention guidelines recommend a stepwise approach to risk stratification and treatment options. What is the first step in risk factor treatment regardless of past medical history, risk factors, or established ASCVD?AInitiate statin for goal LDL

The following question refers to Section 6.1 of the 2021 ESC CV Prevention Guidelines. The question is asked by MGH internal medicine resident Dr. Christian Faaborg-Andersen, answered first by UCSD early career preventive cardiologist Dr. Harpreet Bhatia, and then by expert faculty Dr. Eugenia Gianos. Dr. Gianos specializes in preventive cardiology, lipidology, cardiovascular imaging, and women's heart disease; she is the Director of Women's Heart Health at Lenox Hill Hospital and Director of Cardiovascular Prevention for Northwell Health. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #30 A 65-year-old woman with a history of hypertension, type 2 diabetes mellitus, and coronary artery disease with remote PCI to the RCA presents for follow-up. She has stable angina symptoms that are well controlled with metoprolol tartrate 25 mg BID and are not lifestyle limiting. She takes aspirin 81 mg daily and atorvastatin 40 mg daily. Her LDL-C is 70 mg/dL, hemoglobin A1c is 7.0%, and eGFR is >60. In clinic, her BP is 118/80 mmHg. What is the next step in management?AIncrease atorvastatin for goal LDL-C < 55 mg/dLBNo change in managementCAdd isosorbide mononitrate 30 mg dailyDStop aspirinEStart a sulfonylurea Answer #30 Explanation The correct answer is A – increase atorvastatin for goal LDL-C < 55 mg/dL.In patients with established ASCVD, the ESC guidelines advocate for an LDL goal of < 55 mg/dL with at least a 50% reduction from baseline levels (Class I, LOE A). This patient has stable angina which is not lifestyle limiting; as such, further anti-anginal therapy is not necessary. She has known CAD with prior PCI, so aspirin therapy is appropriate for secondary prevention (Class I, LOE A). There is no indication for a sulfonylurea as her diabetes is well controlled. Notably, in persons with type 2 DM and ASCVD, the use of a GLP-1RA or SGLT2 inhibitor with proven outcome benefits is recommended to reduce CV and/or cardiorenal outcomes (Class I, LOE A).Main TakeawayFor people with established ASCVD, the ESC-recommended LDL-C goal is < 55 mg/dL with a goal reduction of at least 50%.Guideline Loc.Section 6.1 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

Ivor Cummins BE(Chem) CEng MIEI PMP completed a Biochemical Engineering degree in 1990. He has since spent over 25 years in corporate technical leadership and management positions. His career specialty has been leading large worldwide teams in complex problem-solving activity. His uniquely powerful ability has been to rapidly resolve complex multifactorial issues, involving all branches of science and technology – there has been no field which he could not integrate into successful and rapid resolution. In 2015 he was shortlisted in the top six of around 500 applicants for Chartered Engineer status that year, and also completed a Stanford certificate in technical innovation and entrepreneurial management. Since 2012 Ivor has been intensively researching the root causes of modern chronic disease. A particular focus has been on cardiovascular disease, diabetes and obesity. He shares his research insights at public speaking engagements around the world, revealing the key nutritional and lifestyle interventions which will deliver excellent health and personal productivity. He has presented on heart disease primary root causes at the British Association of Cardiovascular Prevention and Rehabilitation (BACPR) in London. He has also debated Irish Professors of Medicine on stage, at the annual conference of the Irish National Institute of Preventative Cardiology (NIPC). Over the past decade he has captivated audiences all over the world – in USA, UK, Ireland, Estonia, Israel, Switzerland etc. Ivor's 2018 book “Eat Rich, Live Long” (co-authored with preventative medicine expert Jeffry Gerber MD, FAAFP), details the conclusions of their shared research: https://www.amazon.com/Eat-Rich-Live-Long-Mastering/dp/1628602732/ His public lectures and interviews are available on YouTube, where he has 230,000+ subscribers and 26 million views have been recorded to date: https://www.youtube.com/channel/UCPn4FsiQP15nudug9FDhluA Ivor's most recent project has been to further democratize health and longevity information via the www.metabolicduo.com platform. Ivor lives in Dublin, Ireland, with his wife and five children. https://covidchroniclesmovie.com/ https://twitter.com/FatEmperor https://thefatemperor.com/about-ivor-cummins/ www.metabolicduo.com The mentioned CBDC cartoon: https://twitter.com/FatEmperor/status/1676125225187000320 Jacob Nordangard's site, and his interview with Ivor: https://blog.jacobnordangard.se/ https://youtu.be/c5w0znxE0f0 Ivor's interview with Mattias Desmet. https://youtu.be/dPisp_VgEO8 The mentioned “Liars Compilation” video: https://youtu.be/wL6MId9_T88 ========= About Tom Nelson: https://linktr.ee/tomanelson1 YouTube: https://www.youtube.com/playlist?list=PL89cj_OtPeenLkWMmdwcT8Dt0DGMb8RGR Twitter: https://twitter.com/tan123 Substack: https://tomn.substack.com/ About Tom: https://tomn.substack.com/about

The following question refers to Section 5.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by MGH medicine resident Dr. Christian Faaborg-Andersen, answered first by Dr. Patrick Azcarate, and then by expert faculty Dr. Laurence Sperling. Dr. Laurence Sperling is the Katz Professor in Preventive Cardiology at the Emory University School of Medicine and Founder of Preventive Cardiology at the Emory Clinic. Dr. Sperling was a member of the writing group for the 2018 Cholesterol Guidelines, serves as Co-Chair for the ACC's Cardiometabolic and Diabetes working group, and is Co-Chair of the WHF Roadmap for Cardiovascular Prevention in Diabetes. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #29 What percentage of the European population currently meets the recommended physical activity guidelines (150 minutes moderate-intensity activity weekly or 75 minutes vigorous-intensity activity weekly)?A75% Answer #29 ExplanationThe correct answer is A:

The following question refers to Section 4.7 and Table 18 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern Student Dr. Shivani Reddy, answered first by Fellow at Johns Hopkins Dr. Rick Ferraro, and then by expert faculty Dr. Roger Blumenthal.Dr. Roger Blumenthal is professor of medicine at Johns Hopkins where he is Director of the Ciccarone Center for the Prevention of Cardiovascular Disease. He was instrumental in developing the 2018 ACC/AHA CV Prevention Guidelines. Dr. Blumenthal has also been an incredible mentor to CardioNerds from our earliest days.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #28 Mr. A. C. is a 78-year-old gentleman with a long-standing history of HTN receiving antihypertensive medications & dietary management for blood pressure control. What is the target diastolic blood pressure recommendation for all treated patients such as Mr. A.C.?A< 80 mmHgB< 90 mmHgC< 70 mmHgD< 95 mmHgE< 100 mmHg Answer #28 Explanation The correct answer is A: DBP < 80 mmHg Blood pressure treatment targets: when drug treatment is used, the aim is to control BP to target within 3 months. Blood pressure treatment targets in the 2021 ESC Prevention guidelines are more aggressive than previously recommended, as evidence now suggests the previously recommended targets were too conservative, especially for older patients. The magnitude of BP lowering is the most important driver of benefit. ·       It is recommended that the first objective of treatment is to lower BP to

The following question refers to Section 4.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern Dr. Maryam Barkhordarian, answered first by medicine resident CardioNerds Academy House Chief Dr. Ahmed Ghoneem, and then by expert faculty Dr. Kim Williams.Dr. Williams is Chief of the Division of Cardiology and is Professor of Medicine and Cardiology at Rush University Medical Center. He has served as President of ASNC, Chairman of the Board of the Association of Black Cardiologists (ABC, 2008-2010), and President of the American College of Cardiology (ACC, 2015-2016). The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #27 Mr. O is a 48-year-old man with a past medical history significant for obesity (BMI is 42kg/m2), hypertension, type 2 diabetes mellitus, and hypercholesterolemia. His calculated ASCVD risk score today is 18.8%. You counsel him on the importance of weight loss in the context of CVD risk reduction. Which of the following weight loss recommendations is appropriate?AMaintaining a weight loss of at least 25% from baseline is required to influence blood pressure, cholesterol, and glycemic control. BHypocaloric diets lead to short term weight loss, but a healthy diet should be maintained over time to reduce CVD risk.CLiraglutide can be used to induce weight loss, as an alternative to diet and exercise.DBariatric surgery is effective for weight loss but has no ASCVD risk reduction benefit. Answer #27 Explanation The correct answer is B. Energy restriction is the cornerstone of management of obesity. All the different types of hypocaloric diets achieve similar short-term weight loss, but these effects tend to diminish by 12 months. It is a class I recommendation to maintain a healthy diet over time to achieve CVD risk reduction. The Mediterranean diet is an example of a diet that can have persistent CV benefit beyond the 12 months. Choice A is incorrect because maintaining even a moderate weight loss of 5 – 10% from baseline has favorable effects on risk factors including blood pressure, cholesterol, and glycemic control, as well as on premature all-cause mortality. Choice C is incorrect because medications approved as aids to weight loss (such as liraglutide, orlistat and naltrexone/bupropion) may be used in addition to lifestyle measures to achieve weight loss and maintenance; they are not alternatives to a healthy lifestyle. Meta-analysis of medication-assisted weight loss found favorable effects on BP, glycemic control, and ASCVD mortality. Choice D is incorrect because patients undergoing bariatric surgery had over 50% lower risks of total ASCVD and cancer mortality compared with people of similar weight who did not have surgery. Bariatric surgery should be considered for obese high-risk individuals when lifestyle change does not result in maintained weight loss (Class IIa). The ACC/AHA guidelines focused primarily on lifestyle interventions for obesity and had no specific recommendations for bariatric surgery or medication-assisted weight loss. Main Takeaway Weight reduction (even as low as 5-10% from baseline) and long-term maintenance of a healthy diet are recommended to improve the CVD risk profile of overweight and obese people. Medication and/or bariatric surgery may have a useful adjunctive role in some patients. Guideline Loc. Section 4.3.3 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!

The following question refers to Sections 3.3 and 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern student Dr. Adriana Mares, answered first by Brigham & Women's medicine resident & Director of CardioNerds Internship Dr. Gurleen Kaur, and then by expert faculty Dr. Allison Bailey. Dr. Bailey is an advanced heart failure and transplant cardiologist at Centennial Heart. She is the editor-in-chief of the American College of Cardiology's Extended Learning (ACCEL) editorial board and was a member of the writing group for the 2018 American Lipid Guidelines.  The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #26 Ms. Priya Clampsia is a 58-year-old never-smoker with a history of hypertension. Her BMI is 29 kg/m2. She also mentions having pre-eclampsia during her pregnancy many years ago. She describes a predominately sedentary lifestyle and works as a receptionist. You see her in the clinic to discuss routine preventive care. Her most recent lipid panel results were LDL of 101 mg/dL, HDL of 45 mg/dL, and triglycerides of 190 mg/dL. What additional step will provide valuable information regarding her CVD risk profile? A Send additional lab workup including C-reactive protein and lipoprotein (a) B Measure her waist circumference C Assess her work stress D Ask her about history of preterm birth E B, C, and D Answer #26 Explanation The correct answer is E – measuring her waist circumference, assessing her occupational stress, and obtaining history about adverse pregnancy outcomes including preterm birth all add valuable information for CVD risk stratification. BMI is easily measured and can be used to define categories of body weight. However, body fat stores in visceral tissue carry higher risk than subcutaneous fat and therefore, waist circumference can be a simple way to measure global and abdominal fat. When waist circumference is ≥102 cm in men and ≥88 cm in women, weight reduction is advised. While these WHO thresholds are widely accepted in Europe, it is important to note that different cut-offs may be appropriate in different ethnic groups. Work stress is important to ascertain as well because there is preliminary evidence of the detrimental impact of worse stress on ASCVD health, independent of conventional risk factors and their treatment. Work stress is determined by job strain (i.e., the combination of high demands and low control at work) and effort-reward imbalance. Pre-eclampsia is associated with increase in CVD risk by factor of 1.5-2.7 compared with all women. Both preterm (RR 1.6) and still birth (RR 1.5) are also associated with a moderate increase in CVD risk. Taking a thorough pregnancy history is important in determining future cardiovascular risk in women. The ESC guidelines give a Class IIb (LOE B) recommendation that in women with history of premature or stillbirth, periodic screening for hypertension and DM may be considered. Of note, the 2018 ACC/AHA guidelines include preeclampsia and premature menopause (occurring at age

"Eat Rich, Live Long" by Ivor Cummins and Dr. Jeffry Gerber is a book that promotes a low-carbohydrate, high-fat (LCHF) lifestyle for optimal health and longevity. The authors argue that a diet high in carbohydrates and sugar, as commonly consumed in Western societies, is responsible for many chronic diseases, such as obesity, diabetes, and heart disease. The book provides scientific evidence supporting the LCHF approach, including studies that demonstrate the benefits of a diet low in carbohydrates and high in healthy fats for weight loss, blood sugar control, and reducing inflammation. The authors also explain how a LCHF diet can improve cardiovascular health, cognitive function, and increase longevity. In addition to discussing the science behind the LCHF approach, the book also offers practical advice for implementing a LCHF diet. This includes guidance on how to select high-quality, nutrient-dense foods, how to choose the right types of fats, and how to prepare delicious meals and snacks that are low in carbohydrates and high in healthy fats. Ivor Cummins BE(Chem) CEng MIEI completed a Biochemical Engineering degree in 1990. He has since spent 30 years in corporate technical leadership positions. His career specialty has been leading large worldwide teams in complex problem-solving activity. Since 2012 Ivor has been intensively researching the root causes of modern chronic disease. A particular focus has been on cardiovascular disease, diabetes and obesity. He shares his research insights at public speaking engagements around the world, revealing the key nutritional and lifestyle interventions which will deliver excellent health and personal productivity. He has recently presented at the British Association of Cardiovascular Prevention and Rehabilitation (BACPR) and also at the Irish National Institute of Preventative Cardiology (NIPC) annual conferences. https://thefatemperor.com/ ----------------------------------------------------- DONATE and help the channel grow - https://donorbox.org/help-me-buy-stuff  PRE-ORDER MY GAMESTOP BOOK - https://wen-moon.com  Buy Brexit: The Establishment Civil War - https://amzn.to/39XXVjq    ----------------------------------------------------- You can listen to the show on Spotify, Apple, and all major platforms - https://chatterpodcast.podbean.com/  Watch Us On Odysee.com - https://odysee.com/$/invite/@TheJist:4    Join My Mailing List - https://www.getrevue.co/profile/thejist  Follow Me On Twitter - https://twitter.com/Give_Me_TheJist  ----------------------------------------------------- Website - https://thejist.co.uk/    Music from Just Jim – https://soundcloud.com/justjim  Extract Labs CBD - https://extract-labs.pxf.io/n10JMa Canva Premium Graphics - https://partner.canva.com/b3A9X6

The following question refers to Section 3.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Hirsh Elhence, answered first by Mayo Clinic Fellow Dr. Teodora Donisan, and then by expert faculty Dr. Eugene Yang.Dr. Yang is professor of medicine of the University of Washington where he is medical director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and chair of the ACC Prevention of CVD Section.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #25 Please choose the CORRECT statement from the ones below.ACAC scoring can be considered to improve ASCVD risk classification around treatment decision thresholds.BPatients with type 1 or type 2 diabetes are considered very high CV risk, regardless of comorbidities and other risk factors.CCKD does not increase the cardiovascular risk in the absence of other risk factors.DMen and women older than 65 years old are at high cardiovascular risk. Answer #25 ExplanationOption A is correct. Coronary artery calcium (CAC) scoring can reclassify CVD risk upwards and downwards in addition to conventional risk factors and may thus be considered in men and women with calculated risks around decision thresholds (Class IIb, Level B). If CAC is detected, its extent should be compared with what would be expected for a patient of the same sex and age. CAC scoring does not provide direct information on total plaque burden or stenosis severity and can be low or even zero in middle-aged patients with soft non-calcified plaque.Option B is false. Not all patients with diabetes are very high risk by default.·       Moderate risk: well controlled diabetes, 75 years-old and men > 65 years-old are usually at high 10-year CVD risk.·       Only between the ages of 55 – 75 years in women and 40 – 65 years in men does the 10-year CVD risk vary around commonly used thresholds for intervention. Of note:·       In younger, apparently healthy patients, we also discuss lifetime CVD risk estimates since 10-year risk assessments often underestimate risk.

The following question refers to Section 6.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by UCSD cardiology fellow Dr. Harpreet Bhatia, and then by expert faculty Dr. Jaideep Patel.Dr. Patel recently graduated from Virginia Commonwealth University cardiology fellowship and is now a preventive cardiologist at the Johns Hopkins Hospital.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #24 A 65-year-old man with a history of ischemic stroke 6 months ago presents to cardiology clinic to establish care. An event monitor was negative for atrial fibrillation and TTE with agitated saline study was negative for a patent foramen ovale. Therefore, his ischemic stroke was presumed to be non-cardioembolic in origin. He is currently taking lisinopril 5 mg daily for hypertension (BP in clinic is 115/70) and atorvastatin 40 mg daily. He has no history of significant gastrointestinal or other bleeding. What do you recommend next?AStart apixaban 5 mg BIDBIncrease lisinopril to 10 mg dailyCStart aspirin 81 mg dailyDStart aspirin 81 mg daily and clopidogrel 75 mg dailyEStart aspirin 81 mg daily and ticagrelor 90 mg BID Answer #24 ExplanationThe correct answer is C – start aspirin 81mg daily.For the secondary prevention of non-cardioembolic ischemic stroke or TIA, anti-platelet therapy is recommended with aspirin only (75-150 mg/day), dipyridamole + aspirin (slightly superior to aspirin), or clopidogrel alone (slightly superior to aspirin) (Class I, LOE A).DAPT with aspirin and clopidogrel or aspirin and ticagrelor should be considered in the immediate period after a minor ischemic stroke or TIA (3 weeks after event, Class IIa), but not 6 months after an ischemic stroke. Dual antiplatelet therapy with aspirin and clopidogrel increases bleeding risk without a significant benefit over either agent alone. Dual antiplatelet therapy with aspirin and ticagrelor increases bleeding risk, but does not improve disability incidence.Oral anticoagulation would be recommended for a cardioembolic stroke, which does not fit the clinical picture.His BP is well controlled so increasing lisinopril is not necessary.Main TakeawayFor the secondary prevention of an ischemic stroke or TIA, anti-platelet therapy with aspirin, aspirin + dipyridamole, or clopidogrel alone is recommended.Guideline Loc.6.3, page 3296-3297 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

The following question refers to Section 6.1 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Eugenia Gianos.Dr. Gianos specializes in preventive cardiology, lipidology, cardiovascular imaging, and women's heart disease; she is the director of Women s Heart Health at Lenox Hill Hospital and director of Cardiovascular Prevention for Northwell Health.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #23 An asymptomatic 55-year-old man with no past medical history presents to clinic after having a cardiac CT as part of an executive physical. His coronary artery calcium (CAC) score was 200 and the coronary CTA demonstrated isolated 70% stenosis of the left circumflex coronary artery. He is asymptomatic and able to jog 2 miles daily without limitation. He was recently started on aspirin 81 mg daily and atorvastatin 40 mg daily by his primary care provider. His LDL is 50 mg/dL, HbA1c is 6.0%. His BP is 108/70. What would you recommend?AStop aspirin 81 mg daily as he has not had an ASCVD event or revascularizationBCardiac catheterization and stent placement in the left circumflexCIncrease atorvastatin to 80 mg dailyDStress testENo change in management Answer #23 Answer choicesAStop aspirin 81 mg daily as he has not had an ASCVD event or revascularizationBCardiac catheterization and stent placement in the left circumflexCIncrease atorvastatin to 80 mg dailyDStress testENo change in managementExplanationThe correct answer is E – no change in management.Though the patient has not had an ASCVD event or revascularization, low-dose aspirin may be considered with definite evidence of CAD on imaging (Class IIb, LOE C).He is asymptomatic and does not have high risk anatomy on CT (i.e., proximal LAD, left main disease, multivessel disease), so percutaneous coronary intervention or stress testing are not indicated.His LDL is well controlled, so increasing atorvastatin would not be appropriate at this time.Main TakeawayAspirin 75-100 md daily may be considered in the absence of MI or revascularization when there is definitive evidence of CAD on imaging (Class IIb, LOE C).Guideline Loc.Section 6.1 CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

Since March 2020, Ivor has dedicated his problem-solving, analytical and biochemical expertise to deep and revealing analysis of the Covid19 pandemic situation. =========================================================================== Activation Products + my other Services & Donations https://www.awakeningpodcast.org/store/ =========================================================================== About my Guest: Ivor Cummins BE(Chem) CEng MIEI PMP completed a Biochemical Engineering degree in 1990. He has since spent over 25 years in corporate technical leadership and management positions. His career specialty has been leading large worldwide teams in complex problem-solving activity. His uniquely powerful ability has been to rapidly resolve complex multifactorial issues, involving all branches of science and technology – there has been no field which he could not integrate into successful and rapid resolution. In 2015 he was shortlisted in the top six of around 500 applicants for Chartered Engineer status that year, and also completed a Stanford certificate in technical innovation and entrepreneurial management. Since 2012 Ivor has been intensively researching the root causes of modern chronic disease. A particular focus has been on cardiovascular disease, diabetes and obesity. He shares his research insights at public speaking engagements around the world, revealing the key nutritional and lifestyle interventions which will deliver excellent health and personal productivity. He has presented on heart disease primary root causes at the British Association of Cardiovascular Prevention and Rehabilitation (BACPR) in London. He has also debated Irish Professors of Medicine on stage, at the annual conference of the Irish National Institute of Preventative Cardiology (NIPC). Over the past decade he has captivated audiences all over the world – in USA, UK, Ireland, Estonia, Israel, Switzerland etc. Since March 2020, Ivor has dedicated his problem-solving, analytical and biochemical expertise to deep and revealing analysis of the Covid19 pandemic situation. Ivor's 2018 book “Eat Rich, Live Long” (co-authored with preventative medicine expert Jeffry Gerber MD, FAAFP), details the conclusions of their shared research: His public lectures and interviews are available on YouTube, where he has >200,000 subscribers and 16 million views have been recorded to date: Ivor lives in Dublin, Ireland, with his wife and five children. What we Discussed: - How he started to start his investigation journal - Why Covid was a Flu - The Simulation proving that this was all organised - The New York Times attack - Censorship - Mask Uselessness - The spread of Influenza - The Spanish Flu - No Media attention as Ivor can prove all the information that he claims - Sweden has lowest morality compared to other Northern countries. - The Mandates with the MRNA jab and side effects - Controlled Opposition - Always know the truth - His launch of metabolic Duo - Why he called his Podcast 'The Fat Emperor and more How to Contact Ivor: Most of Ivor's material is readily accessible via his rapidly growing website: https://thefatemperor.com/ https://www.youtube.com/channel/UCPn4FsiQP15nudug9FDhluA. Book - https://www.amazon.com/Eat-Rich-Live-Long-Mastering/dp/1628602732/ Movie mentioned in the Interview https://covidchroniclesmovie.com/ https://metabolicduo.com/ ================================ More about the Awakening Podcast Store https://www.awakeningpodcast.org/store/ Donations https://www.awakeningpodcast.org/support/ All Podcasts + Coaching and Social Media https://bio.link/podcaster https://awakeningpodcast.org/

The following question refers to Section 4.6 of the 2021 ESC CV Prevention Guidelines. The question is asked by Student Dr. Shivani Reddy, answered first by Johns Hopkins Cardiology Fellow Dr. Rick Ferraro, and then by expert faculty Dr. Eileen Handberg. Dr. Handberg is an Adult Nurse Practitioner, Professor of Medicine, and Director of the Cardiovascular Clinical Trials Program in the Division of Cardiovascular Medicine at the University of Florida. She has served as Chair of the Cardiovascular Team Section and the Board of Trustees with the ACC and is the President for the PCNA. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #22 Mr. HC is a 50-year-old man presenting for a routine clinic visit. He is not sure the last time he had a lipid panel drawn, and would like one today, but ate lunch just prior to your appointment – a delicious plate of 50% fruits and vegetables, 25% lean meats, and 25% whole grains as you had previously recommended. True or False: Mr. HC should return another day to obtain a fasting lipid panel. TRUE FALSE Answer #22 Answer choices TRUE FALSE Explanation  This statement is False. A non-fasting lipid panel is appropriate for risk stratification and lipid evaluation in most patients per the ESC guidelines. While no level of evidence in provided in the ESC guidelines, this recommendation is consistent with AHA/ACC cholesterol guidelines, which have also largely moved away from fasting lipid panels for most patients and give a Class 1 (LOE B) recommendation to obtaining a fasting or nonfasting plasma lipid profile for ASCVD estimation and baseline LDL-C in adults 20 years of age or older. The ESC recommendation is based upon large trials showing that results of fasting and non-fasting panels are largely similar. This is similar to the AHA/ACC guidelines, which note non-fasting and fasting LDL-C change minimal over time following a normal meal, while HDL-C and tryiglycerides appear to have similar prognostic significance with cardiovascular outcomes in fasting or nonfasting states. A fasting lipid panel should be considered in those with hypertriglyceridemia, metabolic syndrome, and diabetes mellitus, as consumption of food or drink can have direct and immediate effects on TG and blood glucose values. Main Takeaway A non-fasting lipid panel is appropriate for the majority of patients undergoing lipid evaluation and cardiovascular risk stratification.  Guideline Loc. Section 4.6.1 CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!

The following question refers to Section 4.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Maryam Barkhordarian, answered first by medicine resident Dr. Ahmed Ghoneem, and then by expert faculty Dr. Noreen Nazir. Dr. Nazir is Assistant Professor of Clinical Medicine at the University of Illinois at Chicago, where she is the director of cardiac MRI and the preventive cardiology program. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #21 Ms. J is a 57-year-old woman with a past medical history of myocardial infarction resulting in ischemic cardiomyopathy, heart failure with reduced ejection fraction, and major depressive disorder who presents today for follow-up. She reports feeling extremely overwhelmed lately due to multiple life stressors. She is on appropriate cardiovascular GDMT agents and is not prescribed any medications for her mood disorder. True or false: in addition to psychotherapy for stress management, it is appropriate to consider Ms. J for anti-depressant SSRI pharmacotherapy at this time to improve cardiovascular outcomes. A True B False Answer #21 Explanation The correct answer is FALSE. An ESC class 3 recommendation states that SSRIs, SNRIs, and tricyclic antidepressants are not recommended in patients with heart failure and major depression; this is based on data suggesting potential lack of SSRI efficacy for reducing depression or cardiovascular events, as well as safety data indicating an association between SSRI use and increased risk of CV events and all-cause as well as cardiovascular mortality among HF patients. Mental health disorders are associated with worse outcomes in patients with ASCVD and appropriate treatment effectively reduces stress symptoms and improves quality of life. Nonpharmacologic modalities of treatment (exercise therapy, psychotherapy, collaborative care) should be considered before pharmacotherapy to improve cardiovascular outcomes in patients with heart failure. Of note, the ESC suggests SSRI treatment be considered for patients with coronary heart disease (without HF) and moderate-to-severe major depression based on data that SSRI treatment is associated with lower rates of CHD readmission (RR 0.63), all-cause mortality (RR 0.56), and the composite endpoint of all-cause mortality/MI/PCI (HR 0.69) vs. no treatment. This is a class 2a recommendation. ESC also gives a class 2a recommendation to consider referral to psychotherapeutic stress management for individuals with stress and ASCVD to improve CV outcomes and reduce stress symptoms. The ACC/AHA guidelines do not provide focused recommendations regarding mental health considerations in patients with elevated cardiovascular risk. Main Takeaway It is important to consider mental health treatment in patients with ASCVD as mental disorders are associated with increased CVD risk and poor patient prognosis, and data support that mental health interventions can improve overall and CVD outcomes, as well as improve quality of life. Guideline Loc. Section 4.4 CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!

Dr. Khurram Nasir, Division Chief of Cardiovascular Prevention and Wellness at Houston Methodist DeBakey Heart & Vascular Center, joins the podcast to discuss his background, top 3 biggest issues in cardiology today, how heart care will evolve over the next 18 months, and today's nerves and excitements.

Dr. Khurram Nasir, Division Chief of Cardiovascular Prevention and Wellness at Houston Methodist DeBakey Heart & Vascular Center, joins the podcast to discuss his background, top 3 biggest issues in cardiology today, how heart care will evolve over the next 18 months, and today's nerves and excitements.

The following question refers to Section 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Adriana Mares, answered first by Brigham & Women's medicine intern & Director of CardioNerds Internship Dr. Gurleen Kaur, and then by expert faculty Dr. Michael Wesley Milks. Dr. Milks is a staff cardiologist and assistant professor of clinical medicine at the Ohio State University Wexner Medical Center where he serves as the Director of Cardiac Rehabilitation and an associate program director of the cardiovascular fellowship. He specializes in preventive cardiology and is a member of the American College of Cardiology's Cardiovascular Disease Prevention Leadership Council. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #20 Ms. Ruma Toid is a 65-year-old African American woman who presents to your clinic in Ohio for routine follow up. She has a history of rheumatoid arthritis, hypertension, obesity, and sleep apnea. Her medications include methotrexate and atenolol. Her blood pressure in the office is 120/80 mmHg, heart rate 68 bpm, and oxygen saturation 99% on room air. Recent lipid testing revealed total cholesterol 165 mg/dL, HDL 42 mg/dL, and LDL 118 mg/dL. She was recently advised to talk to her doctor about taking a statin due to her risk factors but in the past has heard negative things about those medications and would like your advice on next steps. Her calculated ASCVD risk score based on the Pooled Cohort Equation is 7%. Which of the following choices would be the next step?AShe is at borderline risk for ASCVD events. A statin is not indicated at this time.BDue to her history of rheumatoid arthritis, her calculated ASCVD risk should be multiplied by 1.5, yielding an ASCVD risk of 10.5% placing her in the intermediate risk category. Moderate intensity statin would be indicated.CWhen other risk factors are present, rheumatoid arthritis is no longer an enhancing risk factor.DStatins are contraindicated when taking methotrexate. Answer #20 ExplanationThe correct answer is B. Due to her history of rheumatoid arthritis, her calculated ASCVD risk should be multiplied by 1.5, yielding an ASCVD risk of 10.5% placing her in the intermediate risk category. Moderate intensity statin would be indicated. Due to her history of rheumatoid arthritis, her calculated ASCVD risk should be multiplied by 1.5, yielding an ASCVD risk of 10.5% placing her in the intermediate risk category. Moderate intensity statin would be indicated. The ESC gives a Class IIa (LOE B) indication to multiply the calculated total CVD risk by a factor of 1.5 in adults with rheumatoid arthritis due to the observed 50% increased CVD risk in patients with rheumatoid arthritis. This 50% increase in CVD risk attributed to RA is present beyond traditional risk factors, making answer choice C wrong. Answer A is incorrect because when borderline risk is calculated, one should still look for risk enhancers that could potentially increase ASCVD risk before final determination of statin indication. Answer choice D is false as there is no contraindication to take both methotrexate and statins together. Note that it is appropriate to use the pool cohort equations and American risk thresholds for this patient since she is in America where the PCE was validated (versus using SCORE2 risk model which would be more appropriate for European populations).Main TakeawayInflammatory conditions including rheumatoid arthritis and inflammatory bowel disease increase a person's risk for ASCVD events. Specifically for rheumatoid arthritis, there is a Class IIa indication to multiply the calculated risk score by 1.5 to account for rheumatoid arthritis as a risk enhancer.

The following question refers to Section 3.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern, student Dr. Hirsh Elhence, answered first by Ohio State University Cardiology Fellow Dr. Alli Bigeh, and then by expert faculty Dr. Eugene Yang. Dr. Yang is professor of medicine of the University of Washington where he is medical director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and current chair of the ACC Prevention of CVD Section.  The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #19 True or False: A 70-year-old male has an estimated 10-year ASCVD risk (using SCORE2-OP) of 7.5% which confers a very high CVD risk and necessitates treatment with a statin.  TRUE  FALSE  Answer #19 Explanation   FALSE – CVD risk thresholds for risk factor treatment are higher in apparently healthy people 70 years and older in order to prevent overtreatment in the elderly. A 10-year CVD risk ≥15% is considered “very high risk” for individuals ≥70 years of age (compared to a ≥7.5% cut-off for “very high risk” in younger patients 70 years of age, a 10-year CVD risk of 7.5 to 70 years of age, a 10-year CVD risk of

Top cardiologist Dr. Suzanne Steinbaum wants you to know that if you have a heart, you need to think about heart disease—the #1 killer of women in the U.S.We dive into the steps, tests, and lifestyle choices EVERY woman should take to protect their heart for the long haul. And we explore the impact of menopause, stress, and Covid on women's heart health.Jam-packed with heart-health tips, including the heart-healthy snacks Dr. Steinbaum reaches for daily, a favorite get-up-and-get-going exercise for heart health that anyone can do at any age, we also learn more about the heart-health app she is bringing to market as the founder of the heart-tech company Adesso.As a former Director of Women's Cardiovascular Prevention, Health, and Wellness at Mt. Sinai Heart in New York City, and the Director of Women's Heart Health at Northwell Lenox Hill, and a Today Show and GMA favorite, Dr. Steinbaum offers us 30-minutes of do-not-miss heart smarts from one of the country's top docs. SHOW NOTES + TRANSCRIPT:acertainagepod.comFOLLOW A CERTAIN AGE:InstagramFacebookLinkedInGET INBOX INSPO:Sign up for our newsletter AGE BOLDLYWe share new episodes, giveaways, links we live, and midlife resourcesLIKE BOOKS?Each month we do an author BOOK LOOK on Instagram Live Follow us for the fun! @acertainagepodCONTACT US:katie@acertainagepod.com

What if we could prevent the #1 cause of death in the U.S. before it starts? Join experts from our Center for Cardiovascular Prevention, Metabolism & Lipids to learn how to keep your heart healthy and prevent heart disease! Our non-invasive cardiologist, nutritionist and wellness coach talk about everything from diets, exercise, genomics and sudden cardiac death in athletes.Thank you for listening to our podcast! If you have a topic you would like us to discuss, please visit nghs.com/podcast.

As the burden of cardiovascular disease increases in the United States, the importance of enhanced screening tools, early risk prediction, and prevention strategies grows. Novel risk scoring methods, including polygenic risk scores (PRS), may help identify patients that benefit from early intervention and risk modification. In this episode, we discuss how a PRS is calculated, how to incorporate a PRS into clinical practice, and current barriers to the equitable implementation of risk scores. In terms of frontiers in clinical genetics we also discuss the burgeoning field of pharmacogenetics and how pharmacogenetics may be used to identify responders and non-responders to certain therapies. Join CardioNerds Dr. Jessie Holtzman (CardioNerds Academy Chief and Chief Resident and soon FIT at UCSF), Dr. Alaa Diab (CardioNerds Academy Fellow and Medicine Resident at GBMC), and student doctor Hirsh Elhence (CardioNerds Academy Intern and medical student at USC Keck School of Medicine) as they discuss frontiers in clinical genetics with Dr. Pradeep Natarajan (Director of Preventive Cardiology, Massachusetts General Hospital). Audio editing by CardioNerds Academy Intern, student doctor Akiva Rosenzveig. This episode was developed in collaboration with the American Society of Preventive Cardiology and is supported with unrestricted educational funds from Illumina, Inc. All CardioNerds content is planned, produced, and reviewed solely by CardioNerds. This CardioNerds Cardiovascular Genomics series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs. Pearls • Notes • References CardioNerds Cardiovascular Genomics PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Frontiers in Clinical Genetics in Cardiovascular Prevention For common diseases like coronary artery disease, rare mutations may confer a several-fold increased risk of disease – for instance, in familial hypercholesterolemia, a single rare mutation may confer as much as a three-fold increase in risk of coronary artery disease. However, for most common diseases, the overall cumulative impact of several common genetic variants may be greater than that of a monogenetic trait. Family history is a particularly coarse predictor of CV risk, highlighting the need for polygenic risk scores. In particular, younger patients with borderline cardiovascular risk may benefit from the use of a polygenic risk score in the determination of their overall cardiovascular risk profile. A polygenic risk score (PRS) is a weighted sum of several risk-conferring alleles. The weight assigned to an allele is determined by the strength of the association between the allele and CV disease, as determined by genome-wide association studies (GWAS). The data used for genome-wide associated studies in cardiovascular disease have historically included populations primarily of European ancestry. However, more data is being collected from diverse patient cohorts to increase the external validity and broader applicability of such studies. Pharmacogenetic polygenic risk scores may be used to predict drug efficacy and toxicity, as well as to identify biologically plausible drug targets for clinical trial design. Show notes - Frontiers in Clinical Genetics in Cardiovascular Prevention What is a polygenic risk score (PRS)? Monogenic conditions are those in which a variant in a single gene causes a pathological phenotype. For example, familial hypercholesterolemia is often the result of a mutated allele in the LDL receptor gene. In contrast, polygenic risk suggests that there are variants in multiple genes that all confer risk independently, each with a small individual effect size. By aggregating many variants,

Thank you for tuning in for another episode of Life's Best Medicine. Ivor Cummins BE(Chem) CEng MIEI PMP completed a Biochemical Engineering degree in 1990. He has since spent over 25 years in corporate technical leadership and management positions. His career specialty has been leading large worldwide teams in complex problem-solving activity. His uniquely powerful ability has been to rapidly resolve complex multifactorial issues, involving all branches of science and technology – there has been no field which he could not integrate into successful and rapid resolution. Since 2012 Ivor has been intensively researching the root causes of modern chronic disease. A particular focus has been on cardiovascular disease, diabetes and obesity. He shares his research insights at public speaking engagements around the world, revealing the key nutritional and lifestyle interventions which will deliver excellent health and personal productivity. He has presented on heart disease primary root causes at the British Association of Cardiovascular Prevention and Rehabilitation (BACPR) in London. He has also debated Irish Professors of Medicine on stage, at the annual conference of the Irish National Institute of Preventative Cardiology (NIPC). Over the past decade he has captivated audiences all over the world – in USA, UK, Estonia, Israel, Switzerland, Germany etc. Since March 2020, Ivor has dedicated his problem-solving, analytical and biochemical expertise to deep and revealing analysis of the Covid19 pandemic situation. In this discussion Brian and Ivor talk about how Ivor became involved in the metabolic health world, how he became interested in and involved in the Covid-19 pandemic, the many negative impacts that have resulted from the methods employed by various governments to manage the Covid-19 pandemic, the findings of Ivor's research on the Covid-19 virus, the effect of the media companies' coverage of the Covid-19 pandemic on public perception of the virus, the phenomenon of viral interference, the totalitarian nature of the enforcement of extreme Covid-19 management measures, the absolute necessity of open debate for the health and accuracy of science, why integrity is crucial for the health of society and the survival of freedom, and what we've learned coming out of the global Covid-19 situation. Life's Best Medicine According to Ivor: “What keeps me going is the future of humanity. People keep me going. What really drives me is the future for everyone—and especially the children. And that's what keeps me going and going and going because what else is there?” Thank you for listening. Have a blessed day and stay healthy!   Links:   Ivor Cummins: Eat Rich, Live Long (book) YouTube Website   Dr. Brian Lenzkes:  Website Low Carb MD Podcast   Simply Snackin'

Dr. Ebell and Dr. Wilkes discuss the POEM titled ' Polypill better for secondary cardiovascular prevention than physician-directed care '

The following question refers to Section 6.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Jaideep Patel. Dr. Patel recently graduated from Virginia Commonwealth University cardiology fellowship and is now a preventive cardiologist at the Johns Hopkins Hospital. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #18 A 60-year-old Black woman with a history of hypertension and heart failure with reduced ejection fraction (EF 40%) presents to clinic for follow-up. She is currently doing well with NYHA class II symptoms. She is taking carvedilol 25 mg BID, sacubitril/valsartan 97/103 mg BID, and spironolactone 25 mg daily, all of which have been well tolerated. In clinic, her BP is 125/80 mmHg, and her HR is 55 bpm. Routine labs are within normal limits including Cr of 1.0, K of 4.0, and HbA1c of 6.0. What is the most appropriate next step in her management? A. No change in management B. Reduce beta blocker C. Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) D. Add vericiguat E. Add hydralazine/isosorbide dinitrate Answer #18 The correct answer is C – Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) For patients with symptomatic HFrEF, neurohormonal antagonists (ACEi, ARB, ARNI; BB; MRA) improve survival and reduce the risk of HF hospitalization. This patient is already on these agents. The addition of an SGLT2 inhibitor on top of neurohormonal blockade reduces the risk of CV death and worsening HF in patients with symptomatic HFrEF and is the next best step for this patient (Class I, LOE A). Vericiguat may be considered in patients with symptomatic HFrEF with HF worsening despite already being on maximally tolerated neurohormonal blockade (Class IIb, LOE B), but first-line therapies should be started first. Hydralazine/Isosorbide dinitrate should be considered in self-identified Black patients or people who have EF ≤ 35% or

The following question refers to Section 6.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by Houston Methodist medicine resident Dr. Najah Khan, and then by expert faculty Dr. Jaideep Patel. Dr. Patel recently graduated from Virginia Commonwealth University cardiology fellowship and is now a preventive cardiologist at the Johns Hopkins Hospital. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #18 A 60-year-old Black woman with a history of hypertension and heart failure with reduced ejection fraction (EF 40%) presents to clinic for follow-up. She is currently doing well with NYHA class II symptoms. She is taking carvedilol 25 mg BID, sacubitril/valsartan 97/103 mg BID, and spironolactone 25 mg daily, all of which have been well tolerated. In clinic, her BP is 125/80 mmHg, and her HR is 55 bpm. Routine labs are within normal limits including Cr of 1.0, K of 4.0, and HbA1c of 6.0. What is the most appropriate next step in her management? A. No change in management B. Reduce beta blocker C. Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) D. Add vericiguat E. Add hydralazine/isosorbide dinitrate Answer #18 The correct answer is C – Add an SGLT2 inhibitor (dapagliflozin or empagliflozin) For patients with symptomatic HFrEF, neurohormonal antagonists (ACEi, ARB, ARNI; BB; MRA) improve survival and reduce the risk of HF hospitalization. This patient is already on these agents. The addition of an SGLT2 inhibitor on top of neurohormonal blockade reduces the risk of CV death and worsening HF in patients with symptomatic HFrEF and is the next best step for this patient (Class I, LOE A). Vericiguat may be considered in patients with symptomatic HFrEF with HF worsening despite already being on maximally tolerated neurohormonal blockade (Class IIb, LOE B), but first-line therapies should be started first. Hydralazine/Isosorbide dinitrate should be considered in self-identified Black patients or people who have EF ≤ 35% or

The following question refers to Section 4.9 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by UCSD fellow Dr. Patrick Azcarate, and then by expert faculty Dr. Melissa Tracy.Dr. Tracy is a preventive cardiologist, former Director of the Echocardiography Lab, Director of Cardiac Rehabilitation, and solid organ transplant cardiologist at Rush University.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #17 A 74-year-old man with a history of hypertension, chronic kidney disease, and gastroesophageal reflux presents with chest pain and is found to have an NSTEMI due to an obstructive lesion in the proximal LAD. One drug-eluting stent is placed, and he is started on dual antiplatelet therapy with aspirin and clopidogrel. He is concerned about the risk of bleeding from his gastrointestinal tract. What would you recommend to reduce his risk of bleeding? A. Lansoprazole, a proton pump inhibitorB. Famotidine, a histamine-2 blocker C. Calcium carbonate, an antacid D. None, proton pump inhibitors are contraindicated. Answer #17 The correct answer is A.The ESC recommends that patients at high risk for GI bleeding who are receiving antiplatelet therapy take proton pump inhibitors (Class I, LOE A). High risk for bleeding includes patients who are age ≥65, history of peptic ulcer disease, Helicobacter pylori infection, dyspepsia or GERD symptoms, chronic renal failure, diabetes mellitus, and concomitant use of other antiplatelet agents, anticoagulants, nonsteroidal anti-inflammatory drugs, or steroids.Coadministration of proton pump inhibitors that specifically inhibit CYP2C19 (omeprazole or esomeprazole) may reduce the pharmacodynamic response to clopidogrel. Although this interaction has not been shown to affect the risk of ischemic events, coadministration of omeprazole or esomeprazole with clopidogrel is not recommended.Main TakeawayIn patients with high gastrointestinal bleeding risk who are receiving antiplatelet therapy, proton pump inhibitors are recommended. Omeprazole and esomeprazole may reduce the efficacy of clopidogrel and should not be used concomitantly with clopidogrel.Guideline LocationSection 4.9.3, Page 3291Figure 13 page 3278; recommendation table page 3279. CardioNerds Decipher the Guidelines - 2021 ESC Prevention SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor RollCardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

The following question refers to Section 4.3 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern Dr. Maryam Barkhordarian, answered first by pharmacy resident Dr. Anushka Tandon and then by expert faculty Dr. Kim Williams. Dr. Williams is Chief of the Division of Cardiology and is Professor of Medicine and Cardiology at Rush University Medical Center. He has served as President of ASNC, Chairman of the Board of the Association of Black Cardiologists (ABC, 2008-2010), and President of the American College of Cardiology (ACC, 2015-2016). The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #15 Your patient mentions that she drinks “several” cups of coffee during the day. She also describes having a soda daily with lunch and occasionally a glass of wine with dinner. Which of the following recommendations is appropriate?  A. Coffee consumption is not harmful and may even be beneficial, regardless of the number of drinks per day. B. Drinking two glasses of wine/day is safe from a cardiovascular prevention standpoint. C. Soft drinks (and other sugar-sweetened beverages) must be discouraged. D. None of the above Listen to this podcast episode!  Answer #15 The correct answer is C.  Soft drinks (and other sugar-sweetened beverages) must be discouraged. Sugar-sweetened beverages have been associated with a higher risk of CAD and all-cause mortality. The ESC guidelines give a class I recommendation for restriction of free sugar consumption (in particular sugar-sweetened beverages) to a maximum of 10% of energy intake. This is a class IIa recommendation in the ACC/AHA guidelines. Choice A is incorrect because: the consumption of nine or more drinks a day of non-filtered coffee (such as boiled, Greek, and Turkish coffee and some espresso coffees) may be associated with an up to 25% increased risk of ASCVD mortality. Moderate coffee consumption (3-4 cups per day) is probably not harmful, and perhaps even moderately beneficial. Choice B is incorrect: It is a class I recommendation to restrict alcohol consumption to a maximum of 100 g per week. The standard drink in the US contains 14 g of alcohol, so 100 mg of alcohol translate to: o   84 ounces of beer (5% alcohol) o   Or 56 – 63 ounces of malt liquor (75% alcohol) or o   Or 35 ounces of wine (12% alcohol) or ONE 5 fl oz glass of wine/day. o   Or 31.5 ounces of distilled spirits (40% alcohol). The ACC/AHA guidelines recommended limiting alcohol consumption only for the management of hypertension to: ≤2 drinks daily for men and: ≤1 drink daily for women. Main Takeaway The main takeaway: ASCVD risk reduction can be achieved by restricting sugar-sweetened beverages to a maximum of 10% of energy intake. Guideline Location Section 4.3.2, Page 3271 CardioNerds Decipher the Guidelines - 2021 ESC Prevention Series CardioNerds Episode Page CardioNerds Academy Cardionerds Healy Honor Roll CardioNerds Journal Club Subscribe to The Heartbeat Newsletter! Check out CardioNerds SWAG! Become a CardioNerds Patron!

The following question refers to Section 4.6 and Figure 13 of the 2021 ESC CV Prevention Guidelines. The question is asked by student doctor Shivani Reddy, answered first by NP Carol Patrick, and then by expert faculty Dr. Roger Blumenthal. Dr. Roger Blumenthal is professor of medicine at Johns Hopkins where he is Director of the Ciccarone Center for the Prevention of Cardiovascular Disease. He was instrumental in developing the 2018 ACC/AHA CV Prevention Guidelines. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #16 True or False: For patients with established ASCVD, secondary prevention entails adding a PCSK9 inhibitor if goal LDL is not met on maximum tolerated doses of a statin and ezetimibe. Answer #16 The correct answer is True. The ultimate on-treatment LDL-C goal of

The following question refers to Sections 3.3-3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Adriana Mares, answered first by early career preventive cardiologist Dr. Dipika Gopal, and then by expert faculty Dr. Allison Bailey. Dr. Bailey is a cardiologist at Centennial Heart. She is the editor-in-chief of the American College of Cardiology's Extended Learning (ACCEL) editorial board and was a member of the writing group for the 2018 American Lipid Guidelines. Dr. Bailey, thank you so much for joining us! The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #14 Ms. Soya M. Alone is a 70-year-old woman of Bangladeshi ethnicity with a history of anxiety and depression. She currently lives at home by herself, does not have many friends and family that live nearby, and has had a tough year emotionally after the passing of her husband. She spends most of her time in bed with low daily physical activity and has experienced more weakness and exhaustion over the past year along with loss of muscle mass. Which of the following are potential risk modifiers in this patient when considering her risk for CVD?A. Bangladeshi ethnicity B. Psychosocial factorsC. Frailty D. History of anxiety and depressionE. All of the above Answer #14 The correct answer is E – All of the above.Traditional 10-year CVD risk scores do not perform adequately in all ethnicities. Therefore, multiplication of calculated risk by relative risk for specific ethnic subgroups should be considered (Class IIa, LOE B). Individuals from South Asia have higher CVD rates. The ESC guidelines recommend using a correction factor by multiplying the predicted risk by 1.3 for Indians and Bangladeshis, and 1.7 for Pakistanis. These correction factors are derived from data from QRISK3. In the UK, the QRISK calculator algorithm has been derived and validated in 2.3 million people to estimate CVD risk in different ethnic groups and unlike other calculators, it counts South Asian origins as an additional risk factor. The reasons for such differences remain inadequately studied, as do the risks associated with other ethnic backgrounds. Barriers to developing accurate risk prediction tools include the wide heterogeneity amongst the population.The 2019 ACC/AHA guidelines also list high-risk race/ethnicities such as South Asian ancestry as a risk-enhancing factor. However, there is no separate pooled cohort equation for different ethnicities, and consideration should be given that the pooled cohort equations will underestimate ASCVD risk in South Asians.Psychosocial stress including loneliness and critical life events are associated, in a dose-response pattern, with the development and progression of ASCVD, with relative risks between 1.2 and 2.0. Conversely, indicators of mental health, such as optimism and a strong sense of purpose, are associated with lower risk. While there is not a specific way proposed by the guidelines for psychosocial factors to improve risk classification, it is important to screen patients with ASCVD for psychological stress, and clinicians should attend to somatic and emotional causes of symptoms as well. The ESC guidelines give a Class IIa (LOE B) recommendation for assessment of stress symptoms and psychosocial stressors.This patient should also be formally screened for frailty, which is not the same as aging but includes factors such as slowness, weakness, low physical activity, exhaustion and shrinking, and makes her more vulnerable to the effect of stressors and is a risk factor for both high CV and non-CV morbidity and mortality. However, the ability of frailty measures to improve CVD risk prediction has not been formally assessed, so the guidelines do not recommend integrating it into formal...

The following question refers to Section 3.2 of the 2021 ESC CV Prevention Guidelines. The question is asked by student Dr. Hirsh Elhence, answered first by Mayo Clinic Fellow Dr. Teodora Donisan, and then by expert faculty Dr. Eugene Yang. Dr. Yang is professor of medicine of the University of Washington where he is medical director of the Eastside Specialty Center and the co-Director of the Cardiovascular Wellness and Prevention Program. Dr. Yang is former Governor of the ACC Washington Chapter and current chair of the ACC Prevention of CVD Section. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #13 You are seeing a 45-year-old woman with a past medical history of hypertension, overweight status, hyperlipidemia, and active tobacco use disorder. Her BMI is 27 kg/m2, BP is 150/75, HbA1C is 5.8%, total cholesterol is 234 mg/dL, HDL is 59 mg/dL, and LDL is 155 mg/dL. She is from Romania, a country with very high CVD risk. Which of the following statements is CORRECT? A. LDL-C needs to be decreased by at least 50%, as small absolute LDL-C reductions would not provide clinical benefit B. Hypertension is not an important CVD risk factor in our patient, as she is young. C. Prediabetes is not a significant CV risk factor for our patient, as she is not yet diabetic. D. Smoking confers a higher CVD risk for women than for men. E. Her weight does not increase her CVD risk, as she is overweight rather than obese Answer #13 The correct answer is D – Smoking confers a higher CVD risk for women than for men. Prolonged smoking increases the CVD risk more in women than in men. Our patient is 45 years old. CVD risk in smokers < 50 years-old is 5x higher than in non-smokers. Of note, smoking is responsible for 50% of all avoidable deaths in smokers and a lifetime smoker will lose 10 years of life, on average. Secondhand smoke and smokeless tobacco can also increase the CVD risk. Option A is incorrect. The SCORE2 risk chart for populations at very high CVD risk places her at a 14% (very high) 10-year risk for myocardial infarction, stroke, or cardiovascular death. She would derive benefit even from incremental reductions in LDL-C values. The absolute benefit of lowering LDL-C depends on both the absolute risk of ASCVD and the absolute reduction in LDL-C, so even a small absolute reduction in LDL-C may be beneficial in high- or very-high-risk patients. Furthermore, the reduction in CVD risk is proportional to the decrease in LDL-C, irrespective of the medications used to achieve such change. This remains true even when lowering LDL-C values to < 55 mg/dl. Option B is incorrect. Hypertension is a major cause of CVD regardless of age, and the risk of death from either CAD or stroke increases linearly from BP levels as low as 90 mmHg systolic and 75 mmHg diastolic upwards. Particularly relevant for our patient, lifetime BP evolution differs in women compared to men, potentially resulting in an increased CVD risk at lower BP thresholds. Option C is incorrect. Type 1 DM, type 2 DM, and prediabetes are all independent risk factors for ASCVD. Of note, it would be important to address this risk factor with our patient, as women who develop type 2 diabetes have a particularly high risk for stroke. Option E is incorrect. All-cause mortality is lowest at a BMI on 20-25 kg/m2 in apparently healthy patients. Even overweight patients are at increased CVD risk. There is a linear relationship between BMI and mortality in non-smokers and a J-shaped relationship in ever-smokers. In patients with heart failure, a lower mortality risk has been observed with higher BMI – the “obesity paradox.” It would be important to evaluate the waist circumference in our patient, as both BMI and waist circumference are associated with ASCVD risk.

The following question refers to Section 4.11 of the 2021 ESC CV Prevention Guidelines. The question is asked by Dr. Christian Faaborg-Andersen, answered first by UCSF resident Dr. Jessie Holtzman, and then by expert faculty Dr. Laurence Sperling. Dr. Laurence Sperling is the Katz Professor in Preventive Cardiology at the Emory University School of Medicine and Founder of Preventive Cardiology at the Emory Clinic. Dr. Sperling was a member of the writing group for the 2018 Cholesterol Guidelines, serves as Co-Chair for the ACC's Cardiometabolic and Diabetes working group, and is Co-Chair of the WHF Roadmap for Cardiovascular Prevention in Diabetes. The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Question #12 Medically supervised cardiac rehabilitation programs after ASCVD events and for patient with heart failure carries a Class I recommendation. However, placement of referrals, uptake and enrollment after referral, and rigor of rehabilitation all remain inconsistent. What minimum cumulative duration of cardiac rehabilitation has been chosen as a threshold of effectiveness for cardiac rehabilitation by the European Society of Cardiology? A. 100-300 minutes, 10 sessions B. 300-500 minutes, 16 sessions C. 500-700 minutes, 22 sessions D. 700-1000 minutes, 28 sessions E. >1000 minutes, 36 sessions Answer #12 The correct answer is E: >1000 minutes across 36 sessions. Cardiac rehabilitation is a comprehensive, multidisciplinary intervention not just including exercise training and physical activity counselling, but also education, risk factor modification, diet/nutritional counselling, and vocational and psychosocial support. A broad evidence base demonstrates that multidisciplinary cardiac rehabilitation and prevention programs after ASCVD events or revascularization reduce recurrent cardiovascular hospitalizations, myocardial infarction, and cardiovascular mortality. In patients with chronic HF (mainly HFrEF), exercise based cardiac rehabilitation (EBCR) may improve all-cause mortality, reduce hospital admissions, and improve exercise capacity and quality of life. Such programs include a wide array of activities including physical activity, risk factor modification, psychosocial support, nutrition counseling, and more. Despite the heterogenous design of clinical trials, cardiac rehabilitation has been shown to be a cost-effective intervention. Based upon the available review data, the European Association of Preventive Cardiology and the European Society of Cardiology proposed minimum standards for secondary prevention cardiac rehabilitation programs. Based upon a comprehensive review of the literature, ESC recommends that cardiac rehabilitation be multidisciplinary, supervised by health professionals, and start as soon as possible after a cardiovascular event. Cardiac rehabilitation should include both aerobic and muscular resistance tailored to the fitness level of the participant, should carry a duration of >1000 minutes in total, and should exceed 36 sessions total. While uptake remains limited, electronic prompts within the medical record and automatic referrals should be considered to enhance referral and participation. Future research should continue to explore the benefit of home-based cardiac rehabilitation with or without telemonitoring. Lastly, studies have shown that uptake remains lower among women, and targeted programs should be undertaken to address such disparities. Main Takeaway Current European Society of Cardiology guidelines provide a Class I (LOE A) recommendation for the participation in multidisciplinary cardiac rehabilitation programs for the secondary prevention of ASCVD events including revascularization and in individuals with heart failure (mainly HFrEF) to improve patient outcomes.