Dr RR Baliga's "Got Knowledge Doc" Podkast

The POPular PAUSE TAVI trial investigated whether continuing or interrupting oral anticoagulation during transcatheter aortic valve implantation (TAVI) affected clinical outcomes.

The randomized, open-label, noninferiority study included 858 patients and assessed a composite primary outcome of cardiovascular death, stroke, myocardial infarction, major vascular complications, or major bleeding at 30 days.

The trial found that continuation was not noninferior to interruption, with higher bleeding risk but no significant difference in thromboembolic events, supporting interruption of anticoagulation in high-bleeding-risk TAVI patients.

The six orthodox Indian schools of philosophy—Nyaya, Vaisheshika, Samkhya, Yoga, Mimamsa, and Vedanta—offer valuable insights into the mind-body connection, ethics, logic, and holistic well-being.

Understanding these systems can benefit healthcare providers and patients in promoting mental, emotional, and physical health.

The TCW Trial compared TAVI + FFR-guided PCI versus SAVR + CABG in patients with severe aortic stenosis and complex coronary artery disease.

This multicenter, randomized controlled trial included 172 patients aged ≥70 years. At 1 year, the primary composite endpoint (death, MI, stroke, revascularization, valve reintervention, or major bleeding) was significantly lower in the TAVI + PCI group (4%) compared to SAVR + CABG (23%), meeting both noninferiority and superiority criteria.

The study suggests TAVI + PCI as a safer, less invasive alternative with reduced mortality and bleeding risks in selected patients.

🚑 New studies on #OHCA: No significant survival benefit of intraosseous (IO) over IV access. IV remains the preferred route, with IO as backup. #EmergencyMedicine #CPR #CardiacArrest

These 2 randomized clinical trials compared intraosseous (IO) vs. IV vascular access in out-of-hospital cardiac arrest (OHCA).

The first study (Denmark) found no significant difference in return of spontaneous circulation (ROSC), 30-day survival, or neurological outcomes between IO and IV access.

The second study (UK) showed slightly higher ROSC in the IV-first group but no survival advantage. Both studies suggest IV access should remain the first choice, with IO as a backup when IV is not feasible.

🚨 New study: Evolocumab shows strong CV benefits in older adults (≥75 yrs) with ASCVD! 📉 Lower LDL-C, reduced events (HR: 0.79, NNT: 19), & no major safety concerns. Time to rethink lipid guidelines for seniors? 🔬💙 #Cardiology #LipidLowering #Evolocumab

Lipoprotein(a) [Lp(a)] is a genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD) and aortic stenosis. Traditional lipid-lowering therapies have minimal impact on Lp(a), necessitating novel treatments.

Zerlasiran, a small-interfering RNA (siRNA), significantly reduces Lp(a) (~85%) by inhibiting hepatic apolipoprotein(a) synthesis via subcutaneous injection.

Muvalaplin, an oral small-molecule inhibitor, prevents Lp(a) particle formation, reducing levels by up to 85.8%. Both drugs were well-tolerated in Phase 2 trials, with further studies needed to evaluate cardiovascular event reduction.

1. NEJM Article (2024): A 30-year study of 27,939 U.S. women found that high-sensitivity CRP, LDL cholesterol, and lipoprotein(a) independently predicted cardiovascular risk. Higher levels of these biomarkers increased the risk of major cardiovascular events, emphasizing the need for early screening and prevention in women.

2. BrJSportsMed Article (2024): A study of 13,018 women found that even 1–3 minutes/day of vigorous intermittent lifestyle physical activity (VILPA) significantly reduced cardiovascular risk. Women engaging in 3.4 minutes/day had a 45% lower MACE risk and 67% lower heart failure risk, highlighting VILPA as a simple yet effective prevention strategy.

1. "Bioaccumulation of Microplastics in Decedent Human Brains" (Nature Medicine, 2024)

This study confirms the presence of microplastics and nanoplastics (MNPs) in human brain tissue, particularly the frontal cortex. Researchers used pyrolysis gas chromatography-mass spectrometry (Py-GC/MS) and electron microscopy to analyze postmortem samples, finding polyethylene (PE) as the dominant plastic type. Brain tissue exhibited significantly higher plastic concentrations than the liver or kidney, with even greater MNP accumulation in individuals diagnosed with dementia. The findings raise concerns about potential neuroinflammation and long-term neurological effects, though causality remains unproven.

2. "Microplastics and Nanoplastics in Atheromas and Cardiovascular Events" (New England Journal of Medicine, 2024)

This study investigates the presence of microplastics in atherosclerotic plaques and their potential role in cardiovascular disease. Analyzing carotid artery plaques from patients undergoing endarterectomy, researchers found polyethylene (PE) and polyvinyl chloride (PVC) in 58.4% of plaques. Patients with MNP-containing plaques had a 4.53 times higher risk of heart attack, stroke, or death over a three-year follow-up. The study also linked MNP presence to elevated inflammatory markers (IL-18, IL-1β, TNF-α, IL-6), suggesting that microplastics might exacerbate cardiovascular disease progression.

Kapila: Founder of Samkhya Philosophy

Kapila (7th–6th century BCE) is regarded as the founder of the Samkhya school, one of the six orthodox systems of Hindu philosophy. Known for his rational and dualistic approach, he emphasized the distinction between Purusha (consciousness) and Prakriti (matter).

His teachings are captured in the Samkhya Sutras and the Bhagavata Purana, where he elaborated on metaphysics, self-realization, and liberation from suffering.

Kapila's influence extends to Hinduism, Buddhism, and Jainism, making him a pivotal figure in ancient Indian philosophy.

Coronary CT angiography-guided management of patients with stable chest pain: 10-year outcomes from the SCOT- HEART randomised controlled trial in Scotland

Michelle C Williams, Ryan Wereski, Christopher Tuck, Philip D Adamson, Anoop S V Shah, Edwin J R van Beek, Giles Roditi, Colin Berry,Nicholas Boon, Marcus Flather, Steff Lewis, John Norrie, Adam D Timmis, Nicholas L Mills, Marc R Dweck, David E Newby, on behalf of theSCOT-HEART Investigators*

Summary Background The Scottish Computed Tomography of the Heart (SCOT-HEART) trial demonstrated that management guided by coronary CT angiography (CCTA) improved the diagnosis, management, and outcome of patients with stable chest pain. We aimed to assess whether CCTA-guided care results in sustained long-term improvements in management and outcomes.

Methods SCOT-HEART was an open-label, multicentre, parallel group trial for which patients were recruited from 12 outpatient cardiology chest pain clinics across Scotland. Eligible patients were aged 18–75 years with symptoms of suspected stable angina due to coronary heart disease. Patients were randomly assigned (1:1) to standard of care plus CCTA or standard of care alone. In this prespecified 10-year analysis, prescribing data, coronary procedural interventions, and clinical outcomes were obtained through record linkage from national registries. The primary outcome was coronary heart disease death or non-fatal myocardial infarction on an intention-to-treat basis. This trial is registered at ClinicalTrials.gov (NCT01149590) and is complete.

Findings Between Nov 18, 2010, and Sept 24, 2014, 4146 patients were recruited (mean age 57 years [SD 10], 2325 [56·1%] male, 1821 [43·9%] female), with 2073 randomly assigned to standard care and CCTA and 2073 to standard care alone. After a median of 10·0 years (IQR 9·3–11·0), coronary heart disease death or non-fatal myocardial infarction was less frequent in the CCTA group compared with the standard care group (137 [6·6%] vs 171 [8·2%]; hazard ratio [HR] 0·79 [95% CI 0·63–0·99], p=0·044). Rates of all-cause, cardiovascular, and coronary heart disease death, and non-fatal stroke, were similar between the groups (p>0·05 for all), but non-fatal myocardial infarctions (90 [4·3%] vs 124 [6·0%]; HR 0·72 [0·55–0·94], p=0·017) and major adverse cardiovascular events (172 [8·3%] vs 214 [10·3%]; HR 0·80 [0·65–0·97], p=0·026) were less frequent in the CCTA group. Rates of coronary revascularisation procedures were similar (315 [15·2%] vs 318 [15·3%]; HR 1·00 [0·86–1·17], p=0·99) but preventive therapy prescribing remained more frequent in the CCTA group (831 [55·9%] of 1486 vs 728 [49·0%] of 1485 patients with available data; odds ratio 1·17 [95% CI 1·01–1·36], p=0·034).

Interpretation After 10 years, CCTA-guided management of patients with stable chest pain was associated with a sustained reduction in coronary heart disease death or non-fatal myocardial infarction. Identification of coronary atherosclerosis by CCTA improves long-term cardiovascular disease prevention in patients with stable chest pain.