Practice Impact Extra

The NAVIGATE-ESUS and the RE-SPECT ESUS randomized trials assessed the risk of recurrent ischemic stroke comparing aspirin antiplatelet therapy to 2 NOACs rivaroxaban and dabigatran. Major bleeding events from both trials suggest ineffective and unsafe results from indiscriminate anticoagulant treatment with NOAC rivaroxaban or dabigatran for patients with ESUS, stressing the importance of performing comprehensive diagnostic work-ups in patients to assist in uncovering occult causes of Embolic stroke of underdetermined source.

In contrast to the findings of the Simplicity trial in 2014, recent trials reported positive results after catheter-based renal artery denervation. The SPYRAL HTN-OFF MED trial presented at the ACC 2020 scientific meeting evaluated the Spyral catheter renal denervation compared with sham patients off medication with uncontrolled hypertension. The results on blood pressure were significant, but is there more to learn about the effectiveness of RDN on patients taking multiple hypertension medications?

Four observational studies regarding outcomes of COVID patients treated with ACEI and ARB were published in May 2020. More than 22,000 patients were analyzed at Bringham and Woman’s Hospital, University of Milano, NYU Grossman School of Medicine, and the Cleveland Clinic with overall results that do not suggest continued use of ACE inhibitors or ARBs contribute to the severity of COVID 19 in patients.

COVID 19 has been associated with a number of life-threatening conditions beyond respiratory complications including blood clotting leading to potentially deadly thromboembolic events. In order to improve outcomes, should all hospital admitted COVID 19 patients receive anticoagulants?

The REDUCE-IT EPA trial assessed the association of EPA blood levels with outcomes from the REDUCE-IT Trial first published in 2019. Researchers found on treatment the higher the EPA blood level, the lower the rates of different cardiovascular events, deaths, and total mortality. Could this introduce a new era of CV therapies?

Two studies from academic hospitals in Wuhan, China, and a third from NYU find that COVID-19 can cause heart injury even in people without underlying heart issues. High mortality rates in patients with elevated TNT levels as well as elevated C-reactive and BMP levels were evident across the three studies. With so much more to learn from the virus, the long term cardiac effects for recovered patients is still a great unknown.

Backed by machine learning and statistical models that analyzed how patients described their heart attack symptoms based on patient gender and obstructive disease, the Hermes trial found these symptoms reported by 90% of men and women consistently similar.

The Victoria trial assessed the drug Vericiguat in patients with heart failure and reduced ejection fraction. Although the absolute reductions were small, decreases in hospitalization and CV deaths in patients <75 could see Vericiguat added as a treatment for very ill CHF patients.

Research continues to find newer pharmacologic treatments to improve outcomes.

One year after the 2019 Ischemia trial assessed interventional treatment to drug therapy with established angina, ischemia, and stable obstructive coronary artery disease, Dr. Bernie breaks down outcomes related to symptoms and degree of ischemia.

The Treat Stroke to Target Trial demonstrates a reduction of non-fatal CVA and stroke events as a result of aggressive LDL reduction. The trial, like others before it, supports that lower cholesterol is better for the family of atherosclerotic disease, but how low should we go?