Star Update Podcast - Cardiology News Summaries

By ImagicaHealth

Want to hear the latest in cardiology research, reviews, and perspectives? Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in t... more

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Star Update Podcast - Cardiology News Summaries episodes:

April 30, 2024 Prognostic Impact of Early Administration of β-Blockers in Critically Ill Patients with Acute Myocardial Infarction
Prognostic Impact of Early Administration of β-Blockers in Critically Ill Patients with Acute Myocardial Infarction
J Clin Pharmacol . 2024 Apr;64(4):410-417.
doi: 10.1002/jcph.2370.
Abstract
In critically ill patients with acute myocardial
infarction (AMI), the relationship between the early administration of β-blockers and the risks of in-hospital and long-term mortality remains controversial. Furthermore, there are conflicting evidences for the efficacy of the early administration of intravenous followed by oral β-blockers in acute myocardial infarction. We conducted a retrospective analysis of critically ill patients with acute myocardial infarction who received the early administration of β-blockers within 24 hours of admission. The data were extracted from the Medical Information Mart for Intensive Care IV database. We enrolled 2467 critically ill patients with AMI in the study, with 1355 patients who received
the early administration of β-blockers and 1112 patients who were non-users. Kaplan-Meier survival analysis and Cox proportional hazards models showed that the early
administration of β-blockers was associated with a lower risk of in-hospital mortality (adjusted hazard
ratio [aHR] 0.52; 95% confidence interval [95%CI] 0.42-0.64), 1-year mortality (aHR 0.54, 95%CI 0.47-0.63), and 5-year mortality (aHR 0.60, 95%CI
0.52-0.69). Furthermore, the early administration of both oral β-blockers and intravenous β-blockers followed by oral β-blockers may reduce the mortality risk, compared with non-users. The risks of in-hospital and long-term mortality were significantly decreased in patients who underwent revascularization with the early administration of β-blockers. We found that
the early administration of β-blockers could lower the risks of in-hospital and long-term mortality. Furthermore, the early administration of both oral β-blockers and intravenous β-blockers followed by oral β-blockers may reduce the mortality risk, compared with non-users. Notably, patients who underwent revascularization with the early administration of β-blockers showed the lowest risks of in-hospital and long-term mortality.

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy,
validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which
you should exercise in evaluating the information on this website
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3min
April 30, 2024 Ticagrelor was associated with lower fracture risk than clopidogrel in the dual anti-platelet regimen among patients with acute coronary syndrome treated with percutaneous coronary intervention
Ticagrelor was associated with lower fracture risk than clopidogrel in the dual anti-platelet regimen among patients with acute coronary syndrome treated with percutaneous coronary intervention
J Endocrinol Invest. 2024 Apr;47(4):895-902.
doi: 10.1007/s40618-023-02205-1
Abstract
Purpose: Patients with coronary artery disease have
increased fracture risks. P2Y12 inhibitors may impact fracture risks. We compared the fracture risks associated with ticagrelor and clopidogrel in dual
anti-platelet therapy (DAPT).

Methods: We identified all adults who underwent
first-ever percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) between 2010 and 2017 from a territory-wide PCI registry in Hong Kong.
Following 1:1 propensity-score matching for baseline characteristics, patients were followed up till event occurrence, death, or 30 June 2022. Outcomes of
interest were major osteoporotic fractures (MOF) identified by validated ICD-9-CM codes. Cox proportional hazards regression was used to compute the hazard ratio (HR) for major osteoporotic fractures associated with ticagrelor versus clopidogrel use.

Results: 3018 ticagrelor users and 3018 clopidogrel users were identified after propensity-score matching (mean age: 61.4 years; 84.1% men). Upon median follow-up of 6.5 years, 59 ticagrelor users and 119 clopidogrel users sustained major osteoporotic fractures (annualized fracture risks: 0.34 % and 0.56%, respectively).
Ticagrelor use was associated with lower risks of major osteoporotic fractures (HR 0.60, 95%CI 0.44-0.83; p =
0.002). Consistent hazard ratios were observed for fractures over vertebrae, hip and upper limbs. Subgroup analyses showed no interaction according to age, sex, presence of diabetes, presence of chronic kidney disease and prior fracture history.
Conclusion: Among adults who underwent first-ever percutaneous coronary intervention for acute coronary syndrome, ticagrelor use in the dual anti-platelet therapy was associated with a lower risk of major osteoporotic
fractures compared with clopidogrel. Our results support the use of ticagrelor in the dual anti-platelet therapy from the perspective of bone health.

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR
UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information
on this website

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3min
March 31, 2024 ACC Expert Consensus statement 2024 for Treatment of HFrEF: Key Points
2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee.
J Am Coll Cardiol 2024;Mar 8:[Epub ahead of print].

In line with recent evidence and guidelines, the
recommended core guideline-directed medical therapy (GDMT) for chronic heart failure (HF) includes an angiotensin II receptor/neprilysin inhibitor (ARNI), evidence-based beta-blocker, sodium-glucose cotransporter (SGLT) inhibitor, and mineralocorticoid antagonist (MRA). When feasible, early and rapid initiation of these therapies and titration to maximally tolerated doses within 3 months is recommended. While no specific order of initiation or titration of guideline-directed medical therapy is mandated, the following is some useful guidance
a)Start with low doses of core therapies.
b) Delay beta-blocker initiation until HF is compensated.
c) ARNIs and SGLT inhibitors may reduce diuretic needs.
d) MRA and SGLT inhibitors may have minimal BP effects.
e) Mild declines in eGFR don't always require medication
cessation.
Difficulties with adherence to recommended HF therapies can be multifactorial. Effective strategies to improve adherence should be targeted to individual patient needs. Strategies include patient education,
simplification of overall medication regimen, reduction of cost and access barriers, medication reminders, utilization of clinical pharmacist, and cognitive behavioral therapies. In addition to managing cardiovascular (CV) comorbidities, attention should be paid to addressing non-CV comorbidities that impact HF outcomes such as diabetes, chronic kidney disease, sleep-disordered
breathing, iron deficiency, and viral infections (prevention with vaccination).

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any
scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this
website.

...more
3min
March 31, 2024 Myocardial infarction drives trained immunity of monocytes, accelerating atherosclerosis
Myocardial infarction drives trained
immunity of monocytes, accelerating atherosclerosis
Eur Heart J . 2024 Mar 1;45(9):669-684.
Abstract
Background and aims: Survivors of acute coronary
syndromes face an elevated risk of recurrent atherosclerosis-related vascular events despite advanced medical treatments. The underlying causes remain
unclear. This study aims to investigate whether myocardial infarction -induced trained immunity in monocytes could sustain proatherogenic traits and expedite atherosclerosis.
Methods: Apolipoprotein-E deficient (ApoE-/-) mice
and adoptive bone marrow transfer chimeric mice underwent MI or myocardial ischaemia-reperfusion (IR). A subsequent 12-week high-fat diet (HFD) regimen
was implemented to elucidate the mechanism behind monocyte trained immunity. In addition, classical monocytes were analysed by flow cytometry in the blood of enrolled patients.
Results: In MI and IR mice, blood monocytes and bone
marrow-derived macrophages exhibited elevated spleen tyrosine kinase (SYK), lysine methyltransferase 5A (KMT5A), and CCHC-type zinc finger nucleic
acid-binding protein (CNBP) expression upon exposure to a HFD or oxidized LDL (oxLDL) stimulation. MI induced trained immunity was transmissible by transplantation of bone marrow to accelerate
atherosclerosis in naive recipients. KMT5A specifically recruited monomethylation of Lys20 of histone H4 (H4K20me) to the gene body of SYK and synergistically transactivated SYK with CNBP. In vivo small interfering RNA (siRNA) inhibition of KMT5A or CNBP potentially slowed post-MI atherosclerosis. Sympathetic denervation with 6-hydroxydopamine reduced atherosclerosis and inflammation after MI. Classical monocytes from STEMI patients with
advanced coronary lesions expressed higher SYK and KMT5A gene levels.
Conclusions: The findings underscore the crucial role
of monocyte trained immunity in accelerated atherosclerosis after myocardial infarction, implying that spleen tyrosine kinase in blood classical monocytes
may serve as a predictive factor for the progression of atherosclerosis in STEMI patients.
Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any
scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this
website.
...more
4min
March 31, 2024 P2Y12 Inhibitor Monotherapy vs Dual Antiplatelet Therapy After Deployment of a Drug-Eluting Stent: The SHARE Randomized Clinical Trial
P2Y12 Inhibitor Monotherapy vs Dual
Antiplatelet Therapy After Deployment of a Drug-Eluting Stent: The SHARE Randomized Clinical Trial
JAMA Netw Open. 2024 Mar 4;7(3):e240877
Abstract
Importance: P2Y12 inhibitor monotherapy after dual
antiplatelet therapy (DAPT; a P2Y12 inhibitor plus aspirin) for a brief duration has recently emerged as an attractive alternative for patients undergoing percutaneous coronary intervention with a drug-eluting stent.
Objective: To investigate whether P2Y12 inhibitor
monotherapy after 3 months of DAPT
was noninferior to 12 months of DAPT following percutaneous coronary intervention with a drug-eluting stent.
Design, setting, and participants: The Short-Term
Dual Antiplatelet Therapy After Deployment of Bioabsorbable Polymer Everolimus-Eluting Stent (SHARE) open-label, noninferiority randomized clinical
trial was conducted from December 15, 2017, to
December 14, 2020. Final 1-year clinical follow-up was completed in January 2022. This study was a multicenter trial that was conducted at 20 hospitals in
South Korea. Patients who underwent successful percutaneous coronary intervention with bioabsorbable polymer everolimus-eluting stents were enrolled.
Interventions: Patients were randomly assigned to
receive P2Y12 inhibitor monotherapy after 3 months of DAPT (n = 694) or 12 months of Dual Antiplatelet Therapy (n = 693).
Main outcomes and measures: The primary outcome was a net adverse clinical event, a composite of major bleeding and major adverse cardiac and cerebrovascular events (cardiac death, myocardial infarction, stent
thrombosis, stroke, or ischemia-driven target lesion revascularization) between 3 and 12 months after the index percutaneous coronary intervention. The major
secondary outcomes were major adverse cardiac and cerebrovascular events and major bleeding. The noninferiority margin was 3.0%.
Results: Of the total 1452 eligible patients, 65
patients were excluded before the 3-month follow-up, and 1387 patients were assigned to P2Y12 inhibitor monotherapy or Dual Antiplatelet Therapy Between 3
and 12 months of follow-up, the primary outcome occurred in 9 patients in the P2Y12 inhibitor monotherapy group and in 16 patients in the Dual Antiplatelet Therapy group .The major secondary
outcomes major adverse cardiac and cerebrovascular events occurred in 8 patients in the P2Y12 inhibitor
monotherapy group and in 12 patients in
the Dual Antiplatelet Therapy group . Major bleeding occurred in 1 patient in the P2Y12 inhibitor monotherapy group and in 5 patients in the Dual Antiplatelet Therapy group
Conclusions and relevance: In patients with coronary
artery disease undergoing percutaneous coronary intervention with the latest generation of drug-eluting stents, P2Y12 inhibitor monotherapy after 3-month Dual
Antiplatelet Therapy was not inferior to 12-month Dual Antiplatelet Therapy for net adverse clinical events. Considering the study population and lower-than-expected event rates, further research is required in other populations.

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the
accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical
judgment, which you should exercise in evaluating the information on this website.

...more
5min
March 31, 2024 Beta-blocker therapy in heart failure with preserved ejection fraction (B-HFpEF): A systematic review and meta-analysis
Beta-blocker therapy in heart failure
with preserved ejection fraction (B-HFpEF): A systematic review and meta-analysis
Curr Probl Cardiol. 2024 Mar;49(3):102376
Abstract
Introduction: While beta-blockers are considered the
cornerstone of treatment for heart failure with reduced ejection fraction, the same may not apply to patients with heart failure with preserved ejection fraction. To date, the benefit of beta-blockers remains uncertain, and there is no current consensus on their effectiveness. This study sought to evaluate the efficacy of beta-blockers on mortality and rehospitalization among patients
with HFpEF.
Methods: A systematic review and meta-analysis of
randomized or observational cohort studies examined the efficacy of beta-blocker therapy in comparison with placebo, control, or standard medical care in patients with HFpEF, defined as left ventricular ejection fraction ≥50 %. The main endpoints were mortality (i.e., all-cause and cardiovascular), rehospitalization (i.e., all-cause and for heart failure) and a composite of the two.
Results: Out of the 13,189 records initially
identified, 16 full-text records met the inclusion criteria and were analyzed recruiting a total of 27,188 patients. The mean age range was 62-84 years old,
predominantly female, with HFpEF in which 63.4 % of patients received a beta-blocker and 36.6 % did not. The pooled analysis of included cohort studies, of variable follow-up durations, showed a significant reduction in
all-cause mortality by 19 % whereas rehospitalization for heart failure or its composite with all-cause mortality were similar between the beta-blocker
and control groups.
Conclusion : This meta-analysis showed that beta-blocker therapy has the potential to reduce all-cause
mortality in patients with HFpEF based on observational studies. Nevertheless, it did not affect rehospitalization for heart failure or its composite with all-cause mortality. Large scale randomized trials are needed to clarify this
uncertainty.

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the
accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the STAR UPDATE podcast. You
should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
...more
3min
March 31, 2024 The efficacy and safety of aspirin-ticagrelor vs. aspirin-clopidogrel in ischemic stroke patients with cerebral artery stenting
The efficacy and safety of aspirin-ticagrelor vs. aspirin-clopidogrel in ischemic stroke patients with
cerebral artery stenting
Clin Neurol Neurosurg . 2024 Mar 3:239:108229.
Abstract
Objective: First, the efficacy and safety of
aspirin-ticagrelor after cerebral artery stenting in ischemic stroke patients is controversial. Second, there is a gap in the research on guiding two
antiplatelet therapy after stenting based on the CYP2C19 genotype.

Methods: This retrospective study included patients
who underwent cerebral artery stenting at the First Affiliated Hospital of Chongqing Medical University from January 2019 to February 2023. We divided
them into the aspirin-clopidogrel group and aspirin-ticagrelor group and carefully collected baseline information laboratory data and imaging results
from the patients. The efficacy outcomes were 30 days recurrent stroke, 90 days recurrent stroke, and 180 days recurrent stroke, and the safety outcome was
intracranial hemorrhage. T-tests or Fisher's tests were performed for study outcomes in both groups of patients.
Outcome: A total of 372 patients were included. For
efficacy outcomes, aspirin-ticagrelor was associated with a reduced risk of 180 days recurrent stroke, in patients with CYP2C19 LOF allele and CYP2C19
intermediate metabolic genotype compared with aspirin-clopidogrel. There was no significant difference in the rate of intracranial hemorrhage between patients
with aspirin-clopidogrel and aspirin-ticagrelor, regardless of overall, CYP2C19 LOF allele carriers or CYP2C19 intermediate metabolizer. No significant differences were found between the two on other efficacy and safety outcomes.
Conclusion: A cohort study found that aspirin-ticagrelor
was significantly superior to aspirin-clopidogrel in reducing 180 days recurrent stroke in CYP2C19 LOF allele carriers and CYP2C19 intermediate
metabolizers. There was no significant difference between aspirin-ticagrelor and aspirin-clopidogrel in the risk of intracranial hemorrhage in terms of ICH
rates.

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any
scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this
website.

...more
3min
February 29, 2024 A novel score to predict in-hospital mortality for patients with acute coronary syndrome and out-of-hospital cardiac arrest: the FACTOR study
A novel score to predict in-hospital mortality for patients with acute coronary syndrome and out-of-hospital cardiac
arrest: the FACTOR study
Clin Res Cardiol . 2024 Feb 8. doi: 10.1007/s00392-023-02367-1.

Abstract
Introduction: Acute coronary syndromes (ACS) represent a substantial global healthcare challenge. In its most severe form,
it can lead to out-of-hospital cardiac arrest (OHCA). Despite medical advancements, survival rates in OHCA patients remain low. Further, the prediction of outcomes in these patients poses a challenge to all health care providers involved. This study aims at developing a score with variables
available on admission to assess in-hospital mortality of patients with OHCA undergoing coronary angiography.

Method: All patients with OHCA due to ACS admitted to
a tertiary care center were included. A multivariate logistic regression analysis was conducted to explore the association between clinical variables and in-hospital all-cause mortality. A scoring system incorporating variables available upon
admission to assess individual patients' risk of in-hospital mortality was developed (FACTOR score). The score was then validated.

Results: A total of 291 patients were included in the
study, with a median age of 65 [56-73] years, including 47 women (16.2%). The in-hospital mortality rate was 41.2%. A prognostic model was developed in the derivation cohort (n = 138) and included the following variables: age, downtime,
first detected rhythm, and administration of epinephrine. The area under the curve for the FACTOR score was 0.823 (95% CI 0.737-0.894) in the derivation cohort and 0.828 (0.760-0.891) in the validation cohort (n = 153).

Conclusion: The FACTOR score demonstrated a reliable
prognostic tool for health care providers in assessing in-hospital mortality of OHCA patients. Early acknowledgement of a poor prognosis may help in patient management and allocation of resources.

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any
scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
...more
3min
February 29, 2024 Factors Associated With Myocardial Infarction in a Rural Population With Peripheral Arterial Diseases
Factors Associated With Myocardial Infarction in a Rural Population With Peripheral Arterial Diseases
Angiology. 2024 Feb 6:33197241232608. doi:
10.1177/00033197241232608.
Abstract
Peripheral arterial disease (PAD) studies in rural
populations are limited. The incidence of myocardial infarction (MI) is higher in patients with PAD. This study examined the association between sociodemographic and clinical risk factors and MI in patients with PAD in Central Appalachia, comprising of 230 countries across six states in the United States. Data from electronic medical records of 13,455 patients with PAD were extracted from a large health system in Central
Appalachia. Bivariate and logistic regression analyses were conducted. The final sample consisted of 5574 patients with PAD, of whom 24.85% were also diagnosed with MI. The mean age was 71 ± 11.23 years, and the majority were male (56.40%). After adjusting for confounders, patients with hypertension had
three times higher odds of MI (adjusted Odds Ratio [aOR] = 3.21; 95% CI: 2.50-4.14) compared with those without hypertension. The likelihood of MI increased by 51% among patients with diabetes (aOR = 1.51; 95% CI: 1.33-1.71),
34% among ever-smokers (aOR = 1.34; 95% CI: 1.18-1.52), and 45% in males (aOR = 1.45; 95% CI: 1.27-1.65). Hypertension, diabetes, smoking, and male sex were identified as significant risk factors for MI. Screening and effective management of these risk factors in rural areas could potentially prevent MI
incidence among patients with PAD.

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any
scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.

...more
3min
February 29, 2024 Secondary Prevention Therapies in Real-World Patients with Myocardial Infarction: Eligibility Based on Randomized Trials Supporting European and American Guidelines
Secondary Prevention Therapies in Real-World Patients with Myocardial Infarction: Eligibility Based on Randomized
Trials Supporting European and American Guideline
Am J Med . 2024 Feb;137(2):137-146.e10. doi:10.1016/j.amjmed.2023.09.021

Abstract
Objective: We aimed to evaluate the applicability of
the eligibility criteria of randomized controlled trials (RCTs) cited in guideline recommendations in a real-world cohort of patients receiving secondary prevention after acute myocardial infarction from the EPICOR registries.

Methods: Recommendations provided by American and
European guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients.

Results: There were 91.5% patients eligible for beta
blockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations
(69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription of
the recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving the
medications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers).

Conclusion: Most real-world acute myocardial infarction patients are eligible for secondary prevention therapy in both
general and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.

Disclaimer:
Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any
scientific information shared by the HCP on the STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.
...more
4min

FAQs about Star Update Podcast - Cardiology News Summaries:

How many episodes does Star Update Podcast - Cardiology News Summaries have?

The podcast currently has 240 episodes available.

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Star Update Podcast - Cardiology News Summaries

FAQs about Star Update Podcast - Cardiology News Summaries:

How many episodes does Star Update Podcast - Cardiology News Summaries have?

Star Update Podcast - Cardiology News Summaries episodes:

FAQs about Star Update Podcast - Cardiology News Summaries:

How many episodes does Star Update Podcast - Cardiology News Summaries have?

More shows like Star Update Podcast - Cardiology News Summaries

The Holistic GLP-1 Podcast with Elizabeth McGann