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Prof. Stefan Neubauer and Dr. Thomas Nero discuss two recent papers on the utility of coronary inflammation imaging on CT coronary angiography and how that translates to increased heart events. Beyond cholesterol, coronary inflammation is being revealed to be a significant risk factor with future treatments under development.
Prof. Neubauer is the head of the Division of Cardiovascular Medicine and Director of the Oxford Centre for Clinical Magnetic Resonance Research (OCMR) at the University of Oxford and Past President of the Society for Cardiovascular Magnetic Resonance (SCMR). He co-authored two recently published landmark papers:
Farina NH, Mehta NN, Teague HL, et al. Inflammatory risk and cardiovascular events in patients without obstructive coronary artery disease: the ORFAN multicentre, longitudinal cohort study. Lancet. 2024;403(10392):1823-1835. doi:10.1016/S0140-6736(24)00596-8
Farina, C. J., Davidson, M. H., Shah, P. K., Stark, C., Lu, W., Shirodaria, C., Wright, T., Antoniades, C. A., & Nilsson, J. (2024). Inhibition of oxidized low-density lipoprotein with orticumab inhibits coronary inflammation and reduces residual inflammatory risk in psoriasis: a pilot randomized, double-blind placebo-controlled trial. Cardiovascular Research, European Society of Cardiology, March 25, 2024.
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Dr Nero and Dr Gibson discuss how to understand the information when looking at clinical trial data. Is it meaningful for a patient? Did the trail population match the patient's risks and medical problems? The also discuss the importance of Shared Decision Making and the use of Absolute Risk Reduction and Number Needed To Treat when interpreting the results. Yes, this is about statistics, but it isn't boring and it is important for your health.
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Jeff Scott, CEO of Section 810 communication, interviews Dr. Nero on ways to improve cardiac health. The cover a wide range of topics, from diet and exercise to medical therapy and advanced testing. Some future research topics are also discussed. Section 810 Communications is a training and development company based in Greenwich, CT. The interview was recorded on January 18th, 2024 and is also available on YouTube.
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Dr Steven Nissen and Dr Thomas Nero discuss the importance of Lipoprotein a -aka Lp(a)- and its clinical importance as a special type of LDL cholesterol which dramatically increases your cardiovascular risk. They also covers why it important to get it tested at least once and what you can do to lower your risk of heart attack if you have it. If you enjoy this episode you may want to take a listen to the research oriented version of this topic at FUTURE PULSE CARDIOLOGY.
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Dr Nero discusses coronary artery disease and exercise with Dr. Aaron Baggish. Dr Baggish was the founder of the Cardiovascular Performance Program at the Mass General Hospital and is one of the best known sports cardiologists in the world. They discuss the importance of exercise, coronary artery disease in the endurance athlete and current cardiovascular testing.
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Dr. Thomas Nero interviews Dr. John Mandrola on his approach to treating atrial fibrillation. In addition to a nuts and bolts approach they discuss how to assess risk and shared decision making.
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Dr Mathew Budoff discusses the importance of Coronary Artery Calcium Scoring and CT Coronary Angiography to prevent and treat heart disease with Dr. Thomas Nero. In addition they discuss new goals for treating cholesterol based on the CAC. If you enjoy this podcast you can also listen to a longer, in depth discussion on FUTURE PULSE CARDIOLOGY.
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Dr. Ofili and Iyana discuss their experience with the African American Heart Study and why it is so important to be involved.
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Dr Peter Toth discusses with Dr. Thomas Nero the new classes of diabetes medications, SGLT2 inhibitors (eg Jardiance) and GLP1 receptor agonists (eg Ozempic and Munjaro.) These drugs have been in the news due to an impressive effect on weight reduction, but they also improve cardiovascular outcomes in diabetic and non-diabetic patients.
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In this brief discussion, Dr. Toth discusses the current recommendations on decreasing cardiovascular risk and where we are headed to decrease your risk of a heart attack.
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Coronary inflammation is the final pathway for the development of coronary artery disease. Dr. Paul Ridker discusses the role of inflammation, hs-CRP and therapies with Dr. Thomas Nero.
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Dr Christopher Cannon discusses the EVOLVE-MI trial to decrease cholesterol with Evolocumab early after Myocardial Infarction as well as the rational for a less intensive way to study patients with open label, pragmatic clinical trials.
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Dr Kebrina Bartley discuses Spontaneous Coronary Artery Dissection (SCAD) and Heart Disease in Women with Dr Sharonne Hayes, Professor of Medicine at the Mayo Clinic. Their wide ranging conversation discuses SCAD, the difference between SCAD and atherosclerotic heart disease and approaching the female patient who presents with chest pain. The also take a brief dive into the importance involving women in clinical research and broadening or perspective. (audio editor's note, please excuse the audio quality - mea culpa)
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Dr. Kabrina Bartley interviews Dr. Thomas Nero on ways patients can improve their outcomes by understanding their medical issues and becoming more involved with their care. These a a few very simple steps anyone can do
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Dr. Nero discusses with ways to evaluate coronary artery disease with Dr. Cheerag Shirodaria from Oxford. Dr. Shirodaria and his team at Caristo Diagnostics have developed a ground breaking technology that allows us to evaluate not just the severity of a coronary artery lesion, but also how inflamed it is and how likely it is to cause a heart attack in the future. We also briefly discuss the role of CT coronary calcium scoring, CT angiography and stress testing.
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Dr. Kebrina Bartley discusses cholesterol management with Dr. Thomas Nero. They go over the important roll that statins play in coronary artery disease prevention especially in association with diet and exercise. The also discuss other options for lowering cholesterol and briefly discuss the approach to treating patients who feel that they may be having side effects from the medications
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If you REALLY want to understand what your doctor is telling you and how she came to the decisions that she did, then you have to know a little bit about medical statistics. In this episode, we will go over how we make a diagnosis with testing, how to measure benefit of a treatment in relative vs absolute risk reduction , and how to "judge" a study is from a statistical point of view. These concepts are not simple and it may take one or two times through to understand, but in the end it will be worth it. Finally, if you ever want to impress someone at a cocktail party with terms like "Bayesian Analysis" or "P-Value" well here is your chance.
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Understanding cholesterol is an important part of understanding your risk of heart disease and stroke. Your total cholesterol is made up of LDL (The bad cholesterol), HDL (the good cholesterol) and Triglycerides (which are also bad). Since it is made up of both bad and good parts, total cholesterol can be misleading. In this episode we introduce, Non-HDL cholesterol and Apolipoprotein B as better measures of cardiac risk since they are the bad things we want to avoid. We also discuss, Lipoprotein a or Lp(a) as a very important, but not usually measured, factor that is found in many people with family histories of heart disease.
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At Patients First, we aim to improve understanding of difficult topics in cardiology and medicine in general. Easy enough for the layman, but detailed enough for someone who wants to know more about their condition or that of a loved one. This first episode introduces the topic of outcomes based research and evidence based medicine. It also discusses the important concept of NNT: Number Needed to Treat ie we have to treat 50 people for 2 years to avoid 1 event as an important indicator of efficacy of therapy. These concepts will be referred to in future podcasts
