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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 with Fat Attenuation Index (FAI)FAI score. The ORFAN study demonstrated a 20 fold increased risk in CV event rates with low vs high FAI score and a 10 fold increased event rate in patients with elevated FAI score who have no coronary plaque. FAI score re-categorized 40% of patients in their follow-up studies.
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). We discussed two recently published landmark papers from his division:
Kenneth Chan, Elizabeth Wahome , 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
Christopher J. Farina, Michael H. Davidson, Prediman K. Shah, Charles Stark, Wenqi Lu, Cheerag Shirodaria, Timothy Wright, Charalambos A. Antoniades, Jan Nilsson and Nehal N. Mehta (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 Gibson and Dr Nero discuss the oft maligned issue of medical statistics. Their discussion covers the pros and cons of traditional Cox proportional hazards regression models and Kaplan-Meier curves and newer techniques including win ratios. They then dip their toes into AI. A great overview by one of our leading clinical trialists.
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This episode is a deep dive into Lipoprotein a with Dr Steven Nissen from the Cleveland Clinic. He and Dr Nero discuss the genetics of Lp(a), its pathophysiology, current treatment strategies and research into lowering Lp(a) levels. This is a fascinating conversation that also discusses the role of coronary inflammation in the work of Dr. Paul Ridker as well as the role of CT angiography in future clinical trials.
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Dr Steven Nissen from the Cleveland Clinic discuses with Dr. Thomas Nero the basic clinical approach to Lp(a) with need for routine testing and a few simple case studies. In the second (longer podcast) they take a deep deep dive into Lp(a) genetic, pathophysiology and the current research trials.
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Dr Thomas Nero speaks with Dr Aaron Baggish about coronary artery disease in the endurance athlete (and non-athlete as well!) They discuss cardiovascular testing in Masters athletes including ETT, coronary calcium scoring and CT angiography as well as risk factor identification, inflammation, physical & emotional stress and ongoing research. Dr Baggish is a Professor of Sports Cardiology at Université de Lausanne and founder of the Cardiovascular Performance Program, Massachusetts General Hospital, Harvard Medical School. He has been team cardiologist for USA rowing, US Soccer, and the New England Patriots. He was the medical director for the Boston Marathon and is a consultant to the IADA, IOC and FIFA.
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Dr Mandrola discusses recent trail data with Dr. Thomas Nero including the results from Artesia, NOAH Afnet 6, Frail AF, Azalea and Oceanic-AF. They also discuss Left Atrial Appendage Occlusion and utility of wearable devices. Finally, a shout out to Dr. Andre Foy and his work on multi-morbidity and its role in clinical trial interpretation.
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Dr. Thomas Nero speaks with Dr. Mathew Budoff about Coronary Calcium Scoring, CT Coronary Angiography and cardiovascular outcomes. The discussion goes beyond basic risk factor enhancement, highlighting its role to help evaluate disease progression, power future clinical trials and determine efficacy of therapy. Along the way, they discuss coronary inflammation, perivascular adipose tissue imaging and fat attenuation index (FAI) as well as diving into the plaque stabilizing effects of EPA.
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Dr. Elizabeth Ofili discusses the African American Heart Study with Dr. Thomas Nero. They also discuss her work at the NIH and the African American Heart Failure Trial and the role of community based pragmatic clinical trials.
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Dr. Thomas Nero discusses current therapy with Factor X inhibitors, the new research with Factor XI inhibition and specifically the enrolling Milvexian clinical trials with Dr. C Micahel Gibson. In addition they discuss, the addition of these medications along wiht anti-platelet therapy, Lp(a) and other interesting current and future research in cardiovascular disease.
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Dr. Thomas Nero speaks with Dr Peter Toth about the dramatic change occuring in diabtetes management and its effect on cardiovascular disease. Starting with the biochemestry of diabetes and its effects at the cellular level, the discussion goes on to speak about the role SGLT2 inhibitors and GLP1 receptor agonists play in DM management as well as the future of diabetes care. (If you want to skip the excelllent, but quite deep dive into biochemistry, jump to 11:22 - but honestly Dr. Toth's description is breathtaking)
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Dr Paul Ridker discusses his paper on residual inflammatory risk that was recently published in the Lancet with Dr. Thomas Nero. He discusses the pathology of inflammation as part of atherosclerosis, utilization of hs-CRP in clinical trials and in daily practice as well as current therapeutic options and ongoing investigations.
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Dr Christopher Cannon discusses the potential of Pragmatic Clinical Trials in our research armamentarium with Dr. Thomas Nero. They review the EVOLVE-MI trial for Early use of Evolocumab after Myocardial Infarction in detail and highlight the potential for future research.
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Dr. Nero discusses evaluation of coronary artery disease and coronary inflammaiton with Dr. Cheerag Shirodaria from the University of Oxford. Dr. Shirodaria along with Prof. Charalambos Antonidies 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 fatal and non-fatal myocardial infarction. In addition, since it is a biologically active "marker" the Fat Attenuation Index (FAI) can also be used a a way to evaluate success of medical intervention. Using computer post processing from standard 64 or 128 slice CT coronary angiography, they have been able to evaluate not just the vulnerable patient but also (possibly) the vulnerable plaque.
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Prof. Christine Coughlin of Wake Forest School of Law speaks with Dr. Thomas Nero on the FDA approval process, emergency use authorization, Right to Try Legislation and the implications for clinical research, diversity and health care equity. Prof. Coughlin holds positions in the College of Medicine as well as the Law school and in the Center for Bioethics. She has published extensively on the FDA approval process.
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Although exercise usually provides a cardiovascular benefit, there is some data that points to an increase in event rates in extreme endurance athletes. In this episode, Dr. Thomas Nero and Dr. Paul Thompson discuss the surprising findings regarding coronary calcium, cardiac troponins and atrial fibrillation in the endurance athlete and some thoughts about ideas to pursue in future research.
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Dr Nero and Dr Thomposn discuss Statin Associated Muscle Symptoms (SAMS) and the results of the STOMP and SAMSON trials. In addition, they discuss statins and athletic training, options for the statin intolerant patient and research regarding further investigation of the ranitadine receptor among other topics
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Our inaugural podcast is a discussion between Dr. Paul Thompson, Chief of Cardiology, Emeritus, at Hartford Hospital and Professor of Medicine, Emeritus, at University of Connecticut and Dr. Thomas Nero, Director of Cardiovascular Research at CAFC about coronary artery disease, lipid sub-fractionation and the role of lipoprotein a, aka Lp(a).
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