The MICHELLE Trial

Dr. Paul Dobesh discusses the MICHELLE trial with co-host, Dr. Tracy Macaulay.

0:00-1:00: Introduction

1:01-4:14: MICHELLE trial overview

4:15-11:10: Risk stratification and current recommendations for thromboprophylaxis

11:11-19:43: Thoughts on the MICHELLE trial and application to current practice

19:44-23:00: Future directions

23:01-24:03: Closing

References:

MICHELLE

Ramacciotti E, Barile Agati L, Calderaro D, et al. Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial. Lancet. 2022;399(10319):50-59. doi:10.1016/S0140-6736(21)02392-8

ADOPT

Goldhaber SZ, Leizorovicz A, Kakkar AK, et al. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. N Engl J Med. 2011;365(23):2167-2177. doi:10.1056/NEJMoa1110899

MAGELLAN

Cohen AT, Spiro TE, Büller HR, et al. Rivaroxaban for thromboprophylaxis in acutely ill medical patients. N Engl J Med. 2013;368(6):513-523. doi:10.1056/NEJMoa1111096

APEX

Cohen AT, Harrington RA, Goldhaber SZ, et al. Extended Thromboprophylaxis with Betrixaban in Acutely Ill Medical Patients. N Engl J Med. 2016;375(6):534-544. doi:10.1056/NEJMoa1601747

ACTION

Lopes RD, de Barros E Silva PGM, Furtado RHM, et al. Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial. Lancet. 2021;397(10291):2253-2263. doi:10.1016/S0140-6736(21)01203-4

ACTIV-4B

Connors JM, Brooks MM, Sciurba FC, et al. Effect of Antithrombotic Therapy on Clinical Outcomes in Outpatients With Clinically Stable Symptomatic COVID-19: The ACTIV-4B Randomized Clinical Trial. JAMA.2021;326(17):1703–1712. doi:10.1001/jama.2021.17272

Dobesh PP, Trujillo TC. Coagulopathy, Venous Thromboembolism, and Anticoagulation in Patients with COVID-19. Pharmacotherapy. 2020;40(11):1130-1151. doi:10.1002/phar.2465

The Cardiovascular Benefits of Exercise and Physical Activity

Dr. Mary Blanton Covell discusses the cardiovascular benefits of exercise and physical activity with co-host, Dr. Tracy Macaulay.

0:00-1:07: Introduction

1:08-5:05: Background

5:06-15:45: Patient Education and Cardiopulmonary Rehabilitation Programs 

15:46-22:30: What type of exercise is best?

22:31-24:20: Overall Thoughts

24:21-25:05: Closing

References:

Netherlands Cardiac Rehab Trial:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768711

Eijsvogels TMH, Maessen MFH, Bakker EA, et al. Association of Cardiac Rehabilitation With All-Cause Mortality Among Patients With Cardiovascular Disease in the Netherlands. JAMA Netw Open. 2020;3(7):e2011686. doi:10.1001/jamanetworkopen.2020.11686

Iowa State Pilot Study:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6322789/

Schroeder EC, Franke WD, Sharp RL, Lee DC. Comparative effectiveness of aerobic, resistance, and combined training on cardiovascular disease risk factors: A randomized controlled trial. PLoS One. 2019;14(1):e0210292. Published 2019 Jan 7. doi:10.1371/journal.pone.0210292

CardioRACE methods paper: 

https://pubmed.ncbi.nlm.nih.gov/31520895/

Brellenthin AG, Lanningham-Foster LM, Kohut ML, Li Y, Church TS, Blair SN, Lee DC. Comparison of the Cardiovascular Benefits of Resistance, Aerobic, and Combined Exercise (CardioRACE): Rationale, design, and methods. Am Heart J. 2019 Nov;217:101-111. doi: 10.1016/j.ahj.2019.08.008. Epub 2019 Aug 15. PMID: 31520895; PMCID: PMC6861681.

WHO Sedentary Guidelines: 

https://www.who.int/publications/i/item/9789240015128

WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. PMID: 33369898.

ESC Exercise in Patients with Cardiac Disease Guidelines: 

https://academic.oup.com/eurheartj/article/42/1/17/5898937

ESC Scientific Document Group, 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC), European Heart Journal, Volume 42, Issue 1, 1 January 2021, Pages 17–96, https://doi.org/10.1093/eurheartj/ehaa605.

ACC Primary Prevention Guidelines: 

https://academic.oup.com/eurheartj/article/42/1/17/5898937

2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

Morris JN, Chave SP, Adam C, Sirey C, Epstein L, Sheehan DJ. Vigorous exercise in leisure-time and the incidence of coronary heart-disease. Lancet. 1973;1(7799):333-339. doi:10.1016/s0140-6736(73)90128-1

Sattelmair J, Pertman J, Ding EL, Kohl HW 3rd, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011;124(7):789-795. doi:10.1161/CIRCULATIONAHA.110.010710

Carlsson S, Andersson T, Lichtenstein P, Michaëlsson K, Ahlbom A. Physical activity and mortality: is the association explained by genetic selection?. Am J Epidemiol. 2007;166(3):255-259. doi:10.1093/aje/kwm132

Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116(10):682-692. doi:10.1016/j.amjmed.2004.01.009

Paffenbarger RS Jr, Hyde RT, Wing AL, Hsieh CC. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. 1986;314(10):605-613. doi:10.1056/NEJM198603063141003

Lee DC, Pate RR, Lavie CJ, Sui X, Church TS, Blair SN. Leisure-time running reduces all-cause and cardiovascular mortality risk [published correction appears in J Am Coll Cardiol. 2014 Oct 7;64(14):1537]. J Am Coll Cardiol. 2014;64(5):472-481. doi:10.1016/j.jacc.2014.04.058

Mons U, Hahmann H, Brenner H. A reverse J-shaped association of leisure time physical activity with prognosis in patients with stable coronary heart disease: evidence from a large cohort with repeated measurements. Heart. 2014;100(13):1043-1049. doi:10.1136/heartjnl-2013-305242

O’Keefe JH, Patil HR, Lavie CJ, Magalski A, Vogel RA, McCullough PA. Potential adverse cardiovascular effects from excessive endurance exercise [published correction appears in Mayo Clin Proc. 2012 Jul;87(7):704]. Mayo Clin Proc. 2012;87(6):587-595. doi:10.1016/j.mayocp.2012.04.005

Grøntved A, Koivula RW, Johansson I, et al. Bicycling to Work and Primordial Prevention of Cardiovascular Risk: A Cohort Study Among Swedish Men and Women. J Am Heart Assoc. 2016;5(11):e004413. Published 2016 Oct 31. doi:10.1161/JAHA.116.004413

Ellingsen Ø, Halle M, Conraads V, et al. High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction. Circulation. 2017;135(9):839-849. doi:10.1161/CIRCULATIONAHA.116.022924

Authors/Task Force Members, Piepoli MF, Hoes AW, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol. 2016;23(11):NP1-NP96. doi:10.1177/2047487316653709

The SSaSS Trial

Dr. Mary Blanton Covell discusses the SSaSS Trial with co-host, Dr. Tracy Macaulay.

0:00-1:24: Introduction

1:25-5:00: SSaSS Trial Overview

5:01-8:50: Thoughts on the SSaSS Trial

8:51-9:55: Application to Clinical Practice

9:56-11:46: Recent FDA Guidance on Industry Sodium Content

11:47-22:15: Other Dietary Recommendations

22:16 – 23:21: Closing

References:

SSaSS Trial: Neal B, Tian M, Li N, et al. Rationale, design, and baseline characteristics of the Salt Substitute and Stroke Study (SSaSS)-A large-scale cluster randomized controlled trial. Am Heart J. 2017;188:109-117. doi:10.1016/j.ahj.2017.02.033

Guidance for Industry: Voluntary Sodium Reduction Goals: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/guidance-industry-voluntary-sodium-reduction-goals

Estruch R, Ros E, Salas-Salvadó J, et al. Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. N Engl J Med. 2018;378(25):e34. doi:10.1056/NEJMoa1800389

Kim H, Caulfield LE, Garcia-Larsen V, Steffen LM, Coresh J, Rebholz CM. Plant-Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All-Cause Mortality in a General Population of Middle-Aged Adults. J Am Heart Assoc. 2019;8(16):e012865. doi:10.1161/JAHA.119.012865

Victor RG, Lynch K, Li N, et al. A Choi Y, Larson N, Steffen LM, et al. Plant-Centered Diet and Risk of Incident Cardiovascular Disease During Young to Middle Adulthood. J Am Heart Assoc. 2021;10(16):e020718. doi:10.1161/JAHA.120.020718

Kaiser J, van Daalen KR, Thayyil A, Cocco MTARR, Caputo D, Oliver-Williams C. A Systematic Review of the Association Between Vegan Diets and Risk of Cardiovascular Disease. J Nutr. 2021;151(6):1539-1552. doi:10.1093/jn/nxab037v

Drouin-Chartier JP, Chen S, Li Y, et al. Egg consumption and risk of cardiovascular disease: three large prospective US cohort studies, systematic review, and updated meta-analysis. BMJ. 2020;368:m513. Published 2020 Mar 4. doi:10.1136/bmj.m513

CardioScripts Classic – Hypertension [Part 2]

Part 2 of the CardioScripts Classics episode on hypertension with Drs. Tracy Macaulay and Liz Wang.

0:00-1:07: Introduction

1:08-5:23: SPRINT Trial

5:23-9:14: Elderly patients with hypertension

9:15-17:50: Hypertension management in Black patients

17:51-21:57: Hypertension nuances

21:58-23:30: Closing

References:

SPRINT Trial: The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. N Engl J Med 2015;373(22):2103-16.

European Hypertension Guidelines: Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018;39(33):3021-3104.

Sulaica EM, Wollen JT, Kotter J, Macaulay TE. A Review of Hypertension Management in Black Male Patients. Mayo Clin Proc 2020;95(9):1955-1963.

Victor RG, Ravenell JE, Freeman Anne, et al. Effectiveness of a barber-based intervention for improving hypertension control in black men: the BARBER-1 study: a cluster randomized trial. Arch Intern Med 2011;171(4):342-50.

Victor RG, Lynch K, Li N, et al. A Cluster-Randomized Trial of Blood-Pressure Reduction in Black Barbershops. N Engl J Med 2018;378(14):1291-1301.

CardioScripts Classic – Hypertension [Part 1]

Drs. Tracy Macaulay and Liz Sulaica discuss hypertension.

0:00-0:45: Introduction

0:46-2:14: Intro of Dr. Liz Sulaica

2:15-4:19: SHEP Trial

4:20-6:19: Syst-Eur Trial

6:20-11:17: ALLHAT Trial

11:18-15:59: ACCOMPLISH Trial

16:00-18:53: HCTZ vs. Chlorthalidone

18:54-22:03: JNC 8

22:04-22:35: Closing

References:

SHEP Trial: SHEP Cooperative Research Group. Prevention of Stroke by Antihypertensive Drug Treatment in Older Persons With Isolated Systolic Hypertension. JAMA 1991;265:3255-3264.

Syst-Eur Trial: Staessen JA, Fagard R, Thijs L, et al. Randomised double-blind comparison of placebo and active treatment for older persons with isolated systolic hypertension. Lancet 1997;350:757-64.

ALLHAT Trial: ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. JAMA 2002;288(23):2981-97.

ACCOMPLISH Trial: Jamerson KJ, Weber MA, Bakris GL, et al. Benazepril plus Amlodipine or Hydrochlorothiazide for Hypertension in High-Risk Patients. N Engl J Med 2008; 359:2417-28.

Chlorthalidone vs HCTZ: Hripcsak G, Suchard MA, Shea S, et al. Comparison of Cardiovascular and Safety Outcomes of Chlorthalidone vs. Hydrochlorothiazide to Treat Hypertension. JAMA Int Med 2020;80(4):542-51.

JNC 8: James PA, Oparil S, Carter BL, et al. 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults: Report From the Panel Members Appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311(5):507-520.

2017 ACC/AHA Hypertension Guideline: Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71(19):e127-e248.

Ripley TL, Brenner M, Finks S, et al. Key articles and guidelines in the management of hypertension. J Pharm Pract 2015;28(2):146-61.

Wright JT, Fine LJ, Lackland DT, et al. Evidence supporting a systolic BP goal of less than 150 mm Hg in patients aged 60 years or older: the minority view. Ann Intern Med 2014;160(7):499-503.

The ADAPTABLE Trial

Dr. Matthew Wanat and CardioScripts co-host, Dr. Liz Sulaica, discuss the ADAPTABLE trial. 

0:00-0:25: Introduction 

0:26-1:32: Introduction of Dr. Matthew Wanat

1:33-6:25: ADAPTABLE Overview 

6:26-10:23: Aspirin Dosing and Overall Thoughts 

10:24-12:06: Trial Limitations

12:07:-14:15: Literature and Guidelines for Aspirin in Primary Prevention (see additional references below)

14:16-18:11: Pragmatic Study Design

18:12-19:24: Final Thoughts 

19:25-19:57: Closing 

References: 

ADAPTABLE: Jones WS, Mulder H, Wruck LM, et al. Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease. N Engl J Med. 2021;384(21):1981-1990. doi:10.1056/NEJMoa2102137

2019 ACC/AHA Primary Prevention Guidelines: Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. 2020 Jan 28;141(4):e60] [published correction appears in Circulation. 2020 Apr 21;141(16):e774]. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678

ASPREE: McNeil JJ, Nelson MR, Woods RL, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med. 2018;379(16):1519-1528. doi:10.1056/NEJMoa1803955

ARRIVE: Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036-1046. doi:10.1016/S0140-6736(18)31924-X

ASCEND: ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. 2018;379(16):1529-1539. doi:10.1056/NEJMoa1804988

The PARADISE-MI Trial

Dr. Stephanie Dwyer Kaluzna and CardioScripts co-host, Dr. Tracy Macaulay, discuss the PARADISE-MI trial. 

0:00-0:25: Introduction 

0:26-1:19: Introduction of Dr. Stephanie Dwyer Kaluzna

1:20-6:14: PARADISE-MI Overview 

6:15-7:56: Overall Thoughts 

7:57-10:28: Use of ACE-I/ARB in MI

10:30-13:43: Background Therapy Considerations 

13:44-18:08: Applicability and Feasibility of Use

18:09-19:24: Final Thoughts 

19:25-20:02: Closing 

References: 

PARADISE-MI Trial: Design and baseline characteristics: Jering KS, Claggett B, Pfeffer MA, et al. Prospective ARNI vs. ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction (PARADISE-MI): design and baseline characteristics [published online ahead of print, 2021 Apr 12]. Eur J Heart Fail. 2021;10.1002/ejhf.2191. doi:10.1002/ejhf.2191

AIRE Trial: Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet. 1993;342(8875):821-828.

VALIANT Trial: McMurray J, Solomon S, Pieper K, et al. The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction: an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). J Am Coll Cardiol. 2006;47(4):726-733. doi:10.1016/j.jacc.2005.09.055

EPHESUS Trial: Pitt B, Remme W, Zannad F, et al. Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction [published correction appears in N Engl J Med. 2003 May 29;348(22):2271]. N Engl J Med. 2003;348(14):1309-1321. doi:10.1056/NEJMoa030207

Timing of initiation of eplerenone in EPHESUS: Adamopoulos C, Ahmed A, Fay R, et al. Timing of eplerenone initiation and outcomes in patients with heart failure after acute myocardial infarction complicated by left ventricular systolic dysfunction: insights from the EPHESUS trial. Eur J Heart Fail. 2009;11(11):1099-1105. doi:10.1093/eurjhf/hfp136

EMPEROR-Reduced: Reign of the SGLT2 Inhibitors

Dr. Ted Berei and CardioScripts co-host, Dr. Tracy Macaulay, discuss the EMPEROR-Reduced trial. 

0:00-0:28: Introduction 

0:29-1:05: Introduction of Dr. Ted Berei 

1:06-3:40: EMPEROR-Reduced Overview 

3:41-5:08: Overall Thoughts 

5:09 -11:18: Secondary Endpoints 

11:19-19:04: Considerations for Initiation of SGLT2 Inhibitors 

19:05-21:21: Final Thoughts 

21:22-22:02: Closing 

References: 

  • McMurray, John JV, et al. “Dapagliflozin in patients with heart failure and reduced ejection fraction.” New England Journal of Medicine 381.21 (2019): 1995-2008. 
  • Packer, Milton, et al. “Cardiovascular and renal outcomes with empagliflozin in heart failure.” New England Journal of Medicine 383.15 (2020): 1413-1424. 
  • Vardeny, Orly, and Muthiah Vaduganathan. “Practical guide to prescribing sodium-glucose cotransporter 2 inhibitors for cardiologists.” JACC: Heart Failure 7.2 (2019): 169-172. 
  • Das, Sandeep R., et al. “2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes: a report of the American College of Cardiology solution set oversight committee.” Journal of the American College of Cardiology 76.9 (2020): 1117-1145. 

POPular TAVI Trial [Cohort A]

Dr. John Lindsley and CardioScripts co-host, Dr. Liz Sulaica, discuss cohort A of the POPular TAVI trial.

0:00-0:28: Introduction

0:29-1:04: Introduction of Dr. John Lindsley

1:05-6:12: Cohort A Overview

6:13-10:18: Overall Thoughts

10:19-12:30: Subclinical Valve Thrombosis

12:31-15:05: Management strategies

15:06-15:52: Final Thoughts

15:53-16:31: Closing

References:

  • POPular TAVI Trial [Cohort A]: Brouwer J, Nijenhuis VJ, Delewi RS, et al. Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 383: 1447-57. DOI: 10.1056/NEJMoa2017815.
  • POPular TAVI Trial [Cohort B]: Nijenhuis VJ, Brouwer J, Delewi R, et al.  Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 382:1696-1707. DOI: 10.1056/NEJMoa1915152.
  • ARTE Trial: Rodes-Cabau J, Masson J, Welsh RC, et al. Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve: The ARTE (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) Randomized Clinical Trial. JACC Cardiovasc Interv. 2017 Jul 10;10(13):1357-1365.
  • GALILEO Trial: Dangas G, Tijssen JG, Wöhrle J, et al. A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement.
  • PARTNER Trial: Leon MB, Smith CR, Mack M, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. N Engl J Med 2010; 363:1597-1607.
  • Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults With Aortic Stenosis: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2017;69(10):1313-46.