April 2024 Dispatch for the CV Team

Every month, Section Editor L.A. McKeown curates a roundup of recent news tidbits from journals and medical meetings around the globe.

A first-of-its-kind review in the Journal of the American College of Cardiology explores social determinants of health and CVD in Hispanic women. The authors say a multipronged approach is needed to address myriad factors ranging from discrimination and economic stability to health literacy, all of which impact CV risk and exert influence on the ability to receive equitable care in this population.

A new randomized study of adult offspring reassures that babies born to pregnant women given antenatal betamethasone for prevention of neonatal respiratory distress syndrome do not in fact face future health risks: it showed no difference between the placebo and treatment groups in CV risk factors or age at first major adverse cardiovascular event. Writing in PLOS Medicine, the investigators say the follow-up of the offspring, who are now in their 50s, refutes animal data showing later adverse effects of antenatal corticosteroids, including CV health impacts.

Operators in Germany have performed the first ever transcaval TAVI procedure in a 65-year-old patient with pure aortic regurgitation. The alternative access was chosen after surgery, transfemoral, transaxillary, and transcarotid approaches were all ruled out due to the patient’s challenging anatomy and comorbid conditions. Writing in JACC: Case Reports, the team describes how they planned out and executed the procedure, which was successful and led to substantial symptom relief for their patient.

Approximately 70% of all STEMIs occur in people with no known CVD at an average age in their early 60s, according to an analysis of nearly 8,000 patients. Presented as a poster at the recent American College of Cardiology 2024 Scientific Session, the data show that use of preventive medications remains infrequent, with most individuals not on medications to control cholesterol or hypertension and few on aspirin prior to STEMI. Despite a decline in the STEMIs over time, the researchers said in a press release that the results suggest that “those presenting with STEMI look very similar to what we saw 20 years ago.”

A review article on ischemia with nonobstructive coronary arteries (INOCA), published in American Heart Journal Plus: Cardiology Research and Practice, describes pathologies, diagnostic strategies, and management of this underrecognized, challenging condition. The paper also includes female and male case examples with coronary angiogram and microvascular dysfunction testing results.

With a dearth of RCTs in cardiac sarcoidosis, clinicians need guidance on diagnosis and management, which a new scientific statement from the American Heart Association provides. Published in Circulation, the document covers imaging and diagnostic algorithms, as well as a detailed guide to using common immunosuppressive agents.

Artificial intelligence (AI) may have a role to play in improving on risk prediction models for in-hospital mortality among patients hospitalized for heart failure (HF) in whom current methods are not optimally predictive, investigators report in ESC Heart Failure. The AI model incorporates temporal changes in patient-specific vital signs and labs during the admission, which the authors say “may help flag hospitalized HF patients at increased risk of adverse outcomes and may be useful in triggering interventions such as cardiology or advanced HF consultation or upgrade to a higher level of care.”

Patients with atrial fibrillation (AF) who are under age 65 tend to have a high risk factor burden with higher long-term mortality risks than similarly aged patients without AF, investigators write in Circulation: Arrhythmia and Electrophysiology. “Apart from aggressive management of hypertension, vascular disease, diabetes, and HF, focus on smoking cessation with support and counseling along with the incorporation of a goal-directed weight-reduction plan may influence not only AF burden but also mortality and hospitalization,” they say, adding that an integrated multidisciplinary team-based approach makes sense when dealing with multiple risk factors in a single patient.

Racial discrimination in late adolescence may predispose young Black adults to metabolic syndrome by their early 30s, possibly through mediation of inflammation and sleep problems, according to research published in JAMA Network Open. “Future research should further examine these associations and interrogate opportunities for intervention, using sleep as a potential lever for prevention. Strategies to prevent and reduce racial discrimination exposure and associated sequelae are critical for improving health among racially and ethnically minoritized populations and moving us closer toward health equity,” the study authors write.

Despite increasing attention on the intersection between cardiology and oncology, significant efforts are needed to address evidence gaps in areas such as epidemiology, CV risk factors, risk stratification, and social determinants of health, researchers say in a review for novices and experts alike that was recently published in Trends in Cardiovascular Medicine. Additionally, they say it is critical to monitor the progress being made in cardio-oncology to assess whether it has translated into real differences both at a practice level and in terms of patient outcomes.

News Highlights From TCTMD:

INOCA May Be at the Root of Angina for Many Long-COVID Patients

New Heart Failure After AF Diagnosis Merits More Attention

Diltiazem and DOAC Interaction Increases Bleeding Risk in AF

EMA: No Evidence of Link Between GLP-1 Receptor Agonists and Suicidal Thoughts

BE ACTIVE: Gaming for Points and Money Can Boost Step Counts