January 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.

Patients who present with unattributed chest pain in primary care may see their future CVD risk underestimated by algorithms based on the general population. Still, routinely recorded information can shed important light on individual risk, investigators say in the European Journal of Preventive Cardiology. “Consideration of a select number of key risk factors identified here could help target patients at highest risk for preventative measures,” they write.

In clinical trials of heart failure with reduced ejection fraction (HFrEF), women accounted for only a little more than 20% of participants in studies that observed reduced all-cause or CV mortality or HF hospitalization. Reporting in JACC: Advances, researchers say a greater understanding is needed of factors that influence the likelihood of women patients being recruited and retained. Additionally, of the 33 trials they examined, only two were led by women investigators, which may be a missed opportunity to enlarge female trial populations.

Frailty contributes to increased risk of in-hospital mortality in patients undergoing placement of leadless pacemakers, but identifying frail patients may help personalize their care plans, researchers conclude in Heart Rhythm. “For instance, frail patients may necessitate more frequent monitoring or additional support from caregivers to optimize their outcomes. Recognizing frailty status can also facilitate shared decision-making, empowering patients and their families to make informed choices about the risks and benefits of the procedure based on their unique frailty profile,” they write.

Many patients with cardiovascular disease have mental health needs that are not being addressed. An article in STAT discusses how cardiac psychologists are helping to fill these gaps through education and a focus on acknowledging psychological struggles in those living with heart disease.

Low-intensity vascular care is associated with worse long-term event-free survival in patients with chronic limb-threating ischemia (CLTI). In an analysis of Medicare patients who had CLTI, those who earned less income, men, and those treated at safety-net hospitals were most likely to receive low-intensity vascular care in the year before undergoing a major amputation, researchers report in Circulation: Cardiovascular Interventions.

A comprehensive reassessment of the entire care spectrum for disadvantaged populations is needed in aortic valve replacement, researchers assert in the American Journal of Medicine. Across categories of aortic stenosis and urgency of care, the study of nearly 300,000 patients with aortic stenosis found that those who were white were more likely than those who are Black, Hispanic, or Asian to receive valve replacement.

In symptomatic patients with PAD undergoing routine clinical care, psychosocial and socioeconomic factors including depression, anxiety, insurance status, and social support are most predictive of health status at 1 year, researchers conclude in the Journal of Vascular Surgery. They say a better understanding of patient-specific factors is key to informing response to PAD treatments.

An Irish study is one of the first to show that reversal of type 2 diabetes through diet and exercise can lead to substantial reductions in CVD and chronic kidney disease (CKD). Reporting in Diabetologia, the authors say that although their results are encouraging, maintenance of weight loss and remission was short-lived for most in the study. The greatest reductions in CVD and CKD were seen in those who had evidence of at least 4 years of diabetes remission.

A review article in Progress in Cardiovascular Diseases recaps what has happened in the years since the Women’s Health Initiative trial caused support for hormone replacement therapy (HRT) to plummet and suggests that the available evidence has expanded understanding of how and in whom HRT can be cardioprotective. “Although there is a deficiency of prospective, placebo-controlled studies on the use of human bioidentical HRT in postmenopausal women, this should not dissuade general clinicians and specialists in CVD from recommending HRT at least to the majority of their young, recently postmenopausal women patients, for maintaining ideal long-term CV health,” the researchers note.

News Highlights From TCTMD:

Heart Disease Reigns as Top Killer, but Many Don’t Know It

Short Bouts of Physical Activity May Offset Occupational Sitting CVD Risks

Even Low Levels of ApoB and LDL Linked With CAD, Mortality: UK Biobank

CRT-D Offers Persistent Survival Benefit in Long-term RAFT Results

No Fasting Before PCI? Study Shows No Harm—and Happier Patients