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August 15, 2019
News From Medscape
The following recommended articles on are freely available through the partnership between ABC and Medscape, no registration or login required.
Sacubitril/Valsartan Misses in Preserved-EF Heart Failure: Top-Line PARAGON-HF
Treatment with sacubitril/valsartan (Entresto, Novartis) in patients with heart failure and preserved ejection fraction (HFpEF) failed to show a significant benefit for the primary clinical end point in the large, randomized PARAGON-HF trial, the company has announced.
Flag on the Field for Atrial Fibrillation in Retired NFL Players
As National Football League (NFL) training camps begin in earnest this week, the conversation will undoubtedly turn to the long-term health of players and the debilitating brain disorder, chronic traumatic encephalopathy. Now, research suggests these elite athletes also may be at increased risk for atrial fibrillation (AF) and conduction abnormalities decades after leaving the sport.
CV Risk Rises When Payers Deny Alirocumab, Evolocumab Coverage
It has real-world health consequences when patients prescribed PCSK9 inhibitors don't actually get their medication, which often happens because their third-party payer doesn't cover the costly drugs, suggests a retrospective study. Patients in the analysis who could not take advantage of their prescriptions for alirocumab (Praluent, Sanofi/Regeneron) or evolocumab (Repatha, Amgen), either because they were rejected by payers or never filled, showed a greater risk for cardiovascular (CV) events than patients who filled and received their PCSK9 inhibitor prescriptions.
ACC Pathway Empowers Cardiologists to Use Diabetes Drugs for Heart Disease
Cardiologists are concerned because cardiovascular disease is the leading cause of death in patients with diabetes. Indeed, 65% of deaths in patients with diabetes are due to cardiovascular disease. They have higher risks for coronary heart disease, heart failure, and stroke. Even though our diabetes drugs have not primarily been shown to reduce cardiovascular disease risk until recently, we have been able to show that lowering glucose levels reduces risk for microvascular complications such as nephropathy, neuropathy, and retinopathy.
Items of Interest
At Issue: Lancet Initiative Sparks Discussion On Diversity in Cardiology
The Lancet journals announced it will no longer sponsor all-male panels, colloquially known as “manels,” and will take steps to improve the inclusion of all genders, ethnicities, regions and other social categories in research and publishing. Cardiology Today and Healio spoke with several prominent cardiologists, including Clyde W. Yancy, MD, MSc, vice dean of diversity and inclusion, Magerstadt Professor of Medicine at Northwestern University Feinberg School of Medicine and deputy editor of JAMA Cardiology, about the announcement.
Artificial Intelligence in Cardiology: Opportunities for Cardio-Oncology
By Sherry-Ann Brown, MD, PHD
Dr. Sherry-Ann Brown recaps the inaugural and first ever continuing medical education conference on artificial intelligence (AI) in cardiology and eplores how AI could influence care delivery to potentially improve outcomes as well as the experience for each patient and their health professionals, particularly in Cardio-Oncology.
The Evolution of the Role for Artificial Intelligence in Nuclear Cardiology
By Renee Bullock-Palmer, MBBS
Dr. Renee Bullock-Palmer delves into the evolution of Nuclear Cardiology, clarifies key terms within the artificial intelligence (AI) arena - AI, machine learning and deep learning - and also examines how nuclear cardiac imaging can benefit from AI and what that means for the future of Nuclear Cardiology.
Cardiovascular Maternal Morbidity and Mortality In the United States
By Renee Bullock-Palmer, MD
Dr. Renee Bullock-Palmer looks at the increase in maternal cardiovascular morbidity and mortality rates in the U.S. as well as the significant racial and ethnic disparities seen in this increase and illustrates the role the cardiologist can play in tackling this issue, along with potential solutions such as key predictors that could be utilized to assess maternal CVD risk.
Under Pressure: The Hidden Story of
Pregnancy & Preeclampsia
Kecia Gaither, MD, Director, Perinatal Services, Obstetrics & Gynecology, NYC Health + Hospitals/Lincoln is featured in Under Pressure: The Hidden Story of Pregnancy and Preeclampsia, a documentary film directed by Kristine Weatherston that discusses hypertensive disorders of pregnancy through the stories of survivors, researchers, and medical practitioners. The film seeks to educate, raise awareness, and encourage women to advocate for their health by knowing the signs and symptoms of these serious medical conditions. Learn more at the official website.
Black Women: Pregnancy Complications Could Be Sign of Heart Disease Risk
A new study confirms that when it comes to assessing heart health, an important question a doctor can ask an African American woman is, "Did you have complications during a pregnancy?"
New High Blood Pressure Guidelines Could Increase Detection of Gestational Hypertension
In a study of more than 16,000 women, improvements in diagnoses might lead to reduction in maternal and neonatal risk. Using the 2017 ACC/AHA guidelines, the investigators identified 4,100 women (25.1 percent) with hypertension. In contrast, only 678 (4.2 percent) of the women were found to have hypertension using the previous guidelines, indicating a substantial increase in the prevalence of gestational hypertension compared to the previous definition.
Carpal Tunnel Linked to Higher Rates of Amyloidosis and Heart Failure
A large population-based study adds new evidence to support a strong association between carpal tunnel syndrome and future risk of being diagnosed with amyloidosis. In addition to a greater incidence of heart failure, patients in the Danish study also had increased rates of other cardiovascular events compared with individuals without carpal tunnel.
Featured Articles by Members
ABC Members: We welcome your published research submissions and articles for inclusion in future issues of Clinical Updates and Insights. Email Rachel Williams at and please attach file or include links to the original published work and/or abstract.
Resident's Clinic: 50-Year-Old Man With Dyspnea on Exertion, Orthopnea, and Weight Gain
Co-authored by LaPrincess C. Brewer, MD, MPH (with Sae K. Jang, MD and Megha Prasad, MD)
A 50-year-old man presented to his primary care provider with a 2-week history of progressively worsening dyspnea on exertion and chest discomfort while in the flat position. He described his dyspnea as a feeling of “breathing through a straw.” Additional symptoms included a weight gain of 5 kg in the prior 3 weeks, increased abdominal girth, and paroxysmal nocturnal dyspnea. He also noticed a decline in exercise tolerance from a prior ability to ascend 9 flights of stairs to tolerating only a few steps.
Pregnancy and Parenting During Cardiology Fellowship
Co-authored by Sharonne N. Hayes (with Edson J. Mwakyanjala, Jennifer B. Cowart, Janis E. Blair and Michael J. Maniaci)
Medical training, and cardiovascular training in particular, involves intense focus and continuous learning. Trainees are often encouraged to avoid disruptions in their training to optimize their educational experience and minimize stress on the “system.” Despite these pressures, many residents and fellows choose to have children during training, but these choices have different implications for men and women in training. Overall, little is known about the experience of cardiology fellows who become parents during training or its effect on individuals and the field. The survey aims to analyze the experiences and impact of pregnancy, parenthood, and breastfeeding in a cohort of cardiology fellows.
Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis
Co-authored by Vuyisile T. Nkomo, MD, MPH and Rowlens M. Melduni, MD, MPH (with Edward A. El-Am MD, Angela Dispenzieri MD, Naser M. Ammash MD, et al.)
Arrhythmias, conduction abnormalities, and intracardiac thrombus are common in patients with cardiac amyloidosis (CA). Outcomes of direct-current cardioversion (DCCV) for atrial arrhythmias in patients with CA are unknown. This study sought to examine DCCV procedural outcomes in patients with CA.

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Combined, diabetes, obesity, and insulin resistance are the most common cause of preventable death in the United States--responsible for millions of deaths and more than $600 billion in health care costs. As the largest, US-based, multidisciplinary conference centered on the management and prevention of cardiovascular and metabolic disease, CMHC is a can’t-miss event for health care practitioners committed to joining the fight against cardiometabolic disease.

Friday, October 11
Cardiovascular Mechanisms and Safety of Established and Emerging Peptide Therapies
Keynote: Daniel J. Drucker, MD

FDA Update and Late Breaking Trials
Christie M. Ballantyne, MD; Deepak L. Bhatt, MD, MPH; Robert H. Eckel, MD; Keith C. Ferdinand, MD; Jay S. Skyler, MD

Saturday, October 12
Treatment of High-Risk Patients with CVD and Elevated TGs: REDUCE-IT and Beyond
Deepak L. Bhatt, MD, MPH

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Christos S. Mantzoros, MD, DSc

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