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American College of Cardiology, March 28-30

The American College of Cardiology 69th Annual Scientific Session and Expo

The annual meeting of the American College of Cardiology was held virtually from March 28 to 30 and attracted participants from around the world, including clinicians, academicians, allied health professionals, and others interested in cardiology. The conference highlighted recent advances in the treatment, management, and prevention of cardiovascular diseases, with presentations focusing on novel drugs and surgical approaches to improve the quality of care for patients with cardiovascular diseases.

In one study, Ramin Ebrahimi, M.D., of the Veterans Affairs Greater Los Angeles Healthcare System, and colleagues found that posttraumatic stress disorder (PTSD) is a common disorder in female veterans as well as an independent predictor of ischemic heart disease (IHD) in this population.

"PTSD was very prevalent in our women veterans. Over 18 percent of the women veterans had PTSD. It is also significantly associated with IHD: 20 percent increased odds ratio of IHD in patients with PTSD as opposed to those without PTSD," Ebrahimi said. "After doing serial adjustments for (1) age; (2) traditional IHD risk factors (diabetes, hypertension, hyperlipidemia, and smoking); (3) obesity and chronic kidney disease; (4) female-specific risk factors such as gestational diabetes, gestational hypertension, and placental disorders; and (5) psychiatric and neuroendocrine disorders as well as alcohol and illicit drug use, the positive association between PTSD and IHD remained elevated and highly significant, with a P value of less than 0.0001. Our results may have clinical implications for earlier and more routine IHD screening in women veterans with PTSD and potentially women in general."

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In the VOYAGER PAD study, William R. Hiatt, M.D., of the University of Colorado School of Medicine in Denver, and colleagues found that among patients with symptomatic peripheral artery disease undergoing lower-extremity revascularization, a combination of rivaroxaban plus aspirin is effective at preventing acute limb ischemia, major amputation of vascular cause, myocardial infarction, ischemic stroke, and cardiovascular death. Adding clopidogrel does not alter the benefit of rivaroxaban-aspirin; however, it does increase bleeding risk during the time of clopidogrel exposure.

"Historically, and in contemporary practice, dual antiplatelet therapy (DAPT) is used but with little supporting evidence. In the overall VOYAGER PAD trial, the combination of 2.5 mg twice daily rivaroxaban plus 100 mg aspirin was superior to aspirin alone in preventing the composite primary outcome of the following: acute limb ischemia, major amputation of vascular cause, myocardial infarction, ischemic stroke, and cardiovascular death," Hiatt said. "There was consistency among the components of the primary end point and in the secondary end points. TIMI (Thrombolysis in Myocardial Infarction) major bleeding was numerically increased but did not reach statistical significance, while a broader bleeding scale of ISTH (International Society on Thrombosis and Haemostasis) major bleeding was increased. Importantly, the worst bleeds -- intracranial hemorrhage and fatal -- were infrequent and well balanced between groups."

During the trial, the site investigators were also allowed to add a short course of clopidogrel for up to six months, which is commonly done in clinical practice even though there is little evidence of its efficacy.

"The benefit of rivaroxaban-aspirin was not improved or worsened by concomitant use of clopidogrel. In contrast, the addition of clopidogrel on top of rivaroxaban and aspirin was associated with increased ISTH major bleeding during the clopidogrel exposure," Hiatt added. "In patients with symptomatic peripheral artery disease undergoing lower extremity revascularization, practitioners should minimize the use of DAPT and consider switching to a combination of rivaroxaban plus aspirin."

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In another study, Priya Mehta, M.D., of Northwestern University in Chicago, and colleagues examined longitudinal associations between adverse pregnancy complications and future cardiovascular risk for more than 900 white and black women in the Coronary Artery Risk Development in Young Adults study, a national study of adults who have been followed for approximately 30 years. The investigators found that approximately one in three women reported a history of one or more adverse pregnancy outcomes.

"Women who had experienced an adverse pregnancy outcome had higher risk factor levels, including higher body mass index and higher blood pressure, and were more likely to be black," Mehta said. "We found that global longitudinal strain (GLS), a sensitive marker of systolic function in the heart, was significantly more abnormal in women who had experienced any adverse pregnancy outcome compared to those who had not. When we examined adverse pregnancy outcomes by subtype, the difference seen in GLS for women with hypertensive disorders of pregnancy and preterm birth was attenuated by modifiable risk factors."

For women with low birth-weight pregnancies, the investigators found that the difference in GLS persisted after adjusting for modifiable risk factors, with a difference of 0.76 percent. This is a clinically meaningful finding, as a difference in GLS of this magnitude has been shown in other studies to be associated with an increased risk in incident heart failure.

"Previous research has demonstrated that adverse pregnancy complications are linked with a variety of cardiovascular diseases, including heart attack, stroke, and heart failure. This is the first study to examine early changes in heart function prior to symptomatic heart failure that are linked with adverse pregnancy outcomes. This offers an opportunity to screen and target high-risk women who have experienced adverse pregnancy outcomes and ultimately reduce the high burden of cardiovascular disease in women," Mehta said. "This study provides stronger, more direct evidence that pregnancy complications impact cardiovascular risk and harm the health of women. Increased risk of hypertension and diabetes following pregnancy complications are likely key factors in the changes to the heart."

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Cecil Rambarat, M.D., of the University of Florida in Gainesville, and colleagues found that female collegiate athletes appear to be at higher risk for the development of hypertension, a key risk factor for cardiovascular disease.

"In our study, the incidence of elevated blood pressure was as high as 44 percent. One suspected factor leading to elevated blood pressure among this cohort is the static versus dynamic component of their sport and the associated training that goes along with this," Rambarat said. "For example, in our study, athletes in low static/moderate dynamic sports had the highest incidence of abnormal blood pressure values, whereas athletes in high static/low dynamic sports [had] no abnormal blood pressure values."

The investigators are currently performing other research, including examining whether there are any changes on cardiac ultrasound in these athletes with elevated blood pressure.

"Perhaps changing the way in which certain athletes are trained would lower the incidence of elevated blood pressure among this cohort," Rambarat said. "In clinical practice, we recommend monitoring female collegiate athletes for the development of elevated blood pressure. This is an often-overlooked group since they are presumed to be young, healthy persons. If elevated blood pressure persists, we would recommend considering changing the method in which certain athletes are trained, and/or initiating medical treatment for hypertension."

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As part of the ISCHEMIA trial, Harmony Reynolds, M.D., of the Sarah Ross Soter Center for Women's Cardiovascular Disease at NYU Langone Health in New York City, and colleagues found that female sex is independently associated with greater burden of chest pain, even after adjusting for the degree of ischemia on stress testing and extent of coronary artery disease (CAD) on computed tomographic coronary angiography.

"Women with obstructive CAD in the ISCHEMIA trial had more frequent angina, less severe ischemia on stress testing and less extensive CAD than men. On multivariate analysis, female sex was independently associated with greater angina frequency," Reynolds said. "We need to be attentive to our patients' symptoms, ensuring that we do what we can to make them feel better. On average, this means we may need to check in even more closely with our women to make sure we are maximizing their quality of life."

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ACC: E-Cigarette Use Continues to Rise

FRIDAY, March 27, 2020 (HealthDay News) -- Nearly one in 20 U.S. adults reports current use of electronic cigarettes, according to a study presented at the virtual meeting of the American College of Cardiology together with the World Congress of Cardiology, held from March 28 to 30.

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ACC: Increase Seen in Death Rates Due to Hypertension-Related CVD

FRIDAY, March 27, 2020 (HealthDay News) -- From 2007 to 2017, there was an increase in mortality rates due to hypertension-related cardiovascular disease, according to a research letter published online March 19 in the Journal of the American College of Cardiology to coincide with the virtual meeting of the American College of Cardiology together with the World Congress of Cardiology, held from March 28 to 30.

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ACC: Statins Cut Heart Failure Risk in Early Breast Cancer Treatment

THURSDAY, March 26, 2020 (HealthDay News) -- For women with early breast cancer receiving anthracyclines or trastuzumab, statin treatment is associated with a reduced risk for heart failure hospital visits, according to a study presented at the virtual meeting of the American College of Cardiology together with the World Congress of Cardiology, held from March 28 to 30.

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ACC: Many Seniors Hospitalized for Heart Failure Not Tested for CAD

WEDNESDAY, March 25, 2020 (HealthDay News) -- A majority of older patients hospitalized for new-onset heart failure do not receive testing for coronary artery disease, according to a study published online March 24 in Circulation: Heart Failure to coincide with the virtual meeting of the American College of Cardiology together with the World Congress of Cardiology, held from March 28 to 30.

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