Host:

• Scott Webb

Guests:

• Dr. Deepak L. Bhatt
  • Director of Mount Sinai Fuster Heart Hospital
  • Dr. Valentin Fuster Professor of Cardiovascular Medicine at Icahn School of Medicine
• Dr. Kevin C. Maki
  • President and Chief Scientist at Midwest Biomedical Research
  • Adjunct Professor at Indiana University School of Public Health
  • Co-Editor-in-Chief, Journal of Clinical Lipidology

Supported by:

• Independent educational grant from Espirian

Episode Overview:
This episode explores the disparities in cardiovascular care, particularly focusing on LDL cholesterol (LDL-C) management in women and racial/ethnic groups. Dr. Bhatt and Dr. Maki discuss key factors contributing to the risk of atherosclerotic cardiovascular disease (ASCVD) and highlight strategies to improve lipid management and reduce disparities in care.

Key Takeaways:

• Disparities in ASCVD Risk and Care:
  • Cardiovascular disease remains the leading cause of death, and recent trends show increasing mortality rates, partly due to inadequate LDL-C management.
  • Women and racial/ethnic minorities, particularly African Americans and Hispanic/Latino Americans, face greater risk and lower rates of statin use and LDL-C control.
• Barriers to Effective LDL-C Management:
  • Patient awareness, statin intolerance, cultural/language barriers, and social determinants of health all contribute to suboptimal lipid control in underserved populations.
  • Many high-risk patients, including those with ASCVD or elevated LDL-C, are not receiving appropriate statin therapy or other lipid-lowering medications.
• Female-Specific Risk Factors:
  • Unique cardiovascular risk factors for women include pregnancy-related conditions like preeclampsia and gestational diabetes. These factors should be considered in risk assessments, even post-childbearing years.
  • Women are often undertreated for hypercholesterolemia due to concerns about statin use during childbearing years.
• Recommendations to Improve Outcomes:
  • Greater awareness, improved guideline adherence, and the inclusion of LDL-C measurement as a healthcare system performance metric are critical to closing treatment gaps.
  • Using a combination of statins and adjunct therapies can improve LDL-C control and reduce cardiovascular risk, especially in underserved populations.

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Host:

• Dr. Bob Underwood

Guest:

• Dr. Deepak Bhatt
  • Director of Mount Sinai Heart
  • Dr. Valentin Fuster Professor of Cardiovascular Medicine at Icahn School of Medicine

Supported by:

• Independent educational grant from Merck, Sharp, and Dohme

Episode Overview:
In this episode, Dr. Bob Underwood and Dr. Deepak Bhatt discuss novel heart failure medications for both heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). They explore the latest advancements in treatment, including the four pillars of heart failure care and emerging medications like SGLT2 inhibitors and ARNI, backed by key clinical trials.

Key Takeaways:

• Four Pillars of Heart Failure Treatment:
  • The core therapies for HFrEF include beta-blockers, ACE inhibitors or ARNI, mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors. Each plays a distinct role in improving heart failure outcomes, reducing hospitalizations, and decreasing mortality.
• SGLT2 Inhibitors:
  • Originally developed for diabetes, SGLT2 inhibitors now show significant heart failure benefits in both HFrEF and HFpEF patients, regardless of diabetes status. Key trials, such as DAPA-HF and EMPEROR, highlight their efficacy.
• ARNI (Sacubitril/Valsartan):
  • Trials like PARADIGM-HF and PIONEER-HF established ARNI as a key therapy in reducing cardiovascular deaths and hospitalizations in patients with HFrEF, with potential benefit in those with lower ejection fractions within HFpEF.
• GLP-1 Receptor Agonists:
  • Medications like semaglutide, primarily used for diabetes and obesity, are now being investigated for their benefits in heart failure, particularly HFpEF, through trials like STEP-HFpEF, which show improvements in patient symptoms and quality of life.
• 2022 Guidelines for Heart Failure:
  • The updated AHA/ACC/HFSA guidelines emphasize the four pillars of heart failure care for HFrEF and recommend expanding SGLT2 inhibitor use for HFpEF. They highlight the importance of integrating new treatments to optimize patient outcomes.

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Host:

• Robert Underwood, MD

Guest:

• Erin D. Michos, MD, MHS
  • Director of Women’s Cardiovascular Health Research
  • Associate Director of Preventive Cardiology at Johns Hopkins University
  • Co-Director of the IMPACT Center at Johns Hopkins University
  • Co-Editor-in-Chief of the American Journal of Preventive Cardiology

Supported by:

• Independent educational grant from Merck, Sharp, and Dohme

Episode Overview:
In the final episode of this four-part series, Dr. Robert Underwood and Dr. Erin Michos explore health disparities in the diagnosis and treatment of heart failure, particularly in minority racial/ethnic groups and female patients. They discuss the influence of social determinants of health and highlight evidence-based strategies to reduce these disparities and improve outcomes for all patients.

Key Takeaways:

• Health Disparities in Heart Failure:
  • Black and Hispanic populations are at greater risk for heart failure due to higher rates of comorbidities like obesity, hypertension, and diabetes, as well as social determinants of health.
  • Black adults are 200% more likely to be hospitalized for heart failure than white adults, with higher heart failure mortality rates among Black men and women.
• Gender Differences in Heart Failure:
  • Women are more likely to develop heart failure with preserved ejection fraction (HFpEF) and may experience more pronounced symptoms, but they are less likely to undergo diagnostic testing or receive advanced treatments like heart transplants or mechanical circulatory devices.
• Reducing Disparities:
  • Early recognition of heart failure symptoms and the use of diagnostic tools like echocardiograms and BNP levels can help improve diagnosis in minority and female patients.
  • Community-based approaches, such as involving barbershops and faith-based organizations in underserved areas, are innovative strategies to improve cardiovascular health and reduce disparities.
• Case Study:
  • The discussion concludes with a case study involving a 60-year-old Hispanic woman with HFpEF and hypertension. Treatment considerations include the use of diuretics, SGLT2 inhibitors, ARNIs, and lifestyle modifications to address her heart failure and comorbidities.

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