For CME Information and Credit: www.iridiumce.com/lipidsinwomen

Host:

• Dr. Scott Webb

Guests:

• Dr. Keith C. Ferdinand
  • Gerald S. Berenson Endowed Chair in Preventative Cardiology
  • Professor of Medicine, Tulane University School of Medicine
• Dr. Erin Mikos
  • Director of Women's Cardiovascular Health Research
  • Associate Director of Preventative Cardiology, Johns Hopkins University School of Medicine
  • Co-Editor-in-Chief of The American Journal of Preventative Cardiology

Supported by:

• Independent educational grant from Aspirion

Episode Overview:
This episode focuses on disparities in the management of LDL-C and cardiovascular risk among women and individuals from various racial and ethnic groups. Dr. Ferdinand and Dr. Mikos highlight the importance of LDL-C lowering therapies and strategies clinicians can use to improve treatment outcomes for patients at risk for ASCVD (atherosclerotic cardiovascular disease).

Key Takeaways:

• LDL-C Lowering Treatments and Guidelines:
  • LDL-C is a primary target for preventing ASCVD, with guidelines recommending lower thresholds for high-risk patients.
  • Non-statin therapies such as bempedoic acid, PCSK9 inhibitors, and ezetimibe provide valuable alternatives for patients with statin intolerance.
• Importance of Early and Intensive Treatment:
  • Evidence shows that early LDL-C lowering significantly reduces cardiovascular risk, particularly in high-risk patients, including those with diabetes and ASCVD.
  • Combination therapy should be considered earlier in management to achieve target lipid levels, as is done with hypertension and diabetes treatments.
• Disparities in Care:
  • There are lower rates of optimal hypercholesterolemia management in women and racial/ethnic groups, partly due to healthcare access, physician awareness, and patient adherence.
  • Clinicians should be mindful of sex-specific risk enhancers, such as pregnancy-related conditions, and should address social determinants of health when assessing risk in diverse populations.
• Shared Decision Making and Patient Communication:
  • A shared decision-making approach that includes culturally competent, clear communication and educational materials helps engage patients in their care.
  • Tools such as risk calculators (e.g., the AHA’s PREVENT model) and visual aids can help explain cardiovascular risk and the importance of lowering LDL-C to patients.

Case Discussion:
The episode also features a case study of a 56-year-old Hispanic female with multiple cardiovascular risk factors, including dyslipidemia and diabetes. Dr. Mikos and Dr. Ferdinand discuss the importance of intensifying her lipid-lowering therapy and managing her blood pressure to meet guideline-based targets.

Follow Us:
Stay updated on future episodes and educational threads by following Iridium on X (formerly Twitter), Facebook, and LinkedIn.

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.

Follow Us:
Stay updated on future episodes and educational threads by following Iridium on X (formerly Twitter), Facebook, and LinkedIn.

For CME Information and to Claim Your Credit: www.iridiumce.com/hf

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.

Follow Us:
Stay updated on upcoming MedEd threads and CME programs by following Iridium on X, Facebook, and LinkedIn.

For CME Information and to Claim your Credits: https://www.iridiumce.com/hf

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.

Follow Us:
Stay updated on free CME programs by following Iridium on X (formerly Twitter), Facebook, and LinkedIn.

For CME Information and Claim Your Credit Before January 31, 2025: https://www.iridiumce.com/hf-podone

Host:

• Robert Underwood, MD
  • Emergency Physician

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 this episode, Dr. Robert Underwood and Dr. Erin Michos explore innovative strategies and cutting-edge therapies for managing worsening heart failure, focusing on novel treatment approaches, emerging medical devices, and advancements in the use of monitoring technology.

Key Takeaways:

• Edema in Worsening Heart Failure:
  • Edema is a key sign of worsening heart failure, driven by the overstimulation of the renin-angiotensin-aldosterone system (RAS) and sympathetic nervous system, leading to sodium and water retention.
  • As heart failure progresses, natriuretic peptides become less effective, causing more fluid retention and adverse remodeling of the heart, vasculature, and kidneys.
• Role of Diuretics:
  • Diuretics are the cornerstone for managing edema in heart failure. Though not class 1 indicated for heart failure itself, they are essential for decongestion and preventing hospitalization.
  • Commonly used loop diuretics include furosemide and torsemide, but electrolyte imbalances like hypokalemia must be monitored.
• Soluble Guanylate Cyclase (sGC) in Heart Failure Treatment:
  • sGC stimulators like vericiguat help regulate vascular tone, cardiac remodeling, and contractility by enhancing the production of cyclic GMP, which promotes vasodilation and reduces fibrosis.
  • Vericiguat, a first-in-class sGC stimulator, was approved after the VICTORIA trial and is used for patients with chronic heart failure and an ejection fraction <45%.
• The VICTORIA Trial:
  • The VICTORIA trial demonstrated that vericiguat significantly reduced hospitalizations and cardiovascular events in patients with worsening heart failure, with a favorable safety profile and similar adverse events between treatment groups.
• Monitoring Devices for Heart Failure:
  • Implantable Devices: These devices monitor pulmonary artery pressure and provide early detection of worsening symptoms. Though promising, further studies are needed, and current guidelines provide a class 2B recommendation for select patients.
  • Wearable Devices: Wearables like those that measure thoracic fluid index are gaining traction as non-invasive tools to detect heart failure deterioration early. Initial studies suggest a reduction in hospitalizations, but more research is needed.
• Future of Monitoring and AI Integration:
  • As wearable technology and smart devices evolve, there is growing potential for AI to process the massive amounts of data generated, turning it into actionable insights to help manage heart failure and improve patient outcomes.

Next Episode Teaser:
In the next episode, the panel will explore more advanced heart failure treatments and discuss the future role of AI in heart failure management.

Follow Us:
Stay updated on upcoming episodes and MedEd threads by following Iridium on X (formerly Twitter), Facebook, and LinkedIn.

For CME Information and Claim Your Credit Before January 31, 2025: https://www.iridiumce.com/hf-podone

Host:

• Bob Underwood, MD
  • Emergency Physician

Guests:

• Deepak Bhatt, MD, MPH
  • Director of Mount Sinai Heart
  • Inaugural Dr. Valentin Fuster Professor of Cardiovascular Medicine
• Erin 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 this episode, the panel discusses the diagnosis, prognosis, and progression of worsening heart failure, along with new diagnostic techniques and treatment strategies. They highlight the disparities in heart failure outcomes and the importance of early detection and treatment.

Key Takeaways:

• Epidemiology of Heart Failure:
  • Around 6.7 million Americans have heart failure, and this number is increasing.
  • Heart failure is often referred to as an epidemic due to its prevalence and poor prognosis.
• Disease Progression:
  • Heart failure progresses through four stages (A-D). Worsening heart failure occurs when patients experience increasing symptoms despite optimal treatment.
  • Half of the cases involve preserved ejection fraction (HFpEF), and the other half involve reduced ejection fraction (HFrEF).
• Prognosis of Worsening Heart Failure:
  • Prognosis is poor, with a five-year mortality rate of 50%. Worsening heart failure can increase mortality rates threefold and hospitalizations sixfold.
• Diagnosis:
  • Worsening heart failure is often diagnosed through acute cardiovascular care needs, such as hospitalization or intravenous diuretics.
  • Biomarkers like BNP or NT-proBNP, echocardiograms, and imaging techniques aid in diagnosis.
• New Diagnostic Techniques:
  • Point-of-care ultrasound (POCUS) and imaging methods like echocardiograms can detect systemic venous congestion and pulmonary edema, providing valuable insights into heart failure progression.
• Role of Ejection Fraction:
  • Ejection fraction (EF) helps categorize heart failure and guides treatment. New categories such as mid-range EF (41-49%) are emerging.
  • Despite some limitations, EF remains an important tool for diagnosis and treatment decisions, though future advancements like AI could provide more precise categorizations.
• Looking Ahead:
  • Upcoming episodes will explore the role of monitoring devices in heart failure management, including invasive and non-invasive technologies.

Next Episode Teaser:
The discussion continues with a focus on monitoring devices and their role in heart failure management, as well as the future integration of AI in diagnostics.

Follow Us:
Stay updated on upcoming episodes and corresponding MedEd threads on X (formerly Twitter), Facebook, and LinkedIn.

For CME Information & Credit Visit: https://www.iridiumce.com/mastering-the-complexity-of-aml-tx-podcast-2

Summary:

This program discusses the complexities of Acute Myeloid Leukemia (AML) treatment, focusing on the role of transplantation, factors influencing transplant success, and the importance of shared decision-making between patients and healthcare providers. The conversation includes a case study on a patient with a FLIT3 ITD mutation, exploring treatment options and the necessity of balancing efficacy, safety, and quality of life in treatment decisions.

Takeaways:

• Transplant is the main consolidative option for younger patients.
• Factors influencing transplant success include donor and recipient characteristics.
• Shared decision-making enhances patient engagement and satisfaction.
• Patients often have concerns about treatment side effects.
• FLIT3 ITD mutation significantly impacts treatment strategy.
• Transplant remains a curative option for most AML cases.
• Managing treatment-related toxicities is crucial for patient care.
• Patient education helps alleviate treatment-related anxieties.
• Quality of life is a critical consideration in treatment planning.
• Emerging therapies are changing the landscape of AML treatment.

Sound Bites

• "Transplant has become the main consolidative option."
• "Factors that impact transplant success are numerous."
• "Shared decision-making is crucial in AML management."

For CME Information & Credit Visit: https://www.iridiumce.com/leveling-up-pbc-podcast-2

Summary:
This conversation delves into the management of Primary Biliary Cholangitis (PBC), focusing on the role of biomarkers in treatment, the impact of pruritus on patients' quality of life, and the latest strategies for managing this condition. The discussion highlights the importance of effective monitoring and treatment options, as well as the need for new therapies to address the challenges faced by patients with PBC.

Takeaways:

• Biomarkers are crucial for monitoring PBC progression.
• Alkaline phosphatase and bilirubin are key indicators.
• UDCA is the first-line treatment for PBC.
• Pruritus affects up to 75% of PBC patients.
• Antihistamines are ineffective for PBC-related pruritus.
• Colestyramine is the first-line therapy for pruritus.
• New therapies for pruritus are in development.
• Patient quality of life is significantly impacted by pruritus.
• Real-world evidence shows under-treatment of pruritus.
• Effective management strategies are essential for patient adherence.

Sound Bites:

• "Biomarkers play a key role in the management of PBC."
• "Pruritus significantly impacts the lives of patients with PBC."
• "Antihistamines are not effective for PBC-related pruritus."