November 5th, 2012

Reclassifying AHA on the West Coast

Several Cardiology Fellows who are attending AHA.12 in LA this week are blogging together for CardioExchange. The Fellows include Tariq AhmadReva Balakrishnan, Megan Coylewright, Eiman Jahangir, Amit Shah, and John Ryan (moderator). Read the previous post here. Find the next one here. For related CardioExchange content, go to our AHA 2012 Headquarters page.

After 3 years of East Coast AHAs, I was a little surprised to learn that the 2012 Scientific Sessions was being held in Los Angeles. Admittedly, it was a little tough this year, with things being busier at home than ever before. Nonetheless, I was curious and excited to see how things would be different. 

After taking the airport shuttle to my hotel, I caught the convention shuttle just in the nick of time. The ride was appreciated! I was staying 10 miles away in Universal Studios. Public transportation would have taken 3 times as long, and repeated cabs would have broken the bank. On the way there, we witnessed an overturned car in the opposing direction. “I was just on that road 20 minutes ago!” my driver commented. Thankfully it was smooth sailing for us…. Who knows what tomorrow will yield, though, when we wade through rush hour….

I hit the ground running at the convention. Noticeably, it seemed quieter than previous years. Perhaps it was just that time of day, but I did not feel swarmed by masses of curious poster-carrying scientists as in previous years. One thing did not change, however; the Starbucks line was packed!

Eventually, I made my way to the epidemiology evening session on risk prediction. It was the perfect prelude for my presentation tomorrow, which is on the same topic. In a series of excellent talks, several relevant and interesting points were made that stuck in my mind:

  1. Statin use for primary prevention should be considered in light of the number needed to treat against the number needed to harm (myopathy, diabetes). For lower risk patients, the NNT is high and can approach the NNH, depending on the dose of the statin. Simvastatin 80 mg in South Asians may be a bad idea in terms of myopathy!
  2. Multiple risk factor equations exist, but the complicating matter is that they use a variety of endpoints; some include stroke, whereas others do not. The Framingham risk score itself sets a high bar. Only coronary artery calcium scoring consistently shows a significant benefit over other risk predictors such as carotid IMT.
  3. Calcium scoring may be motivational for lifestyle change to patients with positive calcium scores, but the jury is still out, since it motivates doctors as much as it does their patients. Whom does the credit go to?
  4. Lifestyle change is always challenging; just because a patient is motivated to eat healthy after a heart attack does not mean that she or he will stick with the new habit for long. This maintenance and execution is what makes lifestyle change so difficult. Advanced techniques/strategies may be required. Can we accomplish these in a 15-minute office visit? Another option: we can just increase the Lasix dose as our patients eat more salt!?

 Looking forward to an action-packed day tomorrow….

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