CardioExchange Archive

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

It’s a few hours before my flight; people are busy with their noses buried in their smartphones, reading and talking about the election. While my mind is on that topic as well, I figured I would take a moment to consolidate my impressions about AHA this year. Overall, it was a relatively tamer conference than in previous years, perhaps due to a combination of the location and Hurricane Sandy. The exhibition hall seemed smaller and less crowded as well. Some good science was presented, as usual, and I enjoyed good conversation with friends and collaborators.

I wanted to highlight some of my thoughts about the late-breaking trials, as well as some of the other studies…

Late-Breaking Trials

FREEDOM. I was not very surprised about the main outcome, with CABG showing superiority over PCI in diabetics with 3-vessel disease. Nonetheless, it was interesting how a 29% reduction in total deaths from CABG equated to 1.27 total life-years gained. It would give patients some perspective. We can counsel them, “Studies show that if we do open heart surgery, you will live an average of 1.27 years longer.” The cost-effectiveness aspect of the study was also fascinating — $8,123 per QALY is cheap compared to other interventions!

Physicians’ Health Study II. Personally, I was always on the fence about multivitamins, but it seems like these findings support that notion. While the findings were mostly negative, I appreciate the silver linings: a 39% relative risk reduction in MI death (p=0.048) and 8% (p=0.04) reduction in total cancer. It is an impressive study on a population I can identify with, but I sometimes wonder about the problem of multiple comparisons when performing secondary analysis on several different outcomes.

OPERA. Fish oil does not prevent post-CABG Afib — an interesting negative study that seemed initially to have held a lot of promise for a highly prevalent issue. Nonetheless, another silver lining was found; the odds ratio for arterial thromboembolism was 0.37, p=0.047, in favor of PUFA. Is this enough evidence to give high-dose PUFAs to reduce arterial thromboembolism risk? Or should we wait for a dedicated trial on arterial thromboembolism? Is it possible that, over a longer follow-up, we would see any other omega-3 benefits unfold?

Take-Home Tweets about Other Studies 

1. Walnuts lower non-HDL cholesterol by about 10 mg/dL.
2. Dark chocolate, albeit relatively devoid of nutrients once processed, has promise as a potent antioxidant and may even help reduce blood pressure. Beware, lovers of white chocolate!
3. With regards to CAC scoring, counting the number of calcified vessels gives additional predictive capacity — although the question of whether CAC in the left main is more dangerous than CAC in other vessels is still up for debate.
4. Antioxidant fruits such as pomegranates and grapes work by neutralizing free radicals in the gut, as opposed to disseminating in the bloodstream and destroying radicals elsewhere in the body. Maybe the next time you have a steak, have some wine, grapes, or pomegranate juice with it.
5. While CAC is superior to carotid IMT in predicting MI, carotid IMT is superior regarding stroke prediction.

Overall, a good few days, despite the 1-hour commute time. Until next year!