MARCH 2019 
ACC & AHA will release comprehensive guidelines for primary CVD prevention at ACC conference

During the ACC’s 2019 Annual Scientific Session on March 17, 2019, the American College of Cardiology and American Heart Association will “release a revised clinical practice guideline for primary cardiovascular disease prevention,” according to an editorial collaboration published in Medscape. The upcoming guidelines are particularly timely in light of a recent survey conducted between Medscape and ACC, which sought to assess how full-time practicing clinicians were diagnosing and treating patients with—or at risk for—cardiovascular disease. Survey responses focused on the need for increased patient education material, weight management resources, and assessment tools, and ultimately reinforced the recurring issue of diet and lifestyle modifications.

Ticagrelor reduces CV event risk in diabetes patients with coronary disease

A clinical trial comparing the cardiovascular effects of ticagrelor versus placebo in patients with type 2 diabetes mellitus has confirmed that the antiplatelet yields significant benefits. As reported in Medscape, results from the 42-country Effect of Ticagrelor on Health Outcomes in Diabetes Mellitus Patients Intervention Study (THEMIS) demonstrated a statistically significant reduction in patients with coronary artery disease and type 2 diabetes. Deepak L. Bhatt, MD, MPH—Cardiology Today’s Intervention Chief Medical Editor, professor of medicine at Harvard Medical School, executive director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital, co-chair of the THEMIS trial, and member of the CMHC Senior Planning Committee—stated: “The THEMIS trial is the largest randomized trial of patients with type 2 diabetes performed to date…the results could help us refine our understanding of the role of dual antiplatelet therapy in patients across the atherothrombotic spectrum.”

Second price decrease for PCSK9 inhibitor alirocumab

Alirocumab, a biopharmaceutical drug designed to lower high cholesterol for adults whose cholesterol is not controlled by diet and statin treatment, will receive a second price cut, according to a statement from Sanofi and partner Regeneron pharmaceuticals. This resolution follows an initial March 2018 decision to reduce the drug price: as Medscape reports, there have been increasing calls for “greater access to PCSK9 inhibitors” (such as alirocumab) for high-risk patients with elevated cholesterol. The ODYSSEY Outcomes trial last year had previously reported a 15% reduction in cardiovascular events with the use of alirocumab; in 2017, the FOURIER trial likewise reported a 15% reduction in CV-event risk with evolocumab—another PCSK9 inhibitor.

Newly Emerging Intersections of Psoriasis & Cardiovascular Disease

While previous research suggests that psoriasis may elevate atherosclerotic cardiovascular disease (ASCVD), a new analysis indicates that the effect seems even more pronounced in young adult African Americans. In a research letter published February 20 in JAMA Dermatology, the writers state: the extra ASCVD risk that is associated with psoriasis “occurs at an earlier age in African American patients than in white patients,” and is to some extent independent of conventional risk factors. In line with the newly emerging findings are two new joint American Academy of Dermatology-National Psoriasis Foundation guidelines that address the management and treatment of psoriasis in adults, and focus on biologics and comorbidities. As reported in Medscape, it is recommended that patients with psoriasis undergo cardiovascular risk assessments: including screening for hypertension, diabetes, and hyperlipidemia—in accordance with national guidelines.
A 50 year old woman, who is a busy mom working and goes to school part time, is referred for treatment of high cholesterol. While her weight has never been a problem, it is currently higher than her “goal weight,” and can vary by approximately 5 pounds. The patient tries to eat in a nutritious and healthy way, yet remains unsure what diet changes to make. She likes desserts and has switched to portioned ice cream bars, but eats 2 per day. The patient also does not enjoy exercise, but will occasionally walk on a treadmill. Her exam reveals…
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