Future Pulse Cardiology

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Dr Thomas Nero discusses inflammation and the role of rheumatologic disorders on coronary artery disease with Dr Nehal Mehta, exploring how chronic inflammation serves as a cornerstone for various health issues, particularly in patients with conditions like psoriasis and serves as a model for investigating cardiovascular therapies. The discussion highlights the role of immune responses, the impact of lifestyle factors, and the importance of early diagnosis and risk assessment in managing cardiovascular health.
Early Research

• Dr Mehta's research began by observing obese patients with heart attacks despite few cardiovascular risk factors.
• He found adipose inflammation was driving obesity and insulin resistance.
• Psoriasis became a model for studying chronic inflammation's effects on cardiovascular health.

Inflammation and Cardiovascular Disease

• Atherosclerosis requires both injury and lipids.
• Endothelial damage initiates inflammation in atherosclerosis.
• Neutrophils and myeloid cells play a critical role in the inflammatory process.
• Different inflammatory diseases have distinct cytokine profiles (e.g., psoriasis vs. lupus).

Adipose Tissue and Inflammation

• Visceral fat is metabolically active and a key site of inflammation.
• Psoriatic flares increase visceral fat volume and adipose tissue macrophages.
• Obese psoriasis patients have higher risks of cardiovascular events.

Coronary Artery Disease in Inflammatory Conditions

• Coronary inflammation can be detected by perivascular fat attenuation index (pFAI).
• Untreated psoriasis patients show progression from inflammation to plaque formation.
• Coronary artery calcium (CAC) scoring may underestimate disease in younger patients.

Diagnostic Approaches

• Dr. Mehta recommends assessing blood pressure, body mass index, lipids, and glucose.
• Neutrophil-lymphocyte ratio (NLR) and GlycA are useful inflammatory markers.
• Imaging like carotid intima-media thickness and pFAI can help identify early vascular disease.

Treatment Strategies

• Early statin initiation is recommended for psoriasis patients.
• Ongoing trials are exploring various anti-inflammatory agents (e.g., colchicine, IL-6 inhibitors).
• Future therapies may include oral IL-23 inhibitors and weight loss medications.

Future Research Directions

• Retinal arteries as a model for studying vascular disease and lipid deposition.
• Exploring lipid accumulation in various tissues, including the central nervous system.
• Developing therapies to address lipid-driven processes in diseases of aging.

The discussion emphasizes the complex interplay between inflammation, lipid metabolism, and cardiovascular disease, highlighting the need for personalized approaches and continued research in this field.

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Dr. Thomas Nero discusses current therapy with Factor X inhibitors, the new research with Factor XI inhibition and specifically the enrolling Milvexian clinical trials with Dr. C Micahel Gibson. In addition they discuss, the addition of these medications along wiht anti-platelet therapy, Lp(a) and other interesting current and future research in cardiovascular disease.

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Dr. Thomas Nero speaks with Dr Peter Toth about the dramatic change occuring in diabtetes management and its effect on cardiovascular disease. Starting with the biochemestry of diabetes and its effects at the cellular level, the discussion goes on to speak about the role SGLT2 inhibitors and GLP1 receptor agonists play in DM management as well as the future of diabetes care. (If you want to skip the excelllent, but quite deep dive into biochemistry, jump to 11:22 - but honestly Dr. Toth's description is breathtaking)

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Dr Paul Ridker discusses his paper on residual inflammatory risk that was recently published in the Lancet with Dr. Thomas Nero. He discusses the pathology of inflammation as part of atherosclerosis, utilization of hs-CRP in clinical trials and in daily practice as well as current therapeutic options and ongoing investigations.

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Dr Christopher Cannon discusses the potential of Pragmatic Clinical Trials in our research armamentarium with Dr. Thomas Nero. They review the EVOLVE-MI trial for Early use of Evolocumab after Myocardial Infarction in detail and highlight the potential for future research.