Inflammation and Cardio-Rheumatology with Dr Nehal Mehta
12/26/24 • 52 min
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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.
We would love to hear your thoughts on the episodes!
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.
Previous Episode
Inflammation and Cardiovascular Disease with Dr Nehal Mehta
We would love to hear your thoughts on the episodes!
In this conversation, Dr. Nehal Mehta and Dr. Thomas Nero discuss the critical relationship between systemic inflammation and cardiovascular health, particularly in patients with psoriasis. He emphasizes the importance of understanding how an overactive immune system can lead to increased risks of heart disease and other health issues. The discussion also covers lifestyle changes that can help manage inflammation, including diet, exercise, and mental health support.
takeaways
- Systemic inflammation can lead to cardiovascular disease.
- Psoriasis is linked to increased heart attack risk.
- Visceral fat contributes to inflammation and diabetes.
- Weight loss can improve response to treatment.
- Lifestyle changes are crucial for managing inflammation.
- Family support plays a role in health management.
- Mental health is important in managing chronic conditions.
- Dietary changes can significantly impact inflammation levels.
- Regular exercise is beneficial for heart health.
- Education and awareness are key for patients.
keywords
systemic inflammation, cardiovascular disease, psoriasis, immune system, lifestyle changes, diabetes, obesity, heart health, inflammation management, patient education
Future Pulse Cardiology - Inflammation and Cardio-Rheumatology with Dr Nehal Mehta
Transcript
Dr Nero: [00:00:00] So welcome Nehal. I've really been looking forward to our conversation today. Clearly, , inflammation and cardiovascular disease is a very, very, , I hate to use this pun, but a very hot topic. So, um, I am really looking forward , to walking through this all of you today.
Dr Mehta: Thanks.
Dr Nero: So You describe yourself as a cardiorheumatologist.
Uh, I think that really, cardio immunologist may be a be
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