Brief Summary
This podcast episode covers several key topics in cardiology, including the FDA's approval of a triple-drug polypill for hypertension, a review of invasive therapies for pulmonary embolism (PE), trends in heart disease mortality, and advancements in diabetes care. The host shares his evolving perspective on polypills, discusses the complexities and evidence gaps in interventional PE treatments, highlights the significant decline in ischemic heart disease deaths, and touches on promising developments in diabetes management.
- FDA approved triple drug polypill for hypertension
- Deep dive into invasive PE therapies
- Heart disease trends
- Diabetes care advancements
FDA Approves Triple Drug Polypill for Hypertension
The FDA has approved a three-component polypill for hypertension, named "Wida Pill Plick," containing telmisartan (ARB), amlodipine (calcium channel blocker), and indapamide (diuretic). There will be a standard dose pill and two lower-dose options available. The host expresses a change of heart regarding polypills, now appreciating their simplicity and potential to improve medication adherence, aligning with the concept of minimally disruptive care. Clinical evidence supports the polypill's efficacy, with studies showing it lowers systolic blood pressure more effectively than two-drug combinations. While caution is advised for frail, elderly patients, the polypill offers a promising approach to early blood pressure control and adherence in appropriate populations.
A Deep Dive Into Invasive PE Therapies
The host discusses the increasing use of interventional therapies for pulmonary embolism (PE), highlighting a review article in the European Heart Journal Open that examines the endovascular treatment of intermediate-risk PE. PE is not a monolith; it ranges from mild to severe, with most patients presenting with intermediate levels of risk. Endovascular procedures have become more common, paralleling the rise of PERT teams, but there is limited evidence supporting their use in intermediate-risk patients. The rationale for these therapies stems from the PEITHO trial, which showed a small benefit of systemic thrombolytics but with significant bleeding risks. The host emphasizes the need for more rigorous evidence to support the use of these devices, questioning the validity of surrogate endpoints like RV size and highlighting the potential for financial incentives to drive their adoption.
Heart Disease Trends
A study in the Journal of the American Heart Association reveals trends in heart disease mortality over the past 50 years (1970-2022). Overall, heart disease deaths have decreased from 41% to 24% of all deaths, and life expectancy has increased. Ischemic heart disease deaths have significantly declined, particularly deaths from acute myocardial infarction (AMI), which decreased by 89%. Conversely, mortality from other heart disease subtypes, such as heart failure, hypertensive heart disease, and arrhythmias, has increased. The host credits the reduction in smoking and advancements in AMI care as major factors in the decline of ischemic heart disease deaths. While acknowledging the rise in obesity and related conditions, he cautions against alarmist language, emphasizing that increased life expectancy leads to deaths from other diseases.
Diabetes Care Is On Fire
The host briefly discusses advancements in diabetes care presented at the recent ADA meeting in Chicago. Notable developments include early data on once-weekly insulin, new GLP-1 drugs and combinations, and encouraging data on recombinant gene therapy for type 1 diabetes. He predicts that cardiologists will soon be prescribing GLP-1 drugs, similar to the adoption of SGLT2 inhibitors. Additionally, he mentions an upcoming report on potential issues within the tyargular evidence base, based on a BMJ investigation.
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