100. Women’s Heart Health & Women in Cardiology with Dr. Nanette Wenger – Special Go Red Encore

CardioNerds (Amit Goyal & Carine Hamo) discuss the past, present, and future of Women’s Heart Health & Women in Cardiology with Dr. Nanette Wenger, Professor of Medicine in the Division of Cardiology at the Emory University School of Medicine. Dr. Wenger is a true leader in the field of women’s heart health and a strong proponent for women in cardiology and medicine. Her passion, dedication, and advocacy have inspired countless trainees to carry this torch and continue to build on her truly impactful work. Special introduction by Dr. Martha Gulati. This is a special encore in recognition of the Go Red campaign and celebration of women’s health.

Collect free CME/MOC credit for enjoying this episode! 

Dr. Nanette Wenger Women's Cardiovascular Health: Past, Present, & Future
Episode graphic by Dr. Carine Hamo

The Cardionerds CV prevention series  includes in-depth deep dives on so many prevention topics including the ABCs of prevention, approach to obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

This episode initially ran as part of the CardioNerds Prevention Series which we produced in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention!

Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

References and Links

1. Wenger NK (2005) Women in cardiology: The US experience. Heart.

2. Douglas PS, Rzeszut AK, Noel Bairey Merz C, Duvernoy CS, Lewis SJ, Walsh MN, Gillam L (2018) Career preferences and perceptions of cardiology among us internal medicine trainees factors influencing cardiology career choice. JAMA Cardiol.

3. Wenger NK, Speroff L, Packard B (1993) Cardiovascular Health and Disease in Women. N Engl J Med.

4. Burgess S, Shaw E, Zaman S (2019) Women in Cardiology. Circulation.

Meet Dr. Wenger!

Dr. Nanette Wenger is Professor of Medicine in the Division of Cardiology at the Emory University School of Medicine. Dr. Wenger received her medical degree from Harvard Medical School in 1954 as one of their first female graduates followed by training at Mount Sinai Hospital where she was the first female to be chief resident in the cardiology department. She is among the first physicians to focus on heart disease in women with an expertise in cardiac rehabilitation and geriatric medicine.

Dr. Wenger has received numerous awards including the Distinguished Achievement Award from the Scientific Councils of the American Heart Association and its Women in Cardiology Mentoring Award, the James D. Bruce Memorial Award of the American College of Physicians for distinguished contributions in preventive medicine, the Gold Heart Award, the highest award of the American Heart Association, a Lifetime Achievement Award in 2009 and the Inaugural Bernadine Healy Leadership in Women’s CV Disease Distinguished Award, American College of Cardiology. She chaired the U.S. National Heart, Lung, and Blood Institute Conference on Cardiovascular Health and Disease in Women, is a Past President of the Society of Geriatric Cardiology and is past Chair, Board of Directors of the Society for Women’s Health Research. Dr. Wenger serves on the editorial boards of numerous professional journals and is a sought-after lecturer for issues related to heart disease in women, heart disease in the elderly, cardiac rehabilitation, coronary prevention, and contemporary cardiac care. She is listed in Best Doctors in America.

98. Personalized Risk Assessment for Cardiovascular Prevention with Dr. Amit Khera

CardioNerds (Carine Hamo, Amit Goyal and Daniel Ambinder) discuss personalized risk assessment for cardiovascular prevention with Dr. Amit Khera, the immediate past president for the American Society for Preventive Cardiology and Director of the Preventive Cardiology and Professor of Medicine at the University of Texas, Southwestern Medical School in Dallas, Texas. They dive into an illuminating discussion about traditional and next generation personalization of risk assessment which covers the need for personalization, traditional risk stratification, applying risk enhancing factors for decision making, biomarkers, familial hypercholesterolemia, and the use of -Omics. This episode is the 13th and final part of our in-depth prevention series produced in collaboration with the American Society for Preventive Cardiology!

Stay tuned for a bonus segment at the end of the episodeas we talk to Dr. Ankur Kalra, interventionist at the Cleveland Clinic, Podcast host of Parallax by Ankur Kalra, and founder of the non-profit startup, makeadent.org for a discussion about the CHAI (Cardiovascular Health in Asian Indians) Collaborative, an initiative that aims to identify genetic markers of heightened atherosclerosis in South Asians.


Show notes

Coming soon!


Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

The Cardionerds CV prevention series  includes in-depth deep dives on so many prevention topics including the ABCs of prevention, approach to obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.


Guest Profiles

Amit Khera, MD, MSc, FACC, FAHA, FASPC

Dr. Amit Khera is Professor of Medicine at the University of Texas, Southwestern Medical School in Dallas, Texas where he serves as Director of the Preventive Cardiology, and holder of the Dallas Heart Ball Chair in Hypertension and Heart Disease.  He is also currently President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association. His clinical and research interests include the primary and secondary prevention of coronary artery disease, focusing on risk assessment and risk factor modification in those with premature and familial disease.

Dr. Khera received his undergraduate degree in American History from the University of Pennsylvania, with magna cum laude honors. He obtained his medical degree from Baylor College of Medicine where he served as class president and was inducted into the Alpha Omega Alpha honor medical society. He completed an Internal Medicine Residency at Brigham and Women’s Hospital, Harvard Medical School, followed by a Cardiology Fellowship at the University of Texas, Southwestern Medical Center. He also completed his Masters degree in Epidemiology at the Harvard School of Public Health.

He has published over 150 publications in the field of preventive cardiology and has served on numerous local and national committee and leadership roles for the American Heart Association, American College of Cardiology, and American Society for Preventive Cardiology.  He is currently Digital Strategies Editor and an Associate Editor for the journal Circulation.  Dr. Khera has been named Best Doctor in Dallas and Texas SuperDoctor every year since 2014 and was previously the Program Director for the Cardiology Fellowship at UT Southwestern from 2011-2019. 


References and Links

Coming soon!

97. Hypertension part 2 with Dr. Luke Laffin

CardioNerds (Amit Goyal and Daniel Ambinder) are joined by Cleveland Clinic cardiology fellow Dr. Gregory Ogunnowo to discuss hypertension with Dr. Luke Laffin, cardiology faculty in the division of Preventive Cardiology and Rehabilitation and Medical Director of Cardiac Rehabilitation at the Cleveland Clinic. Part 2 of this discussion covers the evaluation for secondary causes of HTN, approach to resistant HTN, interventional anti-hypertensive procedures, and a note on cardiac rehabilitation. Part 1 covered the definition of hypertension, correct measurement of blood pressure, nonpharmacologic HTN management, initial choice of BP agents, and hypertensive disorders of pregnancy.


Show notes

Coming soon!


Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

The Cardionerds CV prevention series  includes in-depth deep dives on so many prevention topics including the ABCs of prevention, approach to obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.


Guest Profiles

Dr. Luke Laffin, serves as cardiology faculty in the division of Preventive Cardiology and Medical Director of Cardiac Rehabilitation at the Cleveland Clinic. Dr. Laffin attended medical school at Vanderbilt University School of Medicine. He trained in internal medicine and cardiology at the University of Chicago where he completed a dedicated fellowship in hypertensive diseases. He is a clinical specialist in hypertension designated by the American Society of Hypertension – which has now merged with the AHA.

Dr. Gregory Ogunnowo is a cardiology fellow at the Cleveland Clinic. He completed medical school at the University of South Carolina School of Medicine in Columbia, South Carolina. He went on to complete internal medicine residency at Washington University School of Medicine in St. Louis where he stayed on as faculty in the Department of Hospital Medicine for a year prior to pursing fellowship. His interests include outcomes research in interventional cardiology and medical education In his spare time, Greg enjoys traveling, exercising, and experiencing new cultures through their food. When he’s not in the hospital, you can find Greg planning a trip with close friends and family.


References and Links

Coming soon!

96. Hypertension part 1 with Dr. Luke Laffin

CardioNerds (Amit Goyal and Daniel Ambinder) are joined by Cleveland Clinic cardiology fellow Dr. Gregory Ogunnowo to discuss hypertension with Dr. Luke Laffin, cardiology faculty in the division of Preventive Cardiology and Rehabilitation and Medical Director of Cardiac Rehabilitation at the Cleveland Clinic. Part 1 of this discussion covers the definition of hypertension, correct measurement of blood pressure, nonpharmacologic HTN management, initial choice of BP agents, and hypertensive disorders of pregnancy. Be sure to follow-up with Part 2 to learn about evaluation for secondary causes of HTN, approach to resistant HTN, interventional anti-hypertensive procedures, and a note on cardiac rehabilitation.


Show notes

Coming soon!


Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

The Cardionerds CV prevention series  includes in-depth deep dives on so many prevention topics including the ABCs of prevention, approach to obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.


Guest Profiles

Dr. Luke Laffin, serves as cardiology faculty in the division of Preventive Cardiology and Medical Director of Cardiac Rehabilitation at the Cleveland Clinic. Dr. Laffin attended medical school at Vanderbilt University School of Medicine. He trained in internal medicine and cardiology at the University of Chicago where he completed a dedicated fellowship in hypertensive diseases. He is a clinical specialist in hypertension designated by the American Society of Hypertension – which has now merged with the AHA.

Dr. Gregory Ogunnowo is a cardiology fellow at the Cleveland Clinic. He completed medical school at the University of South Carolina School of Medicine in Columbia, South Carolina. He went on to complete internal medicine residency at Washington University School of Medicine in St. Louis where he stayed on as faculty in the Department of Hospital Medicine for a year prior to pursing fellowship. His interests include outcomes research in interventional cardiology and medical education In his spare time, Greg enjoys traveling, exercising, and experiencing new cultures through their food. When he’s not in the hospital, you can find Greg planning a trip with close friends and family.


References and Links

Coming soon!

93. Obesity for CardioNerds with Dr. Chiadi Ndumele

CardioNerds (Carine Hamo, Amit Goyal, and Daniel Ambinder) discuss the obesity epidemic and how it relates to the cardiovascular system with Dr. Chiadi Ndumele, cardiologist and epidemiologist at The Johns Hopkins Hospital and chairs the obesity subcommittee of the American Heart Association (AHA). They cover obesity definitions, epidemiology, strengths and limitations of different biometrics, including BMI, impact on myocardial structure and function, and current pharmacologic & surgical options for weight loss. They also discuss the practical approach to addressing obesity with patients. This episode was produced by Dr. Carine Hamo. Show notes & references by Dr. Daniel Ambinder.

CardioNerds (Carine Hamo, Amit Goyal, and Daniel Ambinder) discuss the obesity epidemic and how it relates to the cardiovascular system with Dr. Chiadi Ndumele, cardiologist and epidemiologist at The Johns Hopkins Hospital. They cover obesity definitions, epidemiology, strengths and limitations of different biometrics, including BMI, impact on myocardial structure and function, and current pharmacologic & surgical options for weight loss. This episode was produced by Dr. Carine Hamo. Show notes & references by Dr. Daniel Ambinder.
Episode graphic by Dr. Carine Hamo

Cardionerds Cardiovascular Prevention Page
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Show notes

1. What is obesity and how do we define it at the personal and population level? 

  • Obesity is when there is an excess and often dysfunctional adipose tissue that contributes to morbidity and to premature mortality 
  • The metric used to define obesity is Body Mass Index (BMI), defined as a person’s weight in kilograms divided by the square of the person’s height in meters (kg/m2) 
  • See WHO BMI classification below

2. What is the current epidemiology of obesity and are there certain populations that are affected more than others? 

  • Rates of obesity are climbing. Currently, around 70% of the population meets criteria for being either overweight or obese and ~40% are at the level of obesity. 
  • Minorities such as African Americans, Native Americans, and Latinos have higher rates of obesity. 
  • Higher rates of obesity are also seen in groups with lower socioeconomic status. 
  • Certain populations, such as Southeast Asians, tend to develop severe metabolic consequences of obesity such as insulin resistance and cardiovascular consequences with less excess weight than other populations. 
  • Adult weight is very important but weight history (long standing obesity) plays a role as well when it comes to cardiovascular risk associated with obesity.   

3. Currently the WHO classifies obesity based on BMI. What are the limitations to using BMI as a measure of obesity? Are their benefits to measuring waist circumference instead? 

  • BMI is a far from a perfect measure but it correlates nicely at the population level with cardiovascular events and premature mortality 
  • BMI is more accessible than a direct quantitative or functional measure of adipose tissue   
  • A major limitation of BMI is that it does not reflect body composition. Body composition is very important in understanding risk associated with obesity. For example, football players may fall into the category of grade 1 obesity if just using BMI to classify their weight status. 
  • Waist circumference (WC) is a good way of getting a sense of body composition. Abdominal obesity is most closely linked to insulin resistance and various metabolic consequences such as diabetes, hypertension, and inflammation. This is why WC is incorporated into the metabolic syndrome construct. 
  • Adding WC measurements to the BMI measurements, particularly for individuals in the overweight and grade 1 obesity group (BMI 25-29.9, and 30-34.9) provides significant prognostic information about the development of cardiovascular disease. 

4. How do obesity and metabolic syndrome impact myocardial structure and function? How does obesity and increased adiposity fit into the larger scheme of metabolic risk and metabolic syndrome? 

  • Obesity is independently associated with myocardial remodeling and with increased heart failure risk. This contrasts with coronary heart disease (CAD) and stroke. For CAD and stroke, most associations with obesity are largely mediated by diabetes, hypertension and dyslipidemia. However, in heart failure, there is a strong unexplained association that remains after you consider those associated conditions. 
  • The independent association of obesity with heart failure pertains almost exclusively to heart failure with preserved ejection fraction (HFpEF) and not heart failure with reduced ejection fraction (HFrEF). 
  • The mechanism for this independent association is not well understood and is an area of active research. In mice that are predisposed to obesity have several inflammatory processes that occur locally in the myocardium and systemically that likely contribute to cardiac risk.
  • At the local level, lipotoxicity occurs within the myocardium as it does in nonalcoholic fatty liver disease.
  • At the systemic level, adipose tissue releases adipokines and cytokines that are linked to myocardial damage, injury, and fibrosis. 
  • There is a spectrum of metabolic risk among individuals with excess weight. And when obesity is associated with metabolic syndrome in individuals, the risk for cardiovascular disease markedly rises.   

4. What are some core tenants of addressing obesity when working with patients when it comes to exercise and diet?         

  • A core tenant of discussing obesity with patients is to discuss it! Obesity is generally under-addressed and under-discussed. 
  • Motivation by being positive about risk reduction with a healthier lifestyle can be very effective. 
  • Help patients “take time to invest in themselves”. Having them put items on the calendar that include exercise activities, such as taking a walk or going to the gym, can be a useful strategy for patients who are particularly busy with work or school. 
  • Stress reduction is an important component to diet and exercise. 
  • Smaller activities, a brisk walk or taking the stairs at work can help reduce the activation energy required for exercise and can make exercise feel more attainable to patients. 
  • Meal planning and meal timing are both very important aspects to counseling for patients when it comes to healthy eating. 

5. What are some tips and tricks on broaching the subject of obesity with patients given the sensitivity of the subject. 

  • It is important to check biases in this space. Obesity should not be considered an individual failing when there is a systemic and societal based issue. We need to think of obesity as a multi-factorial disease that has a behavioral component but also has a more complex societal and biological contribution as well. 
  • Approaching the patient with a plan for partnership of management of obesity as a disease, like other diseases such as hypertension and diabetes can be very helpful. 
  • Patients want to lose weight, it just becomes very challenging for a variety matters. 
  • The weight of the clinician can have an impact as to the discussion of weight in the clinic. For example, clinicians with a higher weight than the patient tend to avoid discussing obesity during clinic visits. Clinicians who have healthy weight statuses can used stigmatizing language when counseling patients. 
  • Appreciate that weight management can be challenging and there’ll be stops and starts but there can be great outcomes with long-term partnerships with patients. 

6. What are the current pharmacologic options for weight loss and when should these agents be considered? 

  • Pharmacological agents should be considered once physical activity and social stressors are addressed. Pharmacological therapy can be a nice adjunct to lifestyle modification, particularly when BMI remains above 30 or when BMI remains >27 with comorbidities. 
  • There are a variety of agents such as Orlistat, Liraglutide, Phentermine, Topiramate, and Bupropion. 
  • These medications are generally underutilized due to cost and side effects. 
  • Some agents have cannot be used long term which may limit their use. 
  • The only agent that has been related to cardiovascular risk reduction is Liraglutide. 

7. What do we know about the role of bariatric surgery in cardiovascular disease prevention and does weight loss through bariatric surgery provide differential benefit over other forms of weight loss? 

  • Bariatric surgery is probably the most powerful weapon in our obesity arsenal. 
  • There are two major subtypes of bariatric surgery. There is a restrictive subtype, such as a sleeve gastrectomy, and a malabsoptive subtype, such as a gastric bypass surgery. The Roux-en-Y gastric bypass has both the malabsorptive and restrictive components. 
  • There is prospective data that shows that bariatric surgery is associated with more weight loss than lifestyle modifications. Bariatric surgery is also shown to be associated with a reduction in comorbidities like hypertension, diabetes and dyslipidemia. 
  • Bariatric surgery is also associated with a reduction in pathophysiological processes like inflammation and endothelial dysfunction. 
  • Prospective studies with matched data, such as the Swedish Obesity study cohort, bariatric surgery has been associated with a reduced risk in cardiovascular disease events and a markedly improved survival. There have been significant risk reductions in heart failure as well. 
  • Most cardiovascular disease reductions seen with bariatric surgery occur through the profound weight loss that occurs after surgery. 
  • Risk calculators such as https://riskcalc.org/BariatricSurgeryComplications/ can help guide clinicians and patients when considering bariatric surgery. 
BMIWHO Classification
Below 18.5Underweight
18.5-24.9 Normal weight
25.0-29.9Pre-obesity
30.0-34.9Obesity class I
35.0-39.9Obesity class 2
> 40.0Obesity class 3

Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

The Cardionerds CV prevention series  includes in-depth deep dives on so many prevention topics including the ABCs of prevention, approach to obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.


Guest Profiles

Dr. Chiadi Ndumele is an Assistant Professor in the Department of Medicine at Johns Hopkins University. Dr. Ndumele graduated from Harvard University School of Medicine. He completed his Internal Medicine training at Brigham and Women’s Hospital, where he also served as Chief Medical Resident. He was Chief Cardiology Fellow at Johns Hopkins University. During fellowship training, Dr. Ndumele received an MHS and Ph.D. in Epidemiology at Johns Hopkins Bloomberg School of Public Health. Dr. Ndumele’s research has been supported by career development awards from the NHLBI and Robert Wood Johnson Foundation, a Catalyst Award from Johns Hopkins, an R01 from the NHLBI and an AHA Strategically Focused Research Network Grant. He has received national recognition for his work, including a Young Physician-Scientist Award from the American Society of Clinical Investigation. He has national leadership roles including Chair of the Obesity Subcommittee of the American Heart Association (AHA) and Editorial Board membership on the journals Circulation and Circulation Research. Dr. Ndumele’s research focuses on mechanisms linking adiposity to CVD and strategies to improve prediction and prevention.


References and Links

  1. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of cardiology/American Heart Association task force on practice guidelines and the obesity society. Circulation. 2014;129(25 SUPPL. 1):102-138. doi:10.1161/01.cir.0000437739.71477.ee
  1. Yu Z, Grams ME, Ndumele CE, et al. Association Between Midlife Obesity and Kidney Function Trajectories: The Atherosclerosis Risk in Communities (ARIC) Study. Am J Kidney Dis. September 2020. doi:10.1053/j.ajkd.2020.07.025
  1. Kaze AD, Musani SK, Bidulescu A, et al. Plasma Adipokines and Glycemic Progression Among African Americans: Findings from the Jackson Heart Study. Diabet Med. November 2020. doi:10.1111/dme.14465
  1. Cohen LP, Vittinghoff E, Pletcher MJ, et al. Association of Midlife Cardiovascular Risk Factors with Risk of Heart Failure Subtypes Later in Life. J Card Fail. November 2020. doi:10.1016/j.cardfail.2020.11.008
  1. Khera R, Pandey A, Ayers CR, et al. Performance of the Pooled Cohort Equations to Estimate Atherosclerotic Cardiovascular Disease Risk by Body Mass Index. JAMA Netw open. 2020;3(10):e2023242. doi:10.1001/jamanetworkopen.2020.23242
  1. Fliotsos M, Zhao D, Rao VN, et al. Body Mass Index From Early-, Mid-, and Older-Adulthood and Risk of Heart Failure and Atherosclerotic Cardiovascular Disease: MESA. doi:10.1161/JAHA.118.009599
  1. Mann JFE, Nauck MA, Nissen SE, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. Drug Ther Bull. 2016;54(9):101. doi:10.1056/nejmoa1603827
  1. Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes. N Engl J Med. 2017;376(7):641-651. doi:10.1056/nejmoa1600869
  1. Aminian A, Zajichek A, Arterburn DE, et al. Association of Metabolic Surgery with Major Adverse Cardiovascular Outcomes in Patients with Type 2 Diabetes and Obesity. JAMA – J Am Med Assoc. 2019;322(13):1271-1282. doi:10.1001/jama.2019.14231
  1. https://riskcalc.org/BariatricSurgeryComplications/

92. Diabetes Mellitus for CardioNerds with Dr. Dennis Bruemmer

CardioNerds (Amit Goyal and Daniel Ambinder) discuss diabetes mellitus with Dr. Dennis Bruemmer. This is a must-listen for anyone engaged in the case of the cardiovascular patient. Given the alarming obesity epidemic, we anticipate a rising worldwide tide of diabetes mellitus and ensuing cardiovascular disease. Here we discuss the epidemiology and approach to diabetes management, with emphasis on what CardioNerds need to know. Dr. Bruemmer is board-certified in both cardiology and endocrinology, and is the director of the Center for Cardiometabolic Health in the section of Preventive Cardiology and Rehabilitation at the Cleveland Clinic.

The CardioNerds (Amit Goyal and Daniel Ambinder) discuss diabetes mellitus with Dr. Dennis Bruemmer. This is a must-listen for anyone engaged in the case of the cardiovascular patient. Given the alarming obesity epidemic, we anticipate a rising worldwide tide of diabetes mellitus and ensuing cardiovascular disease. Here we discuss the epidemiology and approach to diabetes management, with emphasis on what CardioNerds need to know. Dr. Bruemmer is board-certified in both cardiology and endocrinology, and is the director of the Center for Cardiometabolic Health in the section of Preventive Cardiology and Rehabilitation at the Cleveland Clinic.
Episode graphic by Dr. Carine Hamo

Cardionerds Cardiovascular Prevention Page
CardioNerds Episode Page
Subscribe to our newsletter- The Heartbeat
Support our educational mission by becoming a Patron!


Show notes

  1. Why should CardioNerds pay attention to diabetes mellitus (DM)? 
    • As a cardiovascular risk equivalent, DM is a key CVD risk factor, associated with a 2-4 fold increased risk. 70% of ACS patients have DM. 
    • Cardiologists will see more patient with DM given the rising prevalence of obesity, subsequent diabetes and ensuing CVD.  
    • Only 6% of patients with DM and cardiovascular disease (CVD) get appropriate care for DM and CVD. 
    • Historically, hypoglycemic agents improved microvascular outcomes (retinopathy, nephropathy, neuropathy), but not macrovascular outcomes (MI, CVA, PAD). However, this has changed with the advent of mandatory cardiovascular safety trials with positive data for GLP1 agonists and SGLT2 inhibitors! 
    • There aren’t enough endocrinologists! They only see ~5% of DM patients. In 2012 the US generated 280 endocrinologists versus  100 million patient with DM or pre-DM. Primary care physicians are key allies in the care of these patients.  
    • So as CardioNerds, let’s get over this therapeutic inertia and take ownership of our patients’ DM as we already do for their HTN and HLD; in collaboration with a multidisciplinary team including the PCP, dietician, pharmacist, DM educators, +/- behavioral therapist, +/- endocrinologist, +/- metabolic surgeon. 
  1. What is your global approach to the patient with DM? 
    • Optimize the non-DM CVD risk factors with lifestyle intervention and medical management: CVD risk factors are very common in patients with DM (sedentary lifestyle, unhealthy weight, HTN, HLD).  The Steno-2 Study (Gaede et al., NEJM 2008) showed that in patients with T2DM & microalbuminuria, intensive intervention with multiple drug combinations and behavioral modification was better with regards to: vascular complications, death from any cause, and death from CV causes.     
      1. Emphasize a healthy lifestyle –  use a patient-centered approach with motivational interviewing and shared decision making, provide education, set realistic goals, identify barriers (socioeconomic, etc), engage family and a multidisciplinary team (nutritionist, exercise physiologist), utilize behavioral interventions. 
      2. Pharmacologic intervention – medical weight loss for BMI > 27 and DM (enjoy upcoming Ndumele episode), anti-HTN (enjoy upcoming Laffin episode), and anti-HLD (enjoy the Navar-Shah episode). NOTE that statins have been shown to have a small effect on increasing incident or worsening DM, but the effect size is small and overcome by the benefit in whom statins are indicated.                
    • Treat the Hyperglycemia itself! Let’s discuss this deeper… 
  1. What is your approach to non-insulin DM management? 
    • First-line agents: US guidelines: in addition to lifestyle intervention, start with metformin as the first line agent. 
    • European guidelines: now give preference to GLP1 agonists and SGLT2 inhibitors in patients with or at risk for cardiovascular disease. 
    • Sulfonylureas: increase pancreatic insulin secretion. Dr. Bruemmer feels they obsolete for the preventive cardiologist from the standpoints of safety, efficacy, and cardiovascular disease. There is no efficacy data past 4 years and no cardiovascular benefit. In contrast data suggests increase all-cause mortality and possibly MACE events. Low cost may make these more affordable for some patients.  
    • Thiazolidinediones (aka: “glitazones”): increase insulin sensitivity, the primary defect in T2DM. Rosiglitazone is discouraged due to adverse cardiovascular outcomes. Pioglitazone has better data, especially in those who’ve had a stroke or TIA (IRIS Trial, NEJM 2016). They may have a role in those for whom other classes are contraindicated or cost-prohibitive.  
    • DPP4 Inhibitors: increase incretin levels (GLP-1 and GIP) which inhibit glucagon release, increase insulin secretion, and delay gastric emptying. They do not cause hypoglycemia or weight gain. These have a very modest glycemic effect and have no CV benefit. There was a signal for increased heart failure hospitalizations with saxagliptin and alogliptin, but not with sitagliptin. These should have very little, if any, role in your management. 
    • See Figures for the “Overall Approach” from the 2019 EASD-ADA update.  
  1. Which anti-glycemic drugs have a proven cardiovascular outcomes benefit? 
    • GLP1 Agonists: bind to GLP1 receptor and promote glucose dependent insulin release, inhibit glucagon secretion, and delay gastric emptying. Note that patients should be counseled that these are injectables (oral semaglutide has not yet proven CV  benefit). Liraglutide (LEADER trial) and injectable semaglutide (SUSTAIN-6) showed significant MACE reduction, but CV benefit does not appear to be a class effect. They likely have an anti-atherothrombotic effect as well as benefits on blood pressure, weight, and glycemic control without hypoglycemia. There is no apparent impact on heart failure hospitalizations. Warn of primarily GI side effects and infrequent risk of acute pancreatitis. Start low and slowly up-titrate as tolerated as GI symptoms typically abate with time.  There is a black box warning for medullary thyroid cancer so AVOID if there is a family or personal history of this. 
    • SGLT2 Inhibitors: bind to and block the SGLT2 co-transporter in the renal proximal renal tubules, thereby inhibiting glucose reabsorption and increasing glucose loss via urine (glycosuria) along with osmotic diuresis as well as weight and blood pressure reduction. They have both cardiovascular and renal outcomes benefits. Importantly they reduce HF and cardiovascular death in those with HFrEF independent of hypoglycemic action and are now a key component for HFrEF optimal medical therapy (enjoy Ep #36 with Dr. Robert Mentz). Risks include: dehydration due to osmotic diuresis (consider reducing concurrent diuretic doses), genitourinary fungal infections (not UTIs including pyelonephritis; caution in those with urinary incontinence and poor perineal hygiene), euglycemic DKA (caution in T1DM and those with ketosis-prone T2DM), and a questionable risk of amputations and fractures associated with canagliflozin but not others in the class.  
    • NOTE: many patients with CVD remain on outdated hypoglycemic agents rather than on these newer agents with proven CV benefit. Much of this is related to cost and access. Whenever you see a patient with DM, review their med list and help them bring it up to speed with the latest data!   
  1. What is the role of metabolic surgery in patients with DM?
    • The prevalence of obesity is rising at an alarming rate and portrays an equally grim epidemiology for rising rates of diabetes and cardiovascular disease. By 2025, 1/5 of the world may be obese. Already, >1/3 of US adults are obese with stark differences based on race and socioeconomic status. The worldwide prevalence of diabetes is similarly expected to rise: >50% in the next decade! Rates of CV disease and mortality will follow suit. 
    • Preventing obesity via education, lifestyle, and policy is of the utmost importance. 
    • Managing obesity requires a multipronged approach with shared decision making including: promoting a healthy lifestyle with diet and exercise, +/- pharmacologic weight loss, +/- metabolic (bariatric) surgery. 
    • Behavioral intervention promoting a healthy lifestyle is the cornerstone for all overweight and obese patients as part of primary, secondary, and tertiary prevention. However the results are typically modest and inconsistently sustained over longer periods. 
    • Pharmacologic intervention for weight loss may provide added benefit over lifestyle alone and is indicated for individuals with BMI ≥30 kg/m2 or BMI ≥27 kg/m2 with at least 1 obesity-associated comorbidity who are motivated, but have failed to lose weight or maintain weight loss by using high-intensity lifestyle intervention alone. Obesity-associated comorbidities include: T2DM, HTN, HLD, ASCVD (CAD, CVA, PAD), CHF, Afib, VTE, OSA, and CKD. There are 5 antiobesity drugs approved by the US FDA: orlistat, lorcaserin, naltrexone-bupropion, phentermine-topiramate, and liraglutide. Of these, only liraglutide has proven CV benefit. 
    • Metabolic (bariatric) surgery is most effective for clinically significant and sustained weight loss and for diabetes remission in obese individuals. Surgical options include: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), adjustable gastric banding (AGB), and biliopancreatic diversion with duodenal switch (BPDDS). Metabolic surgery is recommended for patients with a BMI ≥40 kg/m2 without concomitant medical problems and in patients with a BMI ≥35 kg/m2 who have at least 1 severe obesity-associated comorbidity (e.g. T2DM). Interestingly, some of the cardiometabolic benefits of metabolic surgery are independent of weight loss and include mechanisms related to incretin levels, insulin secretion/sensitivity, inflammatory mediator profile, bile acid circulation, and gut microbiota. The peri-operative risk is low and has declined with improved technique. Nutritional deficiencies are the most common long-term complications and can be prevented with follow-up and supplementation. 

Show notes updated as of 12.13.2020


Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

The Cardionerds CV prevention series  includes in-depth deep dives on so many prevention topics including the ABCs of prevention, approach to obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.


Guest Profiles

Dr. Dennis Bruemmer is the Director of the Center for Cardiometabolic Health in the Section of Preventive Cardiology and Rehabilitation at the Cleveland Clinic. Dr. Bruemmer earned his MD/PhD degrees from the University of Hamburg in Germany. Following residency training in internal medicine and cardiology in Berlin, Dr. Bruemmer completed a two-year research fellowship as the Diabetes Center Fellow in the Department of Endocrinology at UCLA. He is board-certified in Internal Medicine, Endocrinology, Cardiovascular Disease, and Echocardiography, quite a unique combination! Dr. Bruemmer’s research is focused on mechanisms of atherosclerosis and risk factor intervention for the prevention of coronary artery disease. 


References and Links – (bold indicates review or guideline)

1. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Associ. Rev Española Cardiol (English Ed. 2020. doi:10.1016/j.rec.2020.04.007 

2. Acharya T, Deedwania P. The Role of Newer Anti-Diabetic Drugs in Cardiovascular Disease. ACC.org Expert Analysis. https://www.acc.org/latest-in-cardiology/articles/2018/05/22/16/59/the-role-of-newer-anti-diabetic-drugs-in-cv-disease. Published 2018. Accessed December 12, 2020. 

3. Buse JB, Wexler DJ, Tsapas A, et al. Correction to: 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of diabetes (EASD) (Diabetologia, (2020), 63, 2, (221-228), 10.1. Diabetologia. 2020;63(8):1667. doi:10.1007/s00125-020-05151-2 

4. Buse JB, Wexler DJ, Tsapas A, et al. 2019 update to: Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020. doi:10.2337/dci19-0066 

5. Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018. doi:10.1007/s00125-018-4729-5 

6. Gæde P, Lund-Andersen H, Parving H-H, Pedersen O. Effect of a Multifactorial Intervention on Mortality in Type 2 Diabetes. N Engl J Med. 2008. doi:10.1056/nejmoa0706245 

7. Johnson EL, Feldman H, Butts A, et al. Standards of medical care in diabetes—2020 abridged for primary care providers. Clin Diabetes. 2020. doi:10.2337/cd20-as01 

8. Kernan WN, Viscoli CM, Furie KL, et al. Pioglitazone after Ischemic Stroke or Transient Ischemic Attack. N Engl J Med. 2016. doi:10.1056/nejmoa1506930 

9. Pareek M, Schauer PR, Kaplan LM, Leiter LA, Rubino F, Bhatt DL. Metabolic Surgery: Weight Loss, Diabetes, and Beyond. J Am Coll Cardiol. 2018;71(6):670-687. doi:10.1016/j.jacc.2017.12.014 

10. Zelniker TA, Braunwald E. Clinical Benefit of Cardiorenal Effects of Sodium-Glucose Cotransporter 2 Inhibitors: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(4):435-447. doi:10.1016/j.jacc.2019.11.036 

11. Zelniker TA, Braunwald E. Mechanisms of Cardiorenal Effects of Sodium-Glucose Cotransporter 2 Inhibitors: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(4):422-434. doi:10.1016/j.jacc.2019.11.031 

91. Aspirin, Vitamin D, Calcium & Omega 3 Fatty Acids Supplementation with Dr. Erin Michos

The CardioNerds (Carine Hamo and Daniel Ambinder) discuss aspirin as primary prevention, Vitamin D, Calcium, and omega 3 fatty acids supplementation with Dr. Erin Michos, director of women’s cardiovascular health and the associate director of preventive cardiology with Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. We are also joined by Dr. Michos’ mentees, Dr. Rick Ferraro, Dr. Andi Shahu, and student doctor Sunyoung (Sarah) Jang for a discussion about mentorship and career development. This episode was produced by Dr. Rick Ferraro and Dr. Carine Hamo. Show notes & references by Dr. Amit Goyal.

The CardioNerds (Carine Hamo and Daniel Ambinder) discuss aspirin as primary prevention, Vitamin D, Calcium, and omega 3 fatty acids supplementation with Dr. Erin Michos, director of women's cardiovascular health and the associate director of preventive cardiology with Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. We are also joined by Dr. Michos' mentees, Dr. Rick Ferraro, Dr. Andi Shahu, and student doctor Sunyoung (Sarah) Jang for a discussion about mentorship and career development. This episode was produced by Dr. Rick Ferraro and Dr. Carine Hamo. Show notes & references by Dr. Amit Goyal.
Episode graphic by Dr. Carine Hamo

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Show notes – Aspirin, Vitamin D, Calcium & Omega 3 Fatty Acids Supplementation

What is the role of aspirin for primary ASCVD prevention? 

  • The Conundrum: ASCVD event rates are much lower in the primary prevention than in the secondary prevention population, BUT the bleeding rates are comparable. So in the primary prevention patients, the bleeding risk is just as high, but the propensity for benefit is lower. 
  • The Question: Does low dose aspirin have a place in the primary prevention of ASCVD events. 
  • The Data
    • ARRIVE Trial: in moderate risk nondiabetic patients without prior ASCVD events, there was no different in the composite ASCVD end point, but there was an increased risk of bleeding (mostly mild GI bleeding). Thus, in the moderate risk patients –> primary prevention aspirin has an unfavorable risk-benefit profile. The benefit in a higher risk (>10-20% estimated 10-yr risk) remains unclear.  
    • ASCEND Trial: In men and women age ≥ 40yrs with diabetes without prior ASCVD events, there was a modest benefit (NNT = 59 patients for 10 years to prevent 1 major ASCVD event) counterbalanced by a similar magnitude of harm (NNH = 77 patients for 10 years to cause 1 major bleeding event). Thus, in adults with diabetes –> primary prevention aspirin had a neutral risk-benefit profile. 
    • ASPREE Trial: in elderly patients (≥ 70 years; ≥ 65 years for Hispanic or Black patients) without prior ASCVD events, there was no difference in ASCVD events but there was a significant increase in bleeding events (NNH = 42 patients for 10 years to cause 1 major bleeding event). The trial was stopped early due to futility. Interestingly, there was higher all-cause mortality driven primarily by cancer. Importantly, patients had to have a life expectancy longer than 5 years and those with dementia, substantial physical disability, or high estimated bleeding risk were excluded. Thus, in elderly patients –> primary prevention aspirin led to overall harm.  
  • The Recommendations
    • There was insufficient evidence to recommend a specific risk threshold for starting primary prevention aspirin. This may be due to more widespread contemporary prevention strategies like lifestyle management, tobacco cessation, statin use, better blood pressure control, etc.  
    • Individualize the decision based on the totality of evidence for an individual’s risk of ASCVD events versus bleeding events. Notably, those with higher ASCVD risk generally also have a higher bleeding risk.           
    • Class IIB: Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk. 
      • There may be a role for primary prevention aspirin in select adults with a high estimated ASCVD risk and low bleeding risk. 
      • CAC score ≥ 100 may help identify those might benefit from primary prevention aspirin.           
      • As always, shared decision making remains           crucial. 
    • Class III: Low-dose aspirin (75-100 mg orally daily) should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age. 
    • Class III: Low-dose aspirin (75-100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding. 

What is the role of Vitamin D supplementation in preventing cardiovascular disease?            

  • The Conundrum: Low levels of Vit D is associated with increased risk of CV outcomes including myocardial infarction, stroke, heart failure, atrial fibrillation, and more. But while low Vit D seems to be a marker for bad outcomes, correlation ≠ causation. Notably, this correlation was not confirmed by Mendelian randomization studies, further refuting possible causation. Confounding factors include links between low Vit D levels and obesity and sedentary lifestyle, themselves risk factors for adverse CV outcomes. 
  • The Question: Given the association between low Vit D levels & CV disease –> can you prevent CV disease by identifying and treating low Vit D with supplementation.  
  • The Data
    • Randomized Clinical Trials –> treatment with vitamin D does not prevent CV disease. 
    • Women’s Health Initiative: Calcium & Vit D supplementation had no effect on incident coronary or cerebrovascular events. But perhaps this was due to a low Vit D dose of only 400 IU daily. Would a higher dose have benefit? 
    • ViDA Study: monthly high-dose Vit D supplementation (100,000 IU of D3) did not prevent CV disease, including within the 25% of patients who had level < 20 ng/mL. But this was an atypical supplementation regimen. 
    • Vital Trial: neither n-3 fatty acid (1g/day) nor Vit D3 (2000 IU/day) were effective for primary prevention of CV or cancer events among healthy middle-aged men and women over 5 years of follow-up. This was among the largest of the Vit D supplementation trials targeting CV outcomes and most definitively argues against the benefit of supplementation.               
  • The Recommendations:      
    • Data for Vit D supplementation to improve CV outcomes is all null.  
    • National Academy of Medicine: 
      • Age 19-70 years: 600 IU daily 
      • Age > 70: 800 IU daily 
      • Level <12 ng/mL indicates deficiency, 12-20 ng/mL is inadequate, and >20 ng/mL is adequate for bone and overall health. But the optimal level remains contested. The Endocrine Society recommends aiming for level ≥ 30 ng/mL. 

What is the role of Calcium supplementation in preventing cardiovascular disease? 

  • The Conundrum: Calcium supplementation is common and important for bone health. However there is some concern that excess calcium may worsen adverse CV outcomes.  
  • The Question: Does calcium intake cause CV harm? 
  • The Data
    • The Auckland Calcium Study: raised concern that calcium supplementation may increase cardiovascular risk (secondary analysis of a study designed to assess impact on bone health). 
    • EPIC-Heidelberg, MESA, & other observational studies: calcium supplementation is associated with adverse cardiovascular events.  In contrast, calcium intake from food sources does not seem to be associated with adverse CV events.  
    • Meta-analysis by Khan et al. 2019: calcium + Vit D was associated with an increased risk for stroke. 
    • These findings may be from the bolus effect of calcium supplementation whereby a sudden rise in serum calcium levels may result in vascular calcium deposition and interact with the coagulation cascade.  
  • The Recommendations
    • Use calcium supplementation cautiously, according to the recommended daily intake, and using food sources. 
    • Personalized approach using shared decision making considering CV risk and bone health. 
    • Avoid excess calcium supplementation. 
    • Recommended daily intake: 
      • Adults aged 19-50 years old & Men aged 51-70 years: 1000 mg/day 
      • Adults aged >70 years and Women aged 51-70: 1200 mg/day  

What is the role of Omega-3 Polyunsaturated Fatty Acids in preventing cardiovascular disease?  

  • The Conundrum: High triglyceride levels are associated with adverse CV events, but triglyceride-reducing agents like niacin and fibrates, have not been effective in reducing the risk of these events. 
  • The Question: Does intake of Omega-3 Fatty Acids improve CV health and if so, what is the appropriate formulation? 
  • The Data
    • ASCEND Omega-3 Trial & VITAL Trial: lower doses of EPA/DHA combination omega-3 fatty acids ~840mg daily are not beneficial in reducing CV events. 
    • REDUCE-IT Trial: 4g of icosapent ethyl (IPE – a pure EPA formulation) daily reduced MACE events in those with elevated triglyceride levels despite statin use.  The Japanese JELIS trial also showed a CV benefit using a lower dose of pure EPA (1.8mg daily) among statin-treated adults with hyperlipidemia.   
    • STRENGTH Trial: 4g EPA/DHA Omega 3-fatty acid formulation failed to show CV benefit among statin-treated patients with dysplipidemia. The difference from REDUCE-IT trial may be due to the drug formulations (pure EPA vs EPA/DHA combination). Notably, in REDUCE-IT, the benefit had a dose-response relationship with blood levels of EPA; the higher the EPA, the greater the benefit.  
    • Dietary fish oil supplements may include a substantial portion of harmful saturated fats vs the beneficial polyunsaturated fats. Dietary supplements have been shows to contain far less Omega-3 fatty acids than indicated on the label! Furthermore, dietary supplements may get oxidized and contain harmful contaminants.  
  • The Recommendations
    • Use IPE 4g daily for patients ≥ 45 years old with established ASCVD or ≥ 50 years old with diabetes & other risk factor(s) who are on maximally tolerated statin and continue to have elevated Triglyceride level 135-499 mg/dL. 
    • The marked CV benefit from icosapent ethyl seen in the REDUCE-IT trial should not be extrapolated to other fish oil preparations!        

The Cardionerds CV prevention series  includes in-depth deep dives on so many prevention topics including the ABCs of prevention, approach to obesity, hypertension, diabetes mellitus and anti-diabetes agents, personalized risk and genetic risk assessments, hyperlipidemia, women’s cardiovascular prevention, coronary calcium scoring and so much more!

We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association.

Cardionerds Cardiovascular Prevention Series: by the Cardionerds Cardiology Podcast in Collaborate with the The American Society For Preventive Cardiology ASPC
Cardionerds Cardiovascular Prevention Series

Guest Profiles

Dr. Erin Donnelly Michos is an Associate Professor of Medicine at Johns Hopkins School of Medicine, with joint appointment in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. She is the Director of Women’s Cardiovascular Health and the Associate Director of Preventive Cardiology with the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease. Dr. Michos completed medical school at Northwestern University in Chicago, IL, and then completed both her Internal Medicine residency and Cardiology fellowship at the Johns Hopkins Hospital in Baltimore, MD.  She also completed her MHS in Cardiovascular Epidemiology at the Johns Hopkins Bloomberg School of Public Health. She has authored or co-authored over 300 manuscripts in peer reviewed journals and is an internationally known leader in preventive cardiology and women’s health. 

Dr. Rick Ferraro is midwest raised, spent two years as a Teach For America Corps member teaching science in Milwaukee before heading to medical school at Weill Cornell Medicine in NYC. Current senior resident at the Osler Medical Residency program and will begin cardiology fellowship at Johns Hopkins Hospital in 2021. Completed intern year under the incredible leadership of Dr. Amit Goyal. Interested in cardiovascular prevention and imaging

Dr. Andi Shahu is a resident physician in the Osler Medical Residency in Internal Medicine at Johns Hopkins Hospital in Baltimore, MD. He will begin General Cardiology fellowship in July 2021 at Yale University. He is interested in the intersection between cardiovascular outcomes, health equity and health policy. You can follow him on Twitter @andishahu

Sunyoung (Sarah) Jang is a third year medical student at the Johns Hopkins School of Medicine in Baltimore, MD. Interested in public health, she was drawn to Cardiology when she learned that cardiovascular diseases were the leading cause of death globally. She aspires to pursue a career in Cardiology with continued interest in public health, preventative medicine and high value care. 


References and Links

1. Al Mheid I, Quyyumi AA. Vitamin D and Cardiovascular Disease: Controversy Unresolved. J Am Coll Cardiol. 2017. doi:10.1016/j.jacc.2017.05.031 

2. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. 2018. doi:10.1056/nejmoa1804988 

3. McNeil JJ, Nelson MR, Woods RL, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med. 2018. doi:10.1056/nejmoa1803955 

4. Manson JE, Cook NR, Lee I-M, et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med. 2019. doi:10.1056/nejmoa1809944 

5. Scragg R, Stewart AW, Waayer D, et al. Effect of monthly high-dose vitamin D supplementation on cardiovascular disease in the vitamin D assessment study: A randomized clinical trial. JAMA Cardiol. 2017. doi:10.1001/jamacardio.2017.0175 

6. Bolland MJ, Barber PA, Doughty RN, et al. Vascular events in healthy older women receiving calcium supplementation: Randomised controlled trial. BMJ. 2008. doi:10.1136/bmj.39440.525752.BE 

7. Li K, Kaaks R, Linseisen J, Rohrmann S. Associations of dietary calcium intake and calcium supplementation with myocardial infarction and stroke risk and overall cardiovascular mortality in the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition study (EPIC-Heidelberg). Heart. 2012. doi:10.1136/heartjnl-2011-301345 

8. Khan SU, Khan MU, Riaz H, et al. Effects of nutritional supplements and dietary interventions on cardiovascular outcomes. Ann Intern Med. 2019. doi:10.7326/M19-0341 

9. Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007. doi:10.1016/S0140-6736(07)60527-3 

10. Orringer CE, Jacobson TA, Maki KC. National Lipid Association Scientific Statement on the use of icosapent ethyl in statin-treated patients with elevated triglycerides and high or very-high ASCVD risk. J Clin Lipidol. 2019. doi:10.1016/j.jacl.2019.10.014 

11. Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018. doi:10.1016/S0140-6736(18)31924-X 

12. Nicholls SJ, Lincoff AM, Garcia M, et al. Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk. JAMA. 2020. 

13. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;74(10):1376-1414. doi:10.1016/j.jacc.2019.03.009 

Referenced work by Dr. Michos Mentees in this episode

Jang S, Ogunmoroti O, Ndumele CE, et al. Association of the Novel Inflammatory Marker GlycA and Incident Heart Failure and Its Subtypes of Preserved and Reduced Ejection Fraction: The Multi-Ethnic Study of Atherosclerosis. Circ Hear Fail. 2020;(August):251-260. doi:10.1161/CIRCHEARTFAILURE.120.007067

AHA Press release: Low-income adults less likely to receive preventive heart disease care.

ASSOCIATION BETWEEN INDIVIDUAL INCOME AND INCIDENCE OF HEART FAILURE SUBTYPES IN THE MULTI-ETHNIC STUDY OF ATHEROSCLEROSIS (MESA)

Ferraro R, Latina JM, Alfaddagh A, et al. Evaluation and Management of Patients With Stable Angina: Beyond the Ischemia Paradigm: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;76(19):2252-2266. doi:10.1016/j.jacc.2020.08.078