Dr Budoff is a preventive cardiologist and Professor of Medicine at the David Geffen School of Medicine (UCLA) and principal investigator at Lundquist Institute
Sad to report that a very physically active 66 year old patient with negative nuclear 2 years ago, taken off statin with 'clean bill of health', just passed away of SCD/MI with severe 3 VD. Wife had to do CPR. Wrong test, wrong answer. Need more CAC testing in asymptomatic pts
This trial doesn't invalidate the lipid hypothesis, is not the final answer (Progression of soft plaque at 1 year is the final study) and is exactly as originally designed - see i have no skin in the game. i am just presenting our findings
So Honored to have been awarded the physician if the year award by the California chapter of the ACC. So many great clinicians and researchers. Truly humbled.
@ACCinTouch
Evaporate Trial presented at
#escprev2021
as late breaker, showing Icosapent Ethyl can reduce Lipid Rich Necrotic Core and intraplaque hemorrhage, while increasing fibrous cap thickness on CT angiography. Understanding the mechanism is so important.
@DLBHATTMD
@SuvasiniL
My most important CAC paper to date just hit:
CAC is SECONDARY RISK EQUIVALENT AT score >300
(same cohort, not comparing clinical trial patients to observational studies)
@khurramn1
@RonBlankstein
@ErinMichos
@rblument1
Nothing lowers risk more than a CAC of zero. see data from MESA.
#Powerofzero
I trust it in all asymptomatic except the young (< 40 years of age) to derisk my patients, including DM and FH
@khurramn1
@rblument1
@RonBlankstein
I still don't understand why colchicine continues to be disrespected - three positive outcome studies and CCTA plaque studies showing benefit, all for a 2a recommendation?
Add another 54% of 11,805 patients from Denmark with LDL > 193 mg/dl also with normal CAC. NOT Everyone needs a statin, i hold therapy for CAC Zero unless DM, known ASCVD in this population with no CAC.
Finally, CT angiography is the preferred test in US for a majority of patients with chest pain, following the UK (NICE) and ESC 2019 Guidelines. Great editorial by
@RonBlankstein
@DrMarthaGulati
@lesleejshaw
puts this in clinical perspective
Now out: The 2021 Multi Society Chest Pain Guideline
A special thanks to the entire writing group led by
@DrMarthaGulati
and to the countless others who have worked on this over the past several years
👏
@ACCinTouch
@AHAScience
& all partner societies
👉
Great new study in NEJM Today - DISCHARGE Study,
a large randomized trial confirms the CONSERVE Trial results that CTA is safer and results in similar outcomes as an invasive angiography first strategy.
@NEJM
@Heart_SCCT
Yesterday marked another COVID Vaccine milestone - More Than 3.01 Billion Shots Given Globally. If there are any major health concerns, we would have seen it. The largest "N" of any study ever.
A nice article demonstrating the harms of too much exercise. We have long seen the associated harms of marathon running on CAC and CV events, this article breaks it down between exercise volume and intensity.
.
For those confused about LDL cholesterol, it is also about obesity, coronary artery calcium and other risk factors like Diabetes. No one risk factor stands alone to predict risk
Likely the best algorithm on when to incorporate CCTA in primary prevention, and then what to do with the results.
#yesCCT
@Heart_SCCT
-Free article at
@AJPC
We have great long term data from Walter Reed showing those persons with CAC=0 derive 0% benefit from 10+ years of statins.
This is one of many such studies. Let's treat the disease, not everyone dies of CVD.
A critically important study published today by Drs Maron and Rodrigues in
@JACCJournals
showing incidental CAC from ungated studies predict events and offer patients and clinicians a NO-COST opportunity to treat ASCVD. 2x risk of death with CAC > 100. RADIOLOGISTS - REPORT CAC
a great new review paper by my colleague
@JairoaldanaMD
discussing all the data we have on decreasing coronary plaque with different therapies.
@DLBHATTMD
Rita - Taylor and O'Malley did randomized studies with CAC specifically showing no increase in anxiety, depression or somatoform disorders using CAC, so your RCT is asked and answered. They also showed a 3.53 fold improvement in statin compliance over 4 years with CAC.
CAC scans offer no clinical benefits, often lead to more tests and worry, incidental findings and radiation risk. Need to rethink their use. Time for an RCT!
The United States is now catching up to established medical pathways in Europe and the UK for years. CCTA has the best clinical, outcome and cost-effectiveness data of any diagnostic test in Cardiology. We need to continue to move towards the best algorithms for our patients
Heart disease is the leading cause of death in the United States. That's why we led 14 Members in urging
@CMSGov
to cover the use of the cutting-edge CCTA test to detect coronary artery disease. Our letter
#ICYMI
:
CT CAC data bests genetic factors for heart disease risk assessment
Our JAMA paper today showed CAC score is more effective at predicting a person's risk for heart disease than polygenic risk scores.
@AuntMinnie
The presentation Late-Breaking Science in Lipids showing Icosapent Ethyl reduces plaque progression in EVAPORATE will be available on the On-Demand platform within 24 hours
#ESCCongress
2020
So excited to see our CONFIRM paper on CAC 300 and secondary prevention was the most talked about paper at JACC CI last year -
and on the most read list -
How far our society has fallen. Yesterday was the proclaimed "Day of Hate" where anti-semitic activities were being coordinated on a national level by neo-nazis. I spent my Saturday morning driving around my Temple to provide extra eyes and ears to the security guard we employ.
A reminder of power of CAC (and CCTA). Fuchs showed CAC Score of >300 associated risk of 7.05 for MI. Whether an 8-fold increased risk with obstructive-extensive disease by CCTA is superior to 7 fold increased risk with CAC needs exploration
@khurramn1
Please join me at ESC this year to hear about results from icosapent ethyl in the EVAPORATE - FINAL. Free Registration for this virtual meeting.
@the_lundquist
@Heart_SCCT
@ASPCardio
Another great study demonstrating that rapid CAC progression is associated with all-cause mortality. If CAC is progressing, more needs to be done. This is not just 'statin' effect of increased density, rapid progression infers worsening atherosclerosis
@ehj_ed
@ESC_Journals
So important to see these external validations of REDUCE-IT in clinical trials. As a preventive cardiologist, this is one of several very important tools in my toolbox, advocated by EVERY major society that looked at the data. Every group, except some rogue naysayers on twitter
An excellent review of the power of zero and the low prevalence of non-calcified plaque when CAC = 0.
by my former fellows - Irfan Zeb and Yasmin Hamirani
Even more important that the primary prevention cohort saw a 32% event reduction. So unique in so many ways. First study in statin intolerant, first with 48% women, first to show non-statin benefit in primary prevention.
CLEAR Outcomes trial presented & published today- Bempedoic acid moves to the big league of proven LDL lowering (via LDLR clearance of apoB-LP drugs). Amazing results considering the drop in lipid Rx in placebo group.
@society_eas
@nationallipid
We are delighted to announce the online publication of our research paper (open access), which explores the combination of computed tomography angiography with coronary artery calcium scoring to improve the diagnosis of coronary artery disease.
Congrats to Corcal study in
@JACCJournals
(CI) -
The investigators concluded that CAC guidance may be a more efficient, personalized, cost-effective, and motivating approach to statin initiation and maintenance in primary prevention.
Check out our feature story on the RURAL Cohort Study, a long-term research project aimed at assessing the health of residents in the rural South. The study uses a high-tech research clinic on wheels that travels throughout the region. Read here:
And we have 7 (yes 7) prospective trials showing EPA slows or reverses atherosclerosis by QCA, IVUS, OCT, and CCTA, including CHERRY and EVAPORATE Trials. 10 trials is enough. EPA lowers events and slows atherosclerosis.
a new study last month in
@JACCJournals
about the validation of Cleerly's AI-guided coronary CT angiography technology, Enabling a one-stop comprehensive analysis of plaque, stenosis and ischemia detection in a single exam.
Except for the fact that the warranty of a normal CCTA is probably 7-10 years (not 2 years) and the use of CCTA is preferred in men to age 70 (median cac 211) and women up to at least age 75 (median cac 67), this certainly represents a move in the right direction.
Important paper linking osteoporosis to atherosclerosis in MESA -
We can learn so much from opportunistic screening with CT BMD at no additional scanning or radiation
@bdi_ai
As we continue to learn, the presence of CAC with elevated LDL is the most robust predictor of whom is at risk of 'high' LDL. Not everyone develops ASCVD from high lipids, just like all women do not develop breast cancer.
Paraphrasing
@MichaelDavidson
(1) Aggressive Rx of apoB early in life is the key (2) Not a fan of current "10 yr risk-based" analysis - (3) need to relate apoB (LDL) to time (4) Polygenetic risk score is emerging & lipids relate more to genes than diet.
I pray that FDA follows suit and approves a vaccine. 1500 Americans die every day of Covid. the vaccine has the potential to reduce that, and every day the FDA delays, another 1500 americans die. We can do postmarketing surveillance and see how we all do with the vaccine
@DrNadolsky
Spencer - not sure why you are making false claims on X. We did not exclude anyone with plaque, this is just blatantly false. The ONLY study we ever planned was plaque progression, and the trial is ongoing - results pending early 2024. I presented baseline data only so far.
Important study, reminding us that we see the aortic calcifications on PE studies, abdominal CT and lung cancer screening studies and can institute good therapy. Chris's approach to look back at old scans is a model we should all follow when we see new patients for prevention.
For risk stratification, I look in patient's charts for old CT scans, and if I find atherosclerosis - I treat to ASCVD target of LDL < 70 mg/dl.
This trial shows the risk of abdominal Atherosclerosis matches that of CAC score.
An area we are actively studying with serial CCTA in a prospective trial. Ketogenic diets with pronounced LDL responses. See this manuscript just published:
Became part of the solution yesterday. Enrolled in the Oxford Vaccine trial. I believe in vaccines, I believe in clinical trials, so I participated.
@the_lundquist
So important to understand the benefits of EPA, as compared to EPA/DHA. Not sure why many of my colleagues don't get it, but this is another important paper demonstrating that benefit.
Inspired by the actions of my fellow health care professionals who saved a life last night at the Hollywood Bowl. Stepped up, did bystander CPR and saved a young woman's life, despite any unknown COVID risks.
So important to remember the Power of Zero, a population based study showing extremely low risk in patients with CAC zero. What we have been saying all along.
@rblument1
@RonBlankstein
@ErinMichos
So important to recognize that CAC and CCT are critical evaluations for women as well as men. No difference in false positives as seen with nuclear. Glad to see
@ACCinTouch
promoting this use (finally).
Great talk on fish oils and outcomes, including the mineral oil issue, at ISC 2022
@AHAMeetings
,
@American_Stroke
, with Mark Alberts, Lawrence Leiter.
Builds on work from
@SuvasiniL
@DLBHATTMD
and so comprehensive, worth a view.
So happy to be walking the halls of AHA and seeing so many giants of cardiology in one place. Inspiring. Bob Eckel, Carl Pepine, Roger Blumenthal, Bob Rosenson, Steve N, keith Ferdinand, the list goes on. Live meetings are critical to advance science
Every paper since Steve Haffner's original paper have suggested diabetes is about 50% the risk of prior MI. CAC > 300 is similar to prior MI, new data coming out, so if you want CVD risk equivalent, get a CAC scan, with or without DM.
David - that is just not true. Eisner was not an outcome study, it showed CAC improved compliance, lowered blood pressure, cholesterol and weight. it was not powered, and did not show, any significant outcome difference as it was 2,137 patients randomized to cac/no-cac.
On a positive note, I am very excited about going back live to American College of Cardiology in New Orleans next week. Hope to see many friends and colleagues.
#ACC23
/
#WCCardio
Congratulations, a well deserved recipient who has championed CAC testing and validated Power of Zero among many other important concepts with CAC, including leading the Calcium Consortium
Wanted to wish everyone a wonderful Thanksgiving. I am thankful for the incredible science that moved vaccines at (dare I say) warp speed. I am in the Oxford trial, Pfizer and Moderna look even better. Let's hope FDA can approve these and get us all back together soon - ACC2021
Nice Review of CCTA for acute chest pain, jby Suraj Dahal, a Class IA indication with 7 prospective trials showing superiority over nuclear, hs troponins, treadmill, standard of care and CCTA still comes out faster, less expensive and superior.
Very excited to again be part of the Advances in Nuclear Cardiology, Cardiac CT and Cardiac MRI: 37th Annual Case Review with the Experts this January at Cedars Sinai in Los Angeles.
A9. Yes, the St Francis Heart study showed that treating high CAC (>75th percentile) with atorvastatin 20 mg in a randomized trial lowers events by 30%, and those with CAC >400 by 42%.
#NLATwitterChat
#NLACAC
After the ACC/AHA Chest Pain guidelines badly botched the warranty issue with CCTA, we present the data on long term safety of a normal CCTA
@journalCCT
Big believer in CAC for diabetes, especially younger patients were guidelines are not so strong. Not all persons with diabetes have the same CV risk. CAC can help.