Blog: A preventive cardiologist's take on day 1 of the ACC conference
SAN FRANCISCO — The first day of the American College of Cardiology’s 62nd Annual Scientific Sessions and TCT@ACC-i2 was full interesting sessions, exciting late-breaking clinical trial presentations, research abstracts, a crowded exhibit hall and more. The withdrawal of the PREVAIL presentation and full results from the HPS2-THRIVE study received the most buzz. In this blog, Martha Gulati, MD, MS, FACC, FAHA, gives her take on the meeting from the perspective of an attendee.
Saturday, March 10, 8 a.m.
The ACC Scientific Sessions opened with a bang — a real bang. A music video broke out that welcomed us to the 21st century and sung about “leaving your mark on the world.” It was a great start to the meeting.
After the national anthem was played, ACC president, William Zoghbi, MD, FACC, made opening remarks and welcomed us to San Francisco. One thing I did not know was that the ACC had been held in San Francisco at one time, but not since 1973. The theme of this year’s meeting is Discovery to Delivery, with 16 pathways and two new Web-based programs for learning for both the practitioner (Lifelong Learning) and the patient (CardioSmart). This year’s meeting was designated a “green” meeting to minimize our environmental impact on this city. One goal was to minimize printed materials to eliminate waste. With more than 43,000 members of the ACC and, with many of them here at the sessions, it is great that more thought is being given on the environmental impact of our meetings.
The Simon Dack Keynote Lecture was given by Valentin Fuster, MD. Appropriately titled “From Cardiovascular Disease to Health: The Journey of the High-Risk Plaque,” Dr. Fuster presented his lifetime of work, which has truly been a journey of the transition from disease to health. Dr. Fuster is one of the most important leaders in the field of cardiology today. His impact on what we know about atherosclerotic disease has undoubtedly changed how we think about and treat CVD. His earlier work on thrombosis and vulnerable plaques transitioned from the treatment of plaque to the imaging of plaque.
More recently, in 2012 the FREEDOM study was part of his work comparing drug-eluting stents with CABG in diabetic patients, showing that more diffuse inflammatory disease in diabetics was better treated with CABG when compared with DES. Even more recently, this focus for Dr. Fuster has shifted from the treatment of disease to promoting health. He is working at many levels to promote health and prevent CVD, ultimately improving the health of our population. He is involved with child education (a Sesame Street character has been named for him in Spain, known as Dr. Ruster), since health behaviors are likely best learned at ages 3 to 5 years making this a perfect target demographic for teaching good health behaviors for a lifetime. He is also working in a town in Spain targeting health promotion and changing health behaviors with a community based support group. He has also worked to develop young scientific minds to be involved and supported in research on CVD.
What came through from the interesting career of this well-known cardiologist is not only how many people’s lives have been affected by the work he has done, but also how many more in the future will be affected by his recent work to prevent CVD by promoting health.
The ACC presidential address, Globally United to Conquer Cardiovascular Disease, by Dr. Zoghbi was a summary of his and the ACC’s accomplishments. He had the opportunity to present to the U.N. Summit on non-communicable diseases recently, but noted that this was only the second health summit the U.N. has had, the first being the AIDS Summit in 2001. Given the global epidemic of CVD, this should be shocking to hear. Risk factors for CVD overlap with many other major non-communicable diseases.
The triple aim of the ACC is Better Care, Better Population Health and Affordable Care. Dr. Zoghbi addressed how the ACC is accomplishing these Triple Aims, including the effect of data registries that have identified gaps in our care. If guidelines tell us what we should do, registries tell us what we are doing in real life. And, when registries have pointed out deficiencies, we have seen changes occur in response to them. For example, when the ACC registries reported hospitals’ acute MI door-to balloon times publicly, within 5 years more than 90% of hospitals have achieved optimal times compared with much smaller number in the 5 previous years. This ultimately benefited all patients and saved many patient lives as a result.
What appears to be a theme at this ACC Scientific Sessions is that, in addition to disease treatment, the focus has shifted toward prevention. The ACC president ended with this focus. He noted that challenges remain with some simple primary and secondary CVD preventive strategies. Only 47% of people who would benefit from aspirin are taking it; only 46% with hypertension have their BP controlled; only 33% have their cholesterol controlled; and only 23% of those who need assistance with smoking cessation have sought assistance to quit.
It is an exciting time to be a preventive cardiologist since people in our field are actually talking about CVD prevention as a focus, not an afterthought.
The long-awaited results of the HPS2-THRIVE study were presented at the first late-breaking clinical trials session. Ultimately, this trial is consistent with other previous trials. The effect of raising HDL has yet to translate into improving outcomes. This drug had more significant adverse effects and there was no benefit of this drug when added to effective statin therapy in high-risk patients, despite effectively lowering LDL, non-HDL and raising HDL.
At this time, niacin does not appear to have a role in these high-risk patients who are on effective statin therapy.
- Martha Gulati, MD, MS, FACC, FAHA, is Section Director for Preventive Cardiology and Women's Cardiovascular Health; Sarah Ross Soter Chair in Women's Cardiovascular Health; associate professor of medicine in the division of cardiology; and associate professor of clinical public health in the division of epidemiology at The Ohio State University Wexner Medical Center.