Cardiology Digest podcast: Episode #10

Study #1

Our journey begins with a Lancet paper that looks at a potential alternative for treating supraventricular tachycardias (SVTs). Imagine a world where the distress of SVTs can be alleviated without ablation, a rush to the emergency department, or the complexities of intravenous therapy. An intranasal medication might be the key, offering a beacon of hope for patients seeking simpler, yet effective solutions. But how effective is this approach, and what does it mean for the future of SVT management?

"SVTs, which include conditions like atrioventricular nodal reentrant tachycardia (AVNRT), can be stopped by intravenous adenosine. And we can treat chronic cases with oral medications… But oral drugs are absorbed slowly, which limits their effectiveness for acute episodes. So, patients have to head to the emergency department to receive adenosine intravenously."

Stambler, BS, Camm, AJ, Alings, M, et al. 2023. Self-administered intranasal etripamil using a symptom-prompted, repeat-dose regimen for atrioventricular-nodal-dependent supraventricular tachycardia (RAPID): A multicentre, randomized trial. Lancet. 10396: 118–128. (https://doi.org/10.1016/S0140-6736(23)00776-6)

Study #2

Transitioning to the realm of antiplatelet therapy, we confront the longstanding question of P2Y12 inhibitors versus aspirin. Will these new findings tilt the balance and shift our approach to secondary coronary prevention? The nuances of this study prompt a deeper reflection on patient-centric care and the economics of new-generation medications.

"Gragnano and the team conducted a patient-level meta-analysis of randomized trials, and gathered data from 7 trials that included over 24 000 patients. 61% of them had a history of acute coronary syndrome and 70% of them had had a coronary revascularization procedure."

Gragnano, F, Cao, D, Pirondini, L, et al. 2023. P2Y12 inhibitor or aspirin monotherapy for secondary prevention of coronary events. J Am Coll Cardiol. 2: 89–105. (https://doi.org/10.1016/j.jacc.2023.04.051)

Study #3

Lastly, we explore the potential of bempedoic acid in the landscape of cholesterol management, particularly for patients who are intolerant to statins. With cardiovascular diseases looming as a pervasive threat, the quest for alternative treatments is critical. We see if bempedoic acid could play a potential role in reducing major cardiovascular events, either alongside, or perhaps in lieu of, traditional statin therapy.

"This new analysis focused on 4206 patients at high risk for cardiovascular events who can’t tolerate statins. Participants were randomly assigned to either 180 mg of oral bempedoic acid daily or a matching placebo."

Nissen, SE, Menon, V, Nicholls, SJ, et al. 2023. Bempedoic acid for primary prevention of cardiovascular events in statin-intolerant patients. JAMA. 2: 131–140. (https://doi.org/10.1001/jama.2023.9696)

Kazi, DS. 2023. Bempedoic acid for high-risk primary prevention of cardiovascular disease: Not a statin substitute but a good plan B. JAMA. 2: 123–125. (https://doi.org/10.1001/jama.2023.9854)

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