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The study shows a reduction in hemoglobin and a reduced risk of hypoglycemia in participants.

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Researchers push for transparency between health care professionals and patients with diabetes about the safety and efficacy of the influenza vaccine

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In an interview with HCPLive, Harold Bays, MD, Medical Director and President of the Louisville Metabolic and Atherosclerosis Research Center, discussed the considerations of GLP-1 RA as either a staple of care or agent use that is still being defined in the 

Bays led a discussion on GLP-1 receptor agonists at the 2021 American Society for Preventive Cardiology Virtual Summit on CVD Prevention. 

"I think they clearly recognize that any hierarchy abuse, you're going to first implement appropriate nutrition, physical activity, then I think most people would implement Metformin therapy," Bays said. "There's a lot of reasons for that being that first line choice, but then after that, I think the the two anti-diabetes drugs that are most recommended would be the SGLT2 inhibitors and the GLP-1 RA and both of them have a little bit differences in their pharmacodynamics."

He noted this choice between the 2 agents ultimately comes down to treating the comorbid conditions of the patients, including obesity or heart failure, but no agents are available to treat both. 

"For clarity, you would be using it to treat the diabetes mellitus, but the fact that there could be clinically meaningful weight loss amongst your patients with T2D, I think that that that could train you towards the decision of going in the direction of GLP-1 RA," Bays said. 

Lastly, he spoke on the recent FDA decision of semaglutide in the treatment of chronic weight management, noting its development has been a remarkable step forward in diabetes treatment. 

"Now, hopefully, we're gonna see similar types of technology where we could maybe convert other peptides, from injectable only into oral agents," Bays said. "From a conceptual standpoint, the development with the oral semaglutide is just remarkable. But, for semaglutide itself, the type of weight loss that we're seeing is also quite remarkable."

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Harold Bays, MD discussed the effectiveness of GLP-1 RA in treatment, as well as the development of oral semaglutide.  

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Harold Bays, MD: Exploring Benefits and Outcomes of GLP-1 RA Treatment 

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This week, The American Society For Preventative Cardiology (ASPC) 2021 Virtual Summit welcomed a diverse group of doctors, health care professionals, and public speakers to introduce new ideas and strategies into the world of preventive cardiology.

In an interview with HCPLive, Dr. Pam Taub, MD, FACC, FASPC, Professor of Medicine

Director of Step Family Cardiovascular Rehabilitation and Wellness Center explained how diet and socioeconomic challenges affect 

 “Physical Disabilities- Focus on Risk Assessment, Diet, Accessibility – How To Overcome Unique Challenges”.

Taub noted how there are often misconceptions that patients have regarding what a healthy diet is, and how dietary recommendations are impacted by those misconceptions.

“I think that there's very little evidence-based study data to really drive what our recommendations are,” Taub said. “But this is also an area where the popular media gets involved. And there's a lot of fad diets, the keto diet, the Paleo diet, and everybody has their own twist on what the right diet should be, and so patients get confused.”

With the evidence that is available, Taub recommends dietary options based on 4 broad themes: calories, content, food intake, and how patients eat food.

With these 4 themes, Taub and fellow doctors can determine what patients are consuming, what they should be consuming, how often throughout the day patients are eating food, and the overall methods involved in their diet.

Typically, the plant-based Mediterranean diet is at the core of most healthy diet options and has significant data associated with it. Additionally, Taub urges patients to participate in metabolic rest, a process that involves eating at appropriate times throughout the day and keeps patients from late-night snacking and over/under eating.

Of course, each patient has specific dietary needs that can be related to their lifestyle, comorbidities, and overall health.

Additionally, Taub noted that accessibility plays a large role in cardiovascular health, and how it is often impacted by the socioeconomic status of a patient.

“Accessibility definitely depends on socioeconomic status, and race,” Taub said. “I mean, we know that people from low socioeconomic backgrounds and certain minority groups, like Hispanics, and African Americans have poor access to a lot of these resources. Also women. These 3 groups tend to be low utilizers of cardiac rehabilitation and other resources. It is a major problem in the healthcare system, and there are no easy answers about how we improve access.”

Access is a prominent concern for Taub and fellow doctors in the cardiology field, especially given the advancements in technology and communication within the medical community.

New strategies such as telemedicine, remote cardiac rehabilitation and video-based content delivery have become increasingly popular, especially since the world has been grappling with the COVID-19 pandemic.

While some in-person methods such as visits to community-based organizations such as local churches, community centers, or barber shops have proved useful in communicating with patients from low-income communities, Taub believed that all communities should have access to the advanced virtual care that has become more prominent in recent years.

“If this is a strategy that as a nation we're going to be deploying, then we need to make the accessibility of the Internet a basic, fundamental aspect of any program just like we guarantee water to everyone,” Taub said. “We need to guarantee free internet and some kind of device for connecting with their health care provider to everyone. If we focus on really the low-income communities, we will, I think really make a difference.”

Dr. Taub speaks on the technology-based advancements in cardiovascular care and socioeconomic status can affect a patient’s diet and access to care.

Pam Taub, MD: The Implication of Diet and Socioeconomic Status in CVD Management

Peter Toth, MD, Director of Preventive Cardiology, CGH Medical Center, discussed the use of new agents for 

 and whether they will become primary or secondary agents in the treatment.

"I think for the most part, virtually all of them can be used in combination with statins, or ezetimibe, or probably even the PCSK9 monoclonals," Toth said. "But let's say a patient is statin intolerant, then it gives you a whole new mechanistic approach by which to try and impact risk and lower atherogenic lipoprotein burden in serum."

He noted that clinicians can now take advantage of alternative pathways for reducing LDL-C and serum pathways that were once not possible. 

Further, Toth spoke on the effects of the COVID-19 pandemic on cholesterol levels in patients who were currently being treated for various comorbid conditions.

He noted people stopped their medication and did not visit the hospital during a cardiovascular event for fear of becoming infected with COVID-19. 

"We lost an average of one and a half years of life expectancy in the US due to the COVID pandemic," Toth said. "I'm absolutely certain that not only was the trend for rising cardiovascular mortality extended, but I'm sure it's spiked. We have a lot to learn, we're certainly going to have to think of novel ways to protect our patients from future pandemics."

Lastly, Toth observed the complications of statin adherence, as more patients believe themselves to be statin intolerant. 

"In the last 10 years, there has been a continuous rise in cardiovascular mortality among both men and women," Toth said. "Despite the fact that for the previous 30 years, it was a clear downward trend. So we have these miracle drugs, they're being inadequately used, and often for false pretenses being stopped."

Watch the first part of the interview with Peter Toth, MD 

Peter Toth, MD discusses the combination treatment aspects of lipid management agents, as well as the effect of the COVID-19 pandemic on cardiovascular care. 

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Peter Toth, MD: Facing Complications in Lipid Management

The complications of cardiovascular disease are varied and require proper management by patients and doctors alike, and there are often misconceptions on what appropriate and health-centric cardiovascular care can be.

The American Society For Preventative Cardiology (ASPC) 2021 Virtual Summit assembled a diverse array of doctors, health care professionals, and public speakers to create a dialogue on progressive strategies and advancements made in the world of cardiology.

In an interview with HCPLive, Dr. Pam Taub, MD, FACC, FASPC, Professor of Medicine Director of Step Family Cardiovascular Rehabilitation and Wellness Center, spoke of the themes associated with her ASPC presentation “Physical Disabilities- Focus on Risk Assessment, Diet, Accessibility – How To Overcome Unique Challenges”.

Taub urged health care professionals and patients alike to consider the lifestyle approaches that are associated with cardiovascular disease. In many cases, the best strategies involve a combination of medication and physical exertion.

While conversations surrounding multi-layered management might be difficult, they are necessary.

“In addition to pharmacologic approaches, it's always easier to tell a patient to take a drug and to add drugs as to adjust parameters such as lipids, blood pressure,” Taub said. “However, it's much harder to talk to a patient about lifestyle strategies. For instance, exercise, what is the right types of things to be adding to their diet, those kinds of strategies.”

While pharmacologic therapies are often warranted, Taub found that patients received the most benefits when it was coupled with healthy lifestyle modifications.

Taub considered cardiac rehabilitation to be an important but “very underused” lifestyle-based program in the United States and the world at large. Traditionally, these types of programs are recommended to patients after they’ve had a cardiac event.

If a patient were to have a myocardial infraction or bypass surgery, an acceptable form of cardiac rehabilitation could be a valve replacement, resulting in improved exercise capacity and a reduction in rehospitalizations and overall mortality.

“In patients with physical disabilities are frail and elderly patients, they're often dismissed as not being able to benefit from cardiac rehabilitation, because there's this conventional view that in order to benefit from cardiac rehabilitation, you have to get on a treadmill and you have to be able to exercise,” Taub said. “But there's a lot of things that we can do with these patients that don't involve getting on a treadmill.”

Physical activities such as aerobic exercise can be implemented in the daily routines of older patients to build skeletal muscle and improve their quality of life.

Taub clarified that the health care community should not dismiss people with physical disabilities, as they can benefit from a myriad of lifestyle intervention programs like cardiac rehab. 

However, the hesitation surrounding these programs is also patient driven. Often, patients will consider themselves beyond help or lack the knowledge on programs and lifestyles that can truly benefit them.

Addition, Taub mentioned that providers are often data driven, and since the medical community is lacking in data on frail and elderly populations, additional effort must be taken to properly inform and enroll patients in quality, life-enhancing programs.

Taub has had countless successes with cardiovascular programs with her patients.

In the interview, she spoke of 1 former patient with bilateral below-the-knee amputations who was skeptical of the benefits of cardiac rehabilitation. Taub convinced the patient to enroll in a strength training program, and in time both she and the patient recorded physical improvements.

“He did a lot of things that really improved his overall quality of life, there's a lot of strength training that he did, there was a lot of resistance work that he did with bands, and by the end of the program, his skeletal muscle mass had increased his visceral fat had decreased his energy level and exercise performance had increased,” Taub said. “So, sometimes just educating patients that there are a lot of things we can offer.”

Dr. Pam Taub speaks on the misconceptions of cardiac rehabilitation and other lifestyle approaches recommended for patients with cardiovascular diseases. 

Pam Taub, MD: Healthy Lifestyle Programs for Patients with CVD

In an interview with HCPLive, Peter Toth, MD,  Director of Preventive Cardiology, CGH Medical Center, spoke on the trends in 

 and what he considers priorities in research. 

Toth presented "Emerging Therapies in Lipid Management" at the 2021 American Society for Preventive Cardiology Virtual Summit on CVD Prevention.   

"I'll be talking about innovative approaches to pharmacologically modulating serum levels of atherogenic level protein," Toth said. "My talk focuses in on reducing LDL, reducing remnants as well as lipoprotein little (a)."

He noted trends in finding ways to both safely and effectively reduce LDL cholesterol (LDL-C). 

"I think you're gonna see a progressive movement toward finding specific means by which to also reduce serum concentrations of remnant lipoproteins," Toth said. "And I think, third, there's definitely considerable movement toward finding ways to effectively and safely reduce lipoprotein, and then fourth, research on HDL is definitely not dead."

He mentioned the agents discussed included bempedoic acid, PCSK9 inhibitors, natural alternatives to PCSK9is, evinacumab, and others. 

"We find that a drug like bempedoic acid can actually reduce LDL somewhere between 18 and 25%, which is pretty darn good," Toth said. "And you can use it in combination with ezetimibe or statin. So it's very versatile and it gives you additive LDL reduction with other drugs." 

Peter Toth, MD, discusses the movement towards new agents in treatment of lipid management.

Peter Toth, MD: Innovative Approaches to Lipid Management 

Articles

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. Prior to joining MJH Life Sciences in 2019, he worked as a digital reporter covering nanotechnology, life sciences, material science and more with 

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A recent study has found statins are underutilized for NASH and NAFLD patients. 

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Researchers from France challenge previous reports of the IL-17 inhibitor treatment resulting in an increased risk of inflammatory bowel disease in patients with immune disorders like psoriasis.

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Gastrointestinal infections were the most common serious infections associated with biologics, according to a cohort analysis. 

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Andrea Mazzocchi, PhD, explains how tissue and blood samples can be used to improve detection, progression, and treatment for cancer in patients. 

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Patients Stress Flexibility in Scheduling Diabetes Test After Gestational Diabetes 

On this episode of Coping After COVID, Dr. Craig Chepke discusses the challenges for schizophrenia patients.

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FDA Approves Odevixibat for PFIC

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