Last September 10th, Cardiopapers held a symposium in São Paulo, with the objective of bringing the main news in cardiology in an innovative model of teaching and interaction with the audience. The event was attended by all Afya Digital Health teams, such as Whitebook, iClinica, Ipemed, Glic and Além da Medicina. Several guests participated, especially authors of the main national guidelines and physician Renato Lopes, an international researcher.
What are the main messages for “take home?”
- Heart failure (HF): there were two main discussions. The first, on classification, with the proposal to divide the CI into reduced ejection fraction (ICFER: FE < 40%), IC com fração de ejeção intermediária (ICFEi: 41-49%) e a IC com fração de ejeção preservada (ICFEP, FE > 50%), in addition to HF with improved ejection fraction, which are patients previously HFpEF, but who recovered with clinical treatment. Another important point was the result of the Deliver study, with the benefits of dapaglifozin in patients with HFpEF.
- About diabetes mellitus (DM), Dr. Renato Lopes showed the benefits of GLP-1 agonists, such as semaglutide and the long-awaited terziparatide (actually, a GLP-1 and GIP coagonist), which allow not only a glycemic reduction, but also an important weight loss. Obesity is a key player in type 2 DM and in cardiovascular and hepatic complications, such as NASH (non-alcoholic steatohepatitis).
- In the area of dyslipidemia, the importance of reducing LDL to the goal of < 50 mg/dl was reinforced in order to obtain the maximum possible minimization of the risk of cardiovascular events. As many patients do not achieve this goal even with the maximum dose of statin, interest in complementary drugs grows. Ezetimibe has the advantage of dosage convenience, but studies question whether it adds a reduction in the risk of AMI, stroke or death. PCSK9 inhibitors are commercially available, but cost and route of administration are still important barriers. The launch of incliseran is expected in the national market, considered the “cholesterol vaccine”, as biannual injections would bring an important and lasting reduction in LDL, as presented at the last ACC congress.
- In hypertension, Dr. Audes Feitosa showed the importance of home blood pressure measurements, by ABPM or HMBP. Mean blood pressure at home is a more accurate predictor of cardiovascular events than in-office measurements alone. Today, the increasing availability of standardized and tested automatic arm devices has expanded the use of this methodology. Through an internet connection, it is possible to directly transmit the data to your doctor, allowing a more precise and individualized adjustment of the antihypertensive medication.
- In the section on acute coronary disease, the highlights are the importance of stratifying high and very high risk patients for early coronary angiography and the administration of the second antiplatelet agent in the room, after knowing the anatomy, with prasugrel, ticagrelor and clopidogrel.
- Among the highlights of the valvular heart disease guideline, there is an increasing indication and use of TAVI in aortic stenosis, now approved for patients with moderate to high surgical risk. The expectation, with the long-term results, is that this modality becomes the first option for the treatment of senile aortic stenosis due to calcification. On the other hand, there are still few data and much doubt in younger patients with bicuspid aortic valve and aneurysmal aortic root. In the area of mitral regurgitation, the two main topics were the use of mitraclip in patients with advanced HF and high surgical risk, as well as the earlier use of plasty in patients with severe MR alone.
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