Jun 28, 2024 This Week in Cardiology Podcast

Screening echo, multivitamins, wasteful research, another PA sensor for HF, vascular closure devices, and GLP-1 marketing as science research are the topics John Mandrola, MD, discusses this week.
https://www.staging.medscape.com/s/vi...

-TRANSCRIPT-
In This Week’s Podcast
For the week ending June 28, 2024, John Mandrola, MD, comments on the following news and features stories: Screening echocardiography, multivitamins, wasteful research, another pulmonary artery (PA) sensor for heart failure (HF), vascular closure devices (VCDs), and GLP-1 marketing as science research.

TWIC takes next week off to celebrate America’s Independence Day.

Screening for Valvular HD in the Elderly
The European Heart Journal - Cardiovascular Imaging has published a paper on screening that deserves mention. It’s funny how I am developing allergies as I age. If there is one thing in Medicine that is most likely to give me a rash, it is disease creation or medicalization of life. It’s why I despise labels such as stage A HF, pre-hypertension, and pre-diabetes. Being stage A or pre-something is equivalent to getting older and not dying early.

This study chronicles what happens if you invite older patients to have echocardiograms. First author Vasiliki Tsampasian and colleagues mostly from Norwich medical school in the United Kingdom invited about 10,000 older people who had no indication for echocardiography to have echocardiography.

Slightly more than half agreed to have their heart imaged.

The most common types of valvular heart disease (VHD) were regurgitation of the tricuspid (13.8%), mitral (12.8%), and aortic (8.3%) valves. The authors did not include trivial regurgitation.

They noted clinically significant VHD in 2.4% (2.2% moderate and 0.2% severe), with mitral and aortic regurgitation being the most common.

The only characteristic associated with significant VHD was age.

The authors tell us that the number needed to scan to diagnose one clinically significant case of VHD is 42 for individuals ≥ 60 years old and 15 for those ≥75 years old.

The average age of patients was 70 years. Slightly more than half were female.

While the top-line findings were that VHD had a pretty high prevenance, severe disease was found in only seven of more than 4000 patients.

Comments. I am sorry to be critical of this paper. I mean no malice to the authors who were quite balanced and descriptive in the manuscript. They tell us what they found. They write that further studies are needed. Kudos to them and the editors.

I would argue that further studies are not needed. Nearly every attempt at screening for serious disease fails to show a mortality benefit. Even when we screen for diseases like cancer, and vascular disease, we fail to show mortality benefits. Maybe selective aneurysm screening has some promise, but this in highly selected patients.

Screening old people for VHD is like screening for getting wet walking in the rain. VHD is part of aging. If you don’t die at a young age, you stand a very good chance of having an abnormal sonogram.

In this study, seven of 4000 patients had severe valvular heart disease discovered. But how many were labeled with a disease and underwent unnecessary testing? How many developed anxiety about their hearts?

The most common condition of aging discovered was tricuspid regurgitation. Well, it turns out that — at least in the United States — we now have two percutaneous treatments for that. We will soon have direct-to-consumer ads and posters in lobbies of hospitals with messages to ask your doctor about your tricuspid valve.

I realize that the British healthcare system doesn’t have the profit incentives of the American system, but I want to infuse any listener of this podcast with a bit of fear of imaging older people who complain of nothing. Please, friends, resist that urge.

The main job of doctors who care for older people is to not mess up their proven success. Less is almost always more in this group. Ordering tests in older people should scare you.

Vitamins and Wasteful Research

Is Red Meat Healthy? Multiverse Analysis Has Lessons Beyond Meat

May 10, 2024 This Week in Cardiology Podcast

JAMA Network Open has published an observational study on multivitamin use. Once again, I mean no malice to the authors of this study, but I find this large undertaking problematic, even though 86 news outlets reported on it.

The authors begin by telling us that one in three Americans take a multivitamin. They also tell us that the US Preventive Services Task Force has reviewed many randomized controlled trials (RCTs), emphasis on randomized, and found no benefit on important health outcomes vs placebo.

Transcript in its entirety can be found by clicking here: https://www.staging.medscape.com/s/vi...