Recent advances in preventive cardiology and lifestyle medicine: A decade of discovery.

Recent studies have shown that patients who experience acute cardiac events often times had poor dietary habits, were physically inactive, smoked cigarettes, or combinations thereof. Consequently, these three

lifestyle habits have become increasingly known as “the most proximal risk factors” and should be increasingly addressed by the medical community. Indeed, conventional risk factors (cigarette smoking, high blood pressure, elevated blood cholesterol, obesity, diabetes, and physical inactivity) now account for 75 to 90 percent of the population attributable risk of cardiovascular disease. Psychosocial risk factors (depression, stress, social isolation, anger and hostility) and air pollution are believed to account for most of the remaining or “unexplained” risk. Collectively, these data highlight the value of lifestyle modification and contemporary pharmacotherapies in the prevention of initial and recurrent cardiovascular events as these interventions, in tandem, provide independent and additive cardioprotective benefits. Scan the QR code below to listen to a thorough presentation on the subject matter.

Advances in management of abdominal aortic aneurysm

Ruptured abdominal aortic aneurysm is the 13th leading cause of death in people older than 60 years of age. Traditional elective repair consisted of a large abdominal incision, seven day hospital stay and six weeks to

recuperate. Aortic endografts are an accepted minimally invasive alternative requiring markedly smaller incisions, a single overnight hospital stay and a 10 to 14 day recovery.

Technological advances continue to allow catheter-based methods to treat increasingly complex aorto-iliac aneurysms. Beaumont vascular surgeons are consistently involved in these clinical trials, including fenestrated techniques to maintain blood flow to renal arteries for treatment of juxtarenal aortic aneurysms, and branched endografts to maintain pelvic circulation when treating iliac artery aneurysms.

Scan the QR code to listen to a thorough presentation on the subject matter.

Atrial Fibrillation

RESEARCHBeaumont’s Heart and Vascular Research department is one of the largest in the country with many ongoing leading edge clinical research trials.

Selected Current Trials

ABSORB: Bioresorbable coronary stent

The scaffolding effect of a coronary stent is only needed for several months after implantation, so there has been interest in developing stents that are fully absorbed by the body, thus avoiding the need for a permanent implant. In this clinical study, the Absorb Bioresorbable Vascular Scaffold (BVS) will be compared with the Xience everolimus-eluting stent. The Absorb BVS is gradually resorbed over 6-12 months, which has several theoretical benefits such as restoring the artery to its natural function, minimizing the need for long-term medications such as clopidogrel (Plavix), and improving the accuracy of subsequent diagnostic testing with techniques such as coronary computed tomographic angiography. Principal Investigator: AMR ABBAS, M.D. Coordinator: DOROTHY RICHARDSON, 248-898-9161; dorothy.richardson@beaumont.edu

CAP II: Left atrial appendage closure in atrial fibrillation

The left atrial appendage is a frequent source of embolism in patients with atrial fibrillation (AF). Closure of the atrial appendage with the WATCHMAN device is a promising treatment option to reduce risk of stroke and thromboembolism, especially in patients unable to take oral anticoagulation. Previous clinical trials, including PROTECT-AF and PREVAIL, have established the safety and efficacy of percutaneous left atrial appendage closure. Four-year data from PROTECT-AF suggest a statistically significant 40 percent relative risk reduction in death/stroke/systemic embolism in patients treated with WATCHMAN compared with warfarin alone. CAP II is a continued access registry and will enroll any AF patients with CHADS2 score ≤2 who are able to tolerate a minimum of six-weeks oral anticoagulation post-procedure.Primary Investigator: STEVEN ALMANY, M.D. Coordinator: ANN MCHUGH, R.N. 248-898-4627; amchugh@beaumont.edu

DECLARE study: Dapagliflozin effect on cardiovascular events

Dapagliflozin is referred to as a sodium glucose co transporter 2 (SGLT2) inhibitor to treat Type II Diabetes. The DECLARE study will determine whether adding dapagliflozin to a patients current anti-diabetes therapy will be effective in reducing cardiovascular events such as myocardial infarction, ischemic stroke, and cardiovascular related death, compared with a placebo.

Principal investigator: PHILIP KRAFT, M.D. Coordinator: COLEEN TESSMAR, 248-964-8524; ctessmar@beaumont.edu

JUNE 2013, ISSUE V | TRENDING NEWS IN HEART & VASCULAR DISEASE AND SERVICES

Visit: heart.beaumont.edu for other Beaumont Health System heart and vascular information.

Diagnosis and management of low gradient aortic stenosis

Severe aortic stenosis is usually defined by a calculated aortic valve effective orifice area (EOA) of < 1.0 cm2 and a mean trans-aortic valve gradient of ≥ mmhg. “Low-flow, low-gradient” aortic stenosis may be observed in up to 30 percent of patients with severe aortic stenosis (EOA <1.0 cm2, mean gradient < 40 mmhg). The diagnosis and management of

such patients is one of the most challenging situations encountered in the treatment of patients with valvular heart disease. These patients typically undergo dobutamine echocardiography stress imaging to obtain a proper diagnosis. These and other diagnostic studies facilitate selection of appropriate patients for surgical (or transcatheter) aortic valve replacement. Scan the QR code below for a presentation on proper diagnosis and management of these patients.

D ID YOU KN OW ?

Doctors at Beaumont Hospital, Troy performed Michigan’s first robotic Maze procedure to correct atrial fibrillation. For more information on the most advanced treatments for atrial fibrillation, contact the Atrial Fibrillation Clinic at 888-683-7678.

3601 West 13 Mile Rd. | Royal Oak, MI 48073-6769http://heart.beaumont.edu

MARK YOU R CALEN DAR

U P CO M I N G CO N FE RE N CES/EVE NTS

S.E.T. North, presented by Beaumont Health SystemAug. 10, 2013TROY MARRIOTT, TROY, MI

Update in Women’s Heart HealthSept. 20, 2013TOWNSEND HOTEL, BIRMINGHAM, MI

Advances in Cardiovascular Non-Invasive Imaging and Interventions Oct. 3-5, 2013TROY MARRIOTT • TROY, MI

Practical Update in CardiologyNov. 9, 2013MARRIOTT CENTERPOINT • AUBURN HILLS, MI

23rd Annual Cardiovascular ConferenceFeb. 9-12, 2014BEAVER CREEK, CO

To register for any of the above conferences, visit: heart.beaumont.edu/classes-and-events.

For more information about Heart and Vascular Continuing Medical Education, contact Shannon Herrington, CMP, Heart and Vascular Education at 800-732-6368 or email heartandvascularconferences@beaumont.edu

To receive the Beaumont Heart & Vascular Update for Physicians e-newsletter, opt-in at heart.beaumont.edu or scan our code below.

Visit: heart.beaumont.edu for other Beaumont Health System heart and vascular information.

NON-PROFIT ORGU.S. POSTAGE

PAIDPERMIT NO. 404ROYAL OAK, MI

TRENDING NEWS IN HEART & VASCULAR DISEASE AND SERVICES

BEAUMONT HEART & VASCULAR UPDATE FOR PHYSICIANS

EDITORS:

Steven Almany, M.D. &

Simon Dixon, MBChB, FACC

For more information visit: heart.beaumont.edu or to talk to a Beaumont heart and vascular specialist, call 888-877-8766.

DEBATES

Interventional therapy for hypertension Pro: Ready for Primetime, James Jollis, M.D.; Con: Wait! Not enough data, Steven Almany, M.D.

Hypertension affects approximately 25 to 30 percent of all adult Americans. It is a significant cause of cardiovascular mortality. Approximately eight million Americans are taking more than three medications for their blood pressure. The interventional treatment of hypertension may be the hottest thing on

the interventional horizon. Scan the QR code below to listen to a presentation on the pro’s and con’s of interventional therapy for hypertension.

For atrial fibrillation (AF) patients stable on warfarin, there is no need to switch to a novel agent. Pro: Stick with Warfarin, Christopher Granger, M.D., Duke University Con: You should switch, David Haines, M.D., Beaumont Hospital

Introduction of the novel oral anticoagulants (NOACs) to the cardiologist’s tool kit has been a great step forward in the field of managing patients with atrial fibrillation (AF). Dabigatran (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) are highly effective in preventing stroke in patients with non-valvular AF. They

are equivalent to or better than warfarin (Coumadin), and offer significantly improved patient convenience since no blood testing is required. However, they are expensive. While practitioners have been bombarded with claims of the virtues of the NOACs, many believe that “if it isn’t broken, don’t fix it”.

Debate has ensued whether or not to switch a patient from warfarin to a NOAC if the patient is stable and well controlled on warfarin.

Scan the QR code to listen to a debate between two experts in the field on this topic.