Michael J. Blaha
@MichaelJBlaha
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Preventive Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, @CiccaroneCenter
Johns Hopkins Hospital
Joined February 2013
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I just head some great news! The great Dr. Pam Taub has been promoted to Professor at UCSD. Congratulations to Professor Taub, a leader in cardiometabolic disease!
@CBallantyneMD
@NMHheartdoc
@DLBHATTMD
@DrMarthaGulati
@ErinMichos
@ASPCardio
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I think these SELECT top line results are the most important for preventive cardiology since the JUPITER trial. Incredible implications for our field.
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I will be recruiting for a new preventive cardiology / cardiometabolic medicine fellow
@CiccaroneCenter
for 2023. Now that Match is done, futures are being planned. If interested in this 1 or 2 year position, please DM me.
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It is time again to recruit for our Cardiometabolic Fellowship in the Johns Hopkins Ciccarone Center. This is dedicated for those with SPECIFIC interest in preventive cardiology and cardiometabolic disease. If interested, please DM me and I will ask for your CV and PS.
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Here is a nice summary of the new paper on warranty of CAC=0 from MESA.
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Very High Coronary Artery Calcium (CAC ≥ 1000) and Association with CVD Events, Non-CVD Outcomes, and Mortality: Results from The Multi-Ethnic Study of Atherosclerosis (MESA)
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1/14 To facilitate discussion, I put together brief a tweetorial on the DANCAVAS trial while between sessions here in Barcelona.
@NEJM
link:
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New in
@JACCJournals
: Modeling the Recommended Age for Initiating Coronary Artery Calcium Testing in At-Risk Young Adults
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All cardiologists should push back against incorrect comments that CAC costs $800-1000. That is even high for CTA. CAC most commonly costs $75-200.
@CNN
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US FDA approves Jardiance® (empagliflozin) to treat adults living with heart failure with reduced ejection fraction
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So happy for my two star senior research fellows!
@HassanMirbolouk
matched at Yale, and
@solaorimoloye
matched at Vanderbilt (one of my alma maters). Continues the great
@CiccaroneCenter
tradition! Can't wait to see development of my next group.
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Just received my first copy. Great new textbook to check out, very comprehensive 111 chapters covering cardiovascular medicine and surgery.
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@dmljmd
@JAMAInternalMed
One of the most uninformed pieces I have ever read. The wrong message to send patients in 2021. Instead, we should follow our many great guidelines on this topic.
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A Simple Approach to the Identification of Guideline-Based Coronary Artery Calcium percentiles - MESA.
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Just published in JACC Imaging: Warranty Period of a Calcium Score of Zero
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New
@JACCJournals
article - Coronary Artery Calcium Scoring for Adults at Borderline 10-Year ASCVD Risk: CAC Consortium.
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Multi-Ethnic Study of Atherosclerosis (MESA): JACC Focus Seminar 5/8
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Important Topic! New paper in JCL - Coronary artery calcium scoring in patients with statin associated muscle symptoms
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Nice summary figure. Greatful that NLA considered use of CAC for decisions beyond lipids as well. Very useful statement in my view.
National Lipid Association Releases Official Scientific Statement on Coronary Artery Calcium Scoring for ASCVD Risk Reduction
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Is it time to construct a new coronary artery calcium score?
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Impact of Plaque Burden Versus Stenosis on Ischemic Events in Patients With Coronary Atherosclerosis:
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From
@jaccjournals
: Mean Versus Peak Coronary Calcium Density on Non-Contrast CT: Novel Approaches to Calcium Scoring and ASCVD Risk Prediction. Implications for early CAC.
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@MBittencourtMD
@khurramn1
@drjohnm
@rblument1
@BudoffMd
@DrRumberger
@drmikefarkouh
@DrMarthaGulati
"Calcification is part of aging process" is extremely poorly informed. Healthy endothelial cells actually secret proteins inhibiting calcification. It's a pathologic process. As per Marcio, CAC burden in the Tsimane hunter-gatherers is required reading:
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Pooled Cohort Equations and the competing risk of cardiovascular disease vs. cancer
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What an incredible day for cardiovascular prevention! Dapagliflozin meets one of its primary endpoints, solidifying the SGLT2i class with 3 CVOTs an CVD-REAL, and this is back page news given the REDUCE-IT study!
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I just had a great academic trip to London. I rarely share on social media, but must share quite note on my inspiring trip to Albert Street where I was lived after being born. Walked route mom took me to to regents park.
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Strong argument for the unique nature of CAC >1000. Risk exceeds that of FOURIER trial group.
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Trends in e-Cigarette Use in Adults in the United States, 2016-2018 via
@JAMAInternalMed
part of
@JAMANetwork
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Very important paper, very important concept for clinical practice and aggressive prevention.
Are all pts with obstruc. CAD at equally high risk for subsequent events? Are their risk always⬆️than patients with non-obstruc. CAD?
In our
@JACCJournals
paper we show that 5yr risk varies considerably based on CAD severity and RFs.
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Reminder - open to anyone interested in obesity research and treatment -
@MichaelAlbertMD
today at 200 PM EST.
@CiccaroneCenter
. Link:
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@CircAHA
@CBallantyneMD
@vijay_nambi
Everyone knows a CAC score can be repeated right? See data from MESA (). Events paper to be out shortly. Persistent Zero --> low risk, new CAC --> higher risk. Doesn't have to be one-time life decision at age 40 (statin for life vs. never statin).
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The evolving role of coronary computed tomography in understanding sex differences in coronary atherosclerosis.
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New Insights into Prescribing of SGLT2 Inhibitors and GLP-1 Receptor Agonists by Cardiologists in 2020: Major Barriers Limiting Role - American College of Cardiology
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Assessing the Impact of Coronary Plaque on the Relative and Absolute Relative Risk Reduction with Statin Therapy
@JACCJournals
@CiccaroneCenter
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Incredible views of lower Manhattan yesterday from jersey city.
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A reasonable approach to new onset chest pain of suspected cardiac cause that could be widely adopted, with anticipated long-term benefit.
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This is my favorite paper I have ever published, 4 years in the making: Negative risk factors for CVD in Circulation
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Thought question: If a patient had significant coronary plaque, very high Lp(a), but NO measurable 'real" LDL (all Lp(a)), do you think a statin would still improve outcomes?
No, statins work thru LDL
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Yes-statins modify plaque
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Other (please explain)
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Lipoprotein(a) and Subclinical Vascular and Valvular Calcification on Cardiac Computed Tomography: The Atherosclero…
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What is the warranty period of a CAC score of zero in MESA?
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New important study in
@JACCJournals
: Impact of C-Reactive Protein and Coronary Artery Calcium on Benefit Observed With Atorvastatin - St. Francis Heart RCT. See image below.
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Wow, did I read this right? A colleague claims statins often cause muscle symptoms in more than 50% of patients? Data?
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Opinion poll: An invitation for which test is more likely to reduce mortality?
Colonscopy
107
Non-constrast cardiac CT
167
Mammography
121
PSA
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FDA approves inclisiran for LDL lowering
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@CoronaryDoc
@JACCJournals
@lesleejshaw
@Heart_SCCT
@AChoiHeart
@khurramn1
@ghoshhajra
@RonBlankstein
@ErinMichos
@DrMarthaGulati
@gina_lundberg
@ChinnaiyanMD
@Steph_Achenbach
@RBP0612
@SuhnyAbbara
@lipiddoc
@ASPCardio
@dramitkhera
@DrPascalMeier
@iamritu
@CardioimagenINC
@CMichaelGibson
Please also remember this analysis from the St. Francis Heart Study, which randomized to statins:
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Wow fantastic from Karen Alexander and Pam Douglas. Chest Pain Redux: Updated and Patient-centered
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@JAMACardio
Incredibly misleading tweet here by the journal. Please read the full paper not the tweet. Obstructive coronary disease very rare in young patients.
@MaBMortensen
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E-cigarette Use and Risk of Cardiovascular Disease: A Longitudinal Analysis of the PATH Study, 2013-2019
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Super wow! My initial reaction is that this is the biggest finding for my everyday CV care in the lipid space since JUPITER.
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About our recent paper in NYT: From 0 to 10 Million: Vaping Takes Off in the U.S.
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Evaluation of Sotagliflozin in Patients with Type 2 Diabetes with Chronic Kidney Disease or Acute Exacerbation of Heart Failure: the SCORED and SOLOIST-WHF Trials - American College of Cardiology
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This figure sure makes sense to me.
Finally this conservative & compromised approach can not only incorporate
#PowerOfZero
in CP diagnostic algorithms and still reassure those still on the fence
Let common sense prevail and...
Time to at least acknowledge if not completely accept
#PowerOfZero
for stable CP pts
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@MaBMortensen
@miguelcainzos23
@khurramn1
Amazing job by Dr. Martin Mortensen! Becoming a consistent findings, here is the data from MESA
@MKIttlesonMD
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Is the coronary artery calcium scan a proven tool to improve prediction of heart attack risk?
Yes
401
No
165
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Fifty Men, 3510 Marathons, Cardiac Risk Factors, and Coronary Artery Calcium Scores. - PubMed - NCBI
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Highlights of
#SCCT2018
for me: seeing friends, jeopardy (as always), prevention symposium, gladiators, also chest pain in ED very good session.
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The bigger message behind Amgen’s decision to slash cost of its Repatha cholesterol drug
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If a large randomized screening trial included CAC measurement and long-term follow-up, what would be the ideal outcome to demonstrate benefit of screening?
Myocardial Infarction
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MACE
107
Cardiovascular Death
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All Cause Mortality
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Coronary Artery Calcium Scoring in Current Clinical Practice: How to Define Its Value? - PubMed - NCBI
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Framingham at 70: What We’ve Learned About Women and Heart Disease
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Management of Stable Coronary Artery Disease in Patients with Diabetes Mellitus - American College of Cardiology
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@khurramn1
@KoushikReddyMD
@amitvkhera
@AniruddhPatelMD
@AmiBhattMD
@AmericanHeartMA
@skathire
@MGHHeartHealth
@broadinstitute
@AHAMeetings
@dramitkhera
@ASPCardio
@MedGenomeLabs
@miguelcainzos23
@RonBlankstein
@DrMichaelShapir
@kershawpatel
@DrPJoshi
@alka_kanaya
@MBittencourtMD
@pnatarajanmd
@NEJM
Predicting Age of Conversion to CAC >0: A Role for Polygenic Risk Scores?
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In light of national conversation, remember this critical paper in Annals: E-Cigarette Use Without a History of Combustible Cigarette Smoking Among U.S. Adults | Ann Intern Med | ACP |
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The prevalence and correlates of subclinical atherosclerosis among adults with low-density lipoprotein cholesterol <70 mg/dL: The Multi-Ethnic Stud... - PubMed - NCBI
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9/14 Important – what is mechanism of potential benefit? Not revascularization or surgery, no more AF detected, BP control similar. Answer - medical therapy: Aspirin first and of course statin (Table S5 in paper).
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This is a clinical/research position, so US medical license required, can be post residency or post fellowship.
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The MESA Risk Score app is now available for iPhone:
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Exploring the intersection between genetic risk scores and coronary artery calcium - Mutually exclusive or complementary? - PubMed - NCBI
@michael23ca
@pnatarajanmd
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Statin Eligibility, Coronary Artery Calcium, and Subsequent Cardiovascular Events According to the 2016 USPSTF guidelines. - PubMed - NCBI
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@BevTchangMD
@DrMichaelShapir
@DrMarthaGulati
@DrEugeneYang
@ErinMichos
I think the comparison here is to the drugs we consider after statins (so called residual risk). Semaglutide for weight loss appears to have stronger RRR than further LDL lowering for example (and perhaps CV mortality benefit).
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The Asymptomatic Patient: Risk Factor Score or Calcium Score? - American College of Cardiology
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CANTOS, EMPA-REG, LEADER, CANVAS, SUSTAIN6 - more options for improved CV outcomes! I'l be looking at CV mortality results across trials
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Early Contributors to Healthy Arterial Aging Versus Premature Atherosclerosis in Young Adults: The Bogalusa Heart S…
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Cheers to all those more proud of their kids than of any grant or paper. Central Maryland Champion swim team!
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@khurramn1
@rauldsf_santos
@ChristianDalPo1
@MBittencourtMD
@marciominame
@MaBMortensen
@JohnJeffreyCarr
Calculator for predicting this will be out soon, very excited about a study from CAC Consortium
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@BrettSperryMD
@JAMACardio
@MaBMortensen
Agree that "meaning" section lacks context! Should be: obstructive cad rare in very young, but in rare cases when present, up to 50% can be purely noncalcified, particularly for age <40.
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4th place in States (100 & 200 breast) for a very special 13 year old, no tech suit.
@eagleswimteam
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@pnatarajanmd
@khurramn1
@pabeda1
@AndreZimerman
@JAMACardio
@marstonMD
@amitvkhera
Similar to
@khurramn1
, I think that a polygenic risk score could guide timing of CAC scoring, including at younger age. See this paper:
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Interesting article on Addressing the Mineral Oil issue.
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Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis
Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events
www.ahajournals.org
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Amazing paper by the great Dr. Mortensen.
Proud of our JACC paper showing that "plaque burden, not stenosis, is the main predictor of CVD events". Important data that challenge the current primary/secondary prevention paradigm where focus mainly is on lumen stenosis when quantifying CAD severity.
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On way back to Baltimore. Enjoyed
#SCCT2018
and also time with my family visiting Dallas and Forth Worth. Work and family creates balance.
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Conclusions from this study have already been incorporated into new guidelines on lipid management from the Endocrine Society:
What’s Warranty Period of a Calcium Score
#CAC
of Zero?
Comprehensive Analysis From
#MESA
@JACCJournals
@MichaelJBlaha
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Unmet Role of Cardiologists: Use of Cardiometabolic Drugs that Lower Cardiovascular Risk - American College of Cardiology
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What is your guess about the results of the CIRT study?
Very positive (>15% RRR)
33
Mild positive (5-15% RRR)
35
No net benefit (ben=harm)
39
No benefit, mild harm
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New Important Risk Score paper - Equalization of four cardiovascular risk algorithms after systematic recalibration: individual-participant meta-analysis of 86 prospective studies. - PubMed -
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Great quotes by
@pnatarajanmd
and great picture of
@rblument1
!
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14/14 While we debate, impressive to think that study may have saved 108 Danish lives (can also debate this calculation). Lots to unpack in this trial.
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Important study
SAMPSON- n of 1 trial: Most of statin intolerance from "act of taking tablets, rather than what is in them" Symptoms are real, but helpful communication item for shared decision making
@NEJM
#AHA2020
@dmljmd
@ErinMichos
@DrMarthaGulati
@SethShayMartin
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Selective Use of Coronary Artery Calcium Testing | Ann Intern Med | ACP |
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@DBelardoMD
@DrMarthaGulati
@ASPCardio
@EugeniaGianos
@RonBlankstein
@khurramn1
@DrMichaelShapir
@FaRodriguezMD
My fellow made me do it!
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Awesome paper
Really proud and excited about our new paper in Lancet demonstrating that elevated LDL-C in those aged 70-100 years is associated with increased risk of MI and ASCVD. In fact, per 1 mmol/L increase in LDL-C the relative risk is increased similarly to those aged 50-70 years.
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