by HCPLive Cardiology
The Don't Miss a Beat Podcast is a regular news roundup of the latest evidence and clinical trial insights across cardiovascular, renal, and metabolic diseases. Don’t Miss a Beat as Drs. Steve Greene and Muthu Vaduganathan critically examine recent advances in clinical care and research with perspectives from global experts in the field. A vdeo version is available only on HCPLive.com (https://www.HCPLive.com/podcasts/Dont-Miss-A-Beat) .
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April 2, 2025
<div>This episode of <a href="https://www.hcplive.com/podcasts/dont-miss-a-beat">Don’t Miss a Beat</a>, recorded at the <a href="https://www.hcplive.com/conference/acc">American College of Cardiology (ACC) 2025 Annual Scientific Sessions</a>, explores the evolving landscape of <a href="https://www.hcplive.com/clinical/heart-failure">heart failure</a> with preserved ejection fraction (HFpEF) treatment, focusing on the implementation of combination therapies. Hosts Steve Greene, MD, and Muthiah Vaduganathan, MD, MPH, discuss the transition from a previously limited treatment landscape to a new era with multiple proven therapeutic options.<br> <br> To open the episode, Greene argues in favor of rapid-sequence implementation of HFpEF therapies, drawing parallels to the established 4-pillar guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF). He highlights 3 key classes of medications—SGLT2 inhibitors, non-steroidal mineralocorticoid receptor antagonists (MRAs), and incretin-based therapies—as the foundation of HFpEF treatment. He emphasizes the importance of early and aggressive therapy initiation to maximize clinical benefits and reduce the risk of delayed or missed treatment opportunities among this population.<br> <br> Vaduganathan acknowledges the strength of the data supporting combination therapy but suggests a more risk-based approach, considering the broad clinical variability among HFpEF patients. He advocates for prioritizing rapid implementation in high-risk patients, such as those recently hospitalized, while allowing a more measured approach for lower-risk individuals. The discussion also touches on the role of phenotyping in tailoring treatment decisions, with GLP-1 receptor agonists being particularly relevant for patients with obesity and ARNi potentially benefiting those with mildly reduced ejection fraction.<br> <br> Looking ahead, the hosts preview upcoming trials, including CONFIDENCE and CONFIRMATION, which will evaluate combination therapy strategies in chronic kidney disease and HFpEF populations. They also discuss the potential of fixed-dose combination therapies to simplify implementation and improve adherence. The episode closes with both experts agreeing on the need for a structured, evidence-based approach to HFpEF treatment while emphasizing the importance of translating trial data into real-world practice.<br> <br> Relevant disclosures for <strong>Vaduganathan</strong> include Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, Lexicon, and others. Relevant disclosures for <strong>Greene</strong> include Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, and others.<br> <br> <strong>Chapters<br> 00:00-Intro<br> 02:30-Argument for Rapid Sequencing<br> 05:32-Argument Against Rapid Sequencing<br> 10:00-Argument for Risk-Based Sequencing<br> 14:25-Pillars of GDMT in HFpEF<br> </strong><br> <br> <br> </div>
April 1, 2025
<div>In this on-site episode of Don't Miss a Beat from the <a href="https://www.hcplive.com/conference/acc">American College of Cardiology (ACC) 2025 Annual Scientific Sessions</a>, hosts Muthiah Vaduganathan, MD, MPH, and Steve Greene, MD, break down a pair of trials from the meeting: STRIDE and SOUL.<br> <br> <strong>STRIDE Trial</strong><br> The STRIDE trial, funded by Novo Nordisk, was a double-blind, randomized, placebo-controlled study initiated in 2020 to evaluate the effects of semaglutide 1.0 mg (Ozempic) on walking distance in patients with type 2 diabetes (T2D) and peripheral artery disease (PAD). Conducted across 112 sites in 20 countries, the trial enrolled 792 patients, who were randomized 1:1 to receive semaglutide or placebo for 52 weeks.<br> Participants assigned to semaglutide received an escalating dose regimen (0.25 mg to 1.0 mg). The primary endpoint, the ratio from baseline in maximum walking distance at 52 weeks, favored semaglutide (1.21 [interquartile range, 0.95–1.55] vs 1.08 [0.86–1.36]), with an estimated treatment ratio (ETR) of 1.13 (95% CI, 1.06–1.21; P = .0004).<br> Secondary outcomes further supported semaglutide’s benefit. At week 57, the improvement in walking distance was greater with semaglutide (ETR, 1.08; P = .038). Quality-of-life scores (VascuQoL-6) at week 52 were significantly higher in the semaglutide group (median difference, 1.00; P = .011). Pain-free walking distance also improved more with semaglutide than with placebo (ETR, 1.11; P = .0046).<br> <br> <strong>SOUL Trial</strong><br> The SOUL trial was a double-blind, placebo-controlled, event-driven study designed to assess the cardiovascular effects of oral semaglutide (Rybelsus) in patients with T2D and atherosclerotic cardiovascular disease (ASCVD) and/or chronic kidney disease (CKD). The trial enrolled 9650 patients aged ≥50 years and was conducted across 450 centers in 44 countries. Participants were randomized 1:1 to receive semaglutide or placebo, with a mean follow-up of 47.5 months.<br> Primary outcome events occurred in 12.0% of participants receiving semaglutide (3.1 events per 100 person-years) compared with 13.8% in the placebo group (3.7 events per 100 person-years), resulting in a hazard ratio (HR) of 0.86 (95% CI, 0.77–0.96; P = .006). The primary driver of benefit was a 26% reduction in nonfatal myocardial infarction, with additional reductions in nonfatal stroke (12%) and cardiovascular death (7%). No significant improvements in kidney function were observed.<br> Serious adverse events occurred slightly less frequently in the semaglutide group compared with placebo (47.9% vs 50.3%; P = .02). However, gastrointestinal adverse events, including nausea, diarrhea, constipation, and flatulence, were more common in the semaglutide group (5.0% vs 4.4%). Benefits were consistent across subgroups, including participants receiving sodium-glucose cotransporter-2 inhibitors.<br> <br> Relevant disclosures for <strong>Vaduganathan</strong> include Amgen, AstraZeneca, Bayer AG, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, Lexicon, and others. Relevant disclosures for <strong>Greene</strong> include Amgen, AstraZeneca, Bayer Healthcare Pharmaceuticals, Boehringer Ingelheim Pharmaceuticals, Cytokinetics, and others.<br> <br> <strong>Chapters<br> 00:00 - Intro<br> 00:50 - STRIDE Background<br> 02:50 - STRIDE Results<br> 08:19 - SOUL Background<br> 10:40 - SOUL Results</strong> </div>
October 3, 2024
<div>In this episode of <em>Don't Miss a Beat</em>, hosts Muthiah Vaduganathan, MD, MPH, and Steve Greene, MD, are joined by Taher Modarressi, MD, to explore the practicalities of implementing cardiometabolic therapies in clinical practice. Modarressi shares his experiences establishing a cardiometabolic clinic and offers invaluable advice on overcoming barriers like insurance coverage and cost issues. The discussion provides real-world strategies for integrating advanced treatments for conditions such as obesity, diabetes, and cardiovascular disease, while ensuring patient access to these therapies.<br> <br> <strong>Chapters</strong><br> <strong>Introduction - 00:00</strong><br> <strong>Acquiring Expertise in Cardiometabolic Health - 02:29</strong><br> <strong>Advice for Aspiring Cardiometabolic Health Specialists - 04:09</strong><br> <strong>Practical Aspects of Running a Cardiometabolic Practice - 07:30</strong><br> <strong>Navigating Insurance and Cost Barriers - 08:43</strong><br> <strong>Practical Tips for Implementing Cardiometabolic Therapies - 20:21</strong><br> <strong>Conclusion and Final Thoughts - 22:54</strong> </div>
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