2018 Scientific Sessions: The High CV Risk Patient: It’s Not Just About Lipids

The High CV Risk Patient: It’s Not Just About Lipids

If You Don't Snooze, You Lose: Obstructive Sleep Apnea and CVD
Edward R. Chafizadeh, MD
Cardiologist
Cardio Texas
Austin, TX

In this presentation, Edward Chafizadeh, MD, discussed how obstructive sleep apnea is a risk factor of cardiovascular disease. Sleep apnea occurs in 20-30% of males, while 10-15% of females experience symptoms.

Autonomic effects of apnea have both direct (e.g. arrhythmias, CHF) and indirect (risk factor worsening) effects of cardiovascular health. Overall, study data on improved outcomes a bit thin (SAVE study—Mcevoy et al; NEJM 2016: 375: 919) but smaller studies and intermediate endpoint data seems to favor aggressive approach to diagnose and treat.

Take home messages from the presentation included:

Be Alert to the Possibility that Sleep Apnea is Lurking

• Cardiovascular Risks go up with Untreated Sleep Apnea
• Difficult to Control Risk Factors may be Untreatable unless sleep apnea is effectively reversed or treated
• A CPAP machine is the “gold standard” for treatment, but outcomes data for cardiovascular risk reduction isn’t super convincing, so if possible reversal of sleep apnea with weight loss, lifestyle changes or surgery (if appropriate) may be a better path to take

When CV Health Goes Up in Smoke: CV Risks of e-Cigarettes and Marijuana
Tina M. Kaufman, PhD, PA-C
Assistant Professor of Medicine
Knight Cardiovascular Institute
Division of Cardiovascular Medicine
School of Medicine
Oregon Health and Science University
Portland, OR

In this presentation, Tina Kaufman, PhD, PA-C, discussed the emergence of e-cigarettes, marijuana use and each of their impacts on cardiovascular risk.

Though e-cigarettes are perceived as a “healthier” alternative to traditional cigarettes, they still do contain other carcinogens. There is also strong evidence that frequent low or short-term levels of exposure to ultrafine particles (tobacco smoke or air pollution) can increase the risk of cardiovascular and respiratory disease and death. The best advice for patients regarding smoking cessation is for them to quit all traditional tobacco use and to set a quit date for e-cigarette use.

Cardiovascular risks associated with elevated systolic and diastolic blood pressure, tachycardia, an increase of sympathetic stimulation, decreased time to angina and increased use of MI for one hour post-marijuana use. For patients using marijuana for medical use, Dr. Kaufman advised the audience to tell their patients to transition to tincture or topical oils.

Obesity and CVD Jeopardy: When Bariatric Surgery is the Answer
Catherine J. McNeal, MD, PhD, FNLA
Associate Professor of Internal Medicine
Associate Professor of Pediatrics
Director, Nutrition and Weight Management Program
Baylor Scott & White Health
Temple, TX

In this presentation, Catherine McNeal, MD, PhD, FNLA, reviewed the impact of obesity on cardiovascular disease, guidelines for obesity treatment: lifestyle, medications, surgery and the benefits of obesity treatment.

As obesity is a chronic disease with significant associated conditions with morbidity and mortality, lifestyle changes such as improvement of diet and exercise are important. If lifestyle changes do not work in patients with a BMI >30 or >27, drug therapy should be considered. If the patient’s BMI >40 or 35‐39.9 with one comorbidity, bariatric surgery should be considered.

Patients should monitor their weight frequently, and effective counseling methods such as journaling, goal-setting and accountability should be instituted.