Episodes
Friday Dec 14, 2018
Another Attempt to ARRIVE at an Answer Using Aspirin for Primary Prevention
Friday Dec 14, 2018
Friday Dec 14, 2018
Daily low-dose aspirin has long been considered a “wonder drug” for its cardioprotective effects, particularly in patients with pre-existing cardiovascular and cerebrovascular disease; however, despite decades of research, the use of aspirin to prevent a first event is less certain. In 2014, the Food and Drug Administration (FDA) responded to a citizen petition requesting the labeled indications for low dose aspirin be updated to include primary prevention. The FDA concluded that the evidence “fail[ed] to establish that aspirin reduces the risk of primary myocardial infarction (MI) in patients with a coronary heart disease (CHD) risk of 10% or more for over 10 years.” The Asprin to Reduce Risk of Initial Vascular Events (ARRIVE) study is intended to address this gap in our knowledge.
Guest Authors: Amy St. Amand, PharmD, BCPS and Christine Borowy, PharmD, BCPS
Music by Good Talk
Friday Dec 07, 2018
Does a “One-Size-Fits-All” Aspirin Dosing Approach Still Hold WEIGHT?
Friday Dec 07, 2018
Friday Dec 07, 2018
Personalized medicine is at the forefront of health care today, focusing on how best to tailor the treatment approach to each person. But should we be thinking about personalizing the approach for prevention as well? The one-dose-fits-all approach has been used in nearly all aspirin studies. What is poorly understood is the influence of body weight. Perhaps the reason why aspirin has resulted in only modest benefits in clinical trials might be related to under (and over) dosing based on patient weight.
Podcast Case: Weight-based Dosing of Aspirin
Guest Author: Marina Maes, PharmD, BCPS
Music by Good Talk
Friday Nov 23, 2018
Friday Nov 23, 2018
Aspirin is no doubt beneficial in patients with overt vascular disease for the secondary prevention of myocardial infarction, stroke, or cardiovascular death. However, evidence supporting use of aspirin for primary prevention in patients who have not had a cardiovascular event is far less compelling. The clinical uncertainty of aspirin use for the primary prevention of CV events in patients with diabetes is reflected in the different recommendations in current guidelines. The investigators of the ASCEND (A Study of Cardiovascular Events in Diabetes) trial set out to determine the safety and efficacy of daily aspirin use in patients with diabetes without known occlusive arterial disease.
Podcast Case: ASA Use in DM - Evidence ASCENDing?
Guest Author: Kirstie Perry, Pharm.D.
Music by Good Talk
Friday Oct 12, 2018
Friday Oct 12, 2018
The American College of Chest Physicians (ACCP) recently updated their guideline recommendations for the use of antithrombotics for the prevention of stroke in patients with atrial fibrillation (aka the Chest Guidelines). Find out what's new, who shouldn't receive treatment based on the CHA2DS2-VASc score, and why the guideline panel recommends calculating a patient's SAME-TTR score.
Guest Author: Dylan Lindsay, PharmD
Music by Good Talk
Friday Jun 15, 2018
Hypertension – Time for Patients to Control the Wheel
Friday Jun 15, 2018
Friday Jun 15, 2018
Traditionally, the management of hypertension requires routine blood pressure checks by a health professional to adjust medications. Could self-monitoring lead to better outcomes? Would a greater percentage of patients achieve their goal blood pressure (BP)? Self-monitoring may be an efficient method to improve blood pressure control; however, results from published reports are inconsistent. The authors of the TASMINH4 study sought to compare the effectiveness of three different approaches to BP monitoring.
Guest Authors: Vicky Shah, PharmD, BCPS and Daniel Longyhore, MS, PharmD, BCPS
Music by Good Talk
Thursday May 10, 2018
Strategies for Managing Hypertension: Is the Paradigm Shifting?
Thursday May 10, 2018
Thursday May 10, 2018
Forty-five percent of all adults in the United States have high blood pressure — that’s more than 100 million people! Of those treated with pharmacotherapy, more than half are not achieving their blood pressure goals. Thus, millions of Americans are receiving suboptimal care. A recently published systematic review and meta-analysis examined various implementation strategies to improve BP control in patients with high blood pressure. Which implementation strategies work best?
Guest Author: Lauren G Pamulapati, PharmD
Music by Good Talk
Friday Jan 05, 2018
Friday Jan 05, 2018
We’ve all seen and used the American College of Cardiology 10-year atherosclerotic cardiovascular disease (ASCVD) risk calculator. There are several modifiable risk factors such as blood pressure, cholesterol, and smoking status that, if addressed, can lower ASCVD risk. But are there other modifiable risk factors that we are failing to account for and might be able to address? New evidence suggests systemic inflammation may be one.
Guest Authors: Ian Hatlee, Pharm.D and Scott Pearson, Pharm.D.
Music by Good Talk
Friday Dec 15, 2017
Friday Dec 15, 2017
We interview Eric MacLaughlin, Joseph Saseen, and Kristin Rieser about the ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in Adults released in November 2017. Dr. MacLaughin, a member of the Guideline Writing Committee, gives a insiders view of the guidelines development process and explains the rationale for lower blood pressure goals. Drs. Saseen and Rieser talk about some of the practical considerations that we all must consider as we move forward to making these recommendations a reality.
Guests: Kristin Rieser, Pharm.D., Joseph Saseen, Pharm.D, and Eric MacLaughlin, Pharm.D.
Music by Good Talk
Friday Dec 08, 2017
Friday Dec 08, 2017
Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. The potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest. In the setting of CAD, warfarin has resulted in significant more major bleeding when given either alone or in combination with antiplatelet agents when compared to aspirin alone. Therefore, clinicians have been reluctant to embrace the combination of an anticoagulant plus an antiplatelet agent. However, could DOACs have a role in stable CAD? The COMPASS trial aimed to find an answer.
Guest Authors: Candyce Bryant, Pharm.D., Joy Hoffman, Pharm.D., and M. Shawn McFarland, Pharm.D.
Music by Good Talk
Friday Oct 13, 2017
Painting a New CANVAS for SGLT-2 Inhibitors?
Friday Oct 13, 2017
Friday Oct 13, 2017
While good glycemic control has been shown to prevent microvascular complications (e.g. retinopathy, nephropathy, neuropathy), only a few anti-diabetic agents have been shown to reduce macrovascular complications (e.g. cardiovascular events. Empagliflozin, a sodium glucose transporter-2 (SGLT2) inhibitor, not only reduced the risk of CV events but also all-cause mortality in the EMPA-REG OUTCOME study. Based on this data, the SGLT2 inhibitors were given favorable second-line treatment status in the most recent AACE/ACE clinical practice guidelines. But do all SGLT2 inhibitors confer the same benefits… and risks? The Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes (CANVAS) trial assessed the cardiovascular and renal benefits from long-term canagliflozin use. The results are both reassuring and unexpected.
Guest Author: Sean Lasota, Pharm.D.
Music by Good Talk