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Dr Deepak Bhatt Discusses Cardiologists’ Role in COVID-19

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During the surge of the pandemic in the northeast, we saw about a 40% reduction in cardiovascular admissions, while there was a higher rate of mortality among patients who came in, said Deepak L. Bhatt, MD, MPH, of Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School.

That’s a great question so as far as reduce it we’ve asked the analysis that you’re referring to that was presented prior to this european society of cardiology that is an analysis that was presented as a late-breaking clinical trial at sky the society of cardiovascular angiography and intervention with an encore presentation at the american society of preventive

Cardiology so a lot of that data is already out there though not yet published so what reduce it revast did was look at the entire trial of reduce it but then look at the end point of revascularization what was found with significant reductions in revascularization with benefits that were significant by about 11 months so an early benefit there again much

Earlier than we previously appreciated beyond that when we looked at the types of revascularization elective urgent emergent revascularization each of those distinct categories of revascularization was significantly reduced and then we even looked at the occurrence of pci percutaneous coronary intervention during the trial and also of cabbage coronary bypass

Grafting during the trial and each of those subtypes of revascularization were individually statistically significantly reduced with effect sizes that were as large as what was seen decades ago in the 4s trial when stantons first came on the scene so it’s a really large effect that we’re seeing on revascularization both in relative and also absolute terms and

I find it remarkable that in a blinded trial with independent adjudication of endpoints that the end point of coronary artery bypass grafting is significantly reduced so that to me reflects the substantial effect of icosapent ethyl on atherosclerosis and progression of atherosclerosis and bolstering that concept the nine-month data from the evaporate trial a

Mechanistic imaging study of icosapent ethyl using the same drug and dose that reduce it did there the nine-month data as published in cardiovascular research the interim data already showed that multiple different markers of plaque composition and volume were favorably affected significantly affected by acos of pentethyl versus placebo and interestingly the

Final results of that study were also presented as a late-breaking clinical trial dsc the 18-month result so now we have several sources of data showing us that icosapentethyl does seem to kick in pretty early in particular for endpoints of plaque progression and for endpoints of revascularization to answer the second part of your question how is that relevant

When we’re living in a pandemic that’s a really great question so of course in the setting of a pandemic we’ve seen i’ll tell you in the uh mass general brooklyn healthcare system we’ve seen about a 40 reduction that occurred in cardiovascular admissions during the surge of the pandemics i’m talking about late march april may so when things were really bad

In the northeast including in boston and it isn’t that patients suddenly weren’t having heart attacks or didn’t need care they were understandably afraid to come into the hospital so there was a real downtick in cardiovascular admissions but of those patients that came in there was a higher rate of mortality so it’s really a double whammy patients that should

Come in aren’t coming in the ones that come in are in pretty bad shape and i think in that context anything we can do to further reduce cardiovascular risk the sort of stuff we should really do anyway but in particular in the context of a pandemic anything we can do to control risk factors and help keep patients appropriately out of the hospital that is keep

Them well and healthy and not really needing to go to the hospital would be even more important so i would say for sure patients that are eligible for icosapentethyl should be on it but i would generalize that further to say if they’re if they should be on a statin you know make sure they’re on it make sure they’re taking it make sure they’re filling their

Prescriptions and not just letting their prescription run out and not going to the pharmacy or or getting their prescriptions delivered or however they get their medicines and i would extend that as well to things like blood pressure control glycemic control in patients with diabetes so i it’s very clear that patients that are dying from covet infection have

Heightened cardiovascular risk so i would at least like to think anything we do to reduce that cardiovascular risk would alter their trajectory and perhaps decrease covert related morbidity and mortality but even if that hypothesis isn’t true i would still think doing all these different things i mentioned still the right thing to do that is if someone has an

Indication to be on a statin or more intense glycemic or blood pressure control or on icosapentethyl or whatever cardiovascular risk reduction is indicated in their case well they should be on it even if it’s not a pandemic but perhaps it’s even more important if they are in the middle of a pandemic so it’s an interesting question sure well there’s no question

That culved causes a lot of cardiovascular morbidity studies vary but there’s a significant chunk of patients with positive troponin and i don’t mean just low level barely positive i mean within the range that one would normally say oh myocardial infarction maybe not necessarily the slope of change but the magnitude of troponin elevations can be quite high so

There is substantial cardiovascular damage that’s occurring in the context of cobin 19 related illnesses and it seems like persistent risk including cardiovascular risk including cardio pulmonary risk in people that survive coping now this is magnified in people with cardiovascular risk factors and people at older age and people with obesity and people with

Diabetes so cardiovascular prevention i think is an important part or should be an important part of our overall strategy towards dealing with cobit 19 that is controlling risk factors before people potentially get infected and certainly those that have survived a cobia 19 illness to make sure to take care not only of any coba 19 specific related issues that

Have developed under all sorts of issues issues like cognitive dysfunction that have been raised and just lots of different problems but in particular to not forget that cardiovascular risk reduction is also part of what those patients often need because such a high prevalence of them have cardiovascular disease or risk factors for cardiovascular disease so i

Would say that even though it’s easy to focus on the cobin 19 aspects of that patient’s care and illness to not forget all the important cardiovascular prevention things that we should normally be doing anyway but in the setting of a patient that is at risk for or has cobit 19 we shouldn’t forget about in fact it might be even more important in that type of patient

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Dr Deepak Bhatt Discusses Cardiologists' Role in COVID-19 By AJMCtv