Cardiac rehabilitation is greatly underused, the Mediterranean Diet absolutely works and the debate over aspirin’s value in cases of atrial fibrillation is not over. Those were just some of the takeaways from Christiana Care Cardiology Consultants’ 25th Annual Update in Cardiology, held Saturday, March 1, in the John H. Ammon Medical Education Center at Christiana Hospital.
Nearly 200 practicing physicians, physician assistants, nurse practitioners, nurses and other health care professionals attended the daylong conference to hear from 13 leaders in the field on subjects including resistant hypertension, statins, new anticoagulants, renal vein ablation and other prominent topics in management and treatment of cardiovascular disease.
“Some of our speakers are long-time colleagues. Others are new to us, but we were able to show them the caliber of presenters we’ve had over the years, people who make them say, ‘Wow, this is a world-class symposium,’” said Program Chair Andrew Doorey, M.D., clinical cardiologist with Christiana Care Cardiology Consultants. “Our goal was to take controversies or uncertainties in clinical practice—frequent things seen every day—and tell people either what the solutions are if they’re known or what’s the best advice based on available evidence. We’re not looking for obscure things or rare things. We’re talking about things that these physicians or nurse practitioners see every day.”
The first of those things was a topic appearing on more and more newsstands and bookshelves these days. In his presentation, William Weintraub, M.D., the John H. Ammon Chair of Cardiology and director of the Christiana Care Center for Outcomes Research, posed the question “Should we all be on a Mediterranean Diet” of olive oil, nuts, seeds, fish, fresh fruits and vegetables, herbs, full grains and low-fat cheese? Citing a trial in Spain featuring nearly 7,500 patients and more than 50 other studies, Dr. Weintraub announced the diet’s many positive benefits—lower rate of strokes, heart attacks and death from cardiovascular disease; decreased risk of metabolic syndrome; lower waist circumference; increased HDL cholesterol; decreased triglycerides; lower blood pressure; lower blood glucose—while highlighting its many selling points to skeptical diners.
“Should we all be on it?” he asked. “One, it’s good for you. Two, it’s delicious. Three, it’s ecologically sustainable. So, yes!”
Nanette Wenger, M.D., was equally enthusiastic in informing her peers of the value of cardiac rehabilitation and the need particularly to refer women, the elderly and even those diagnosed with stable, congestive heart failure to cardiac rehabilitation programs. The professor of medicine (cardiology) emeritus at Emory University School of Medicine and consultant with the Emory Heart and Vascular Center stressed that the benefits of rehabilitation “were comparable to contemporary medical and surgical therapies” and that it decreases hospitalizations, recurrent myocardial infarction and long-term mortality.
Wenger’s fellow presenters spanned a wide range of specialties. Avinash Chandra, M.D., attending cardiologist with Christiana Care Cardiology Consultants, addressed the question of what to use as the third or fourth drug when treating resistant hypertension, but cautioned early in his presentation that other factors must be eliminated before diagnosis of resistant hypertension. Among those is sleep apnea, which Dr. Chandra said can be as high as 70 percent in people seemingly resistant to hypertension treatment.
Joseph Loscalzo, M.D., Ph.D., chair of the Department of Medicine of Brigham and Women’s Hospital and the Hersey Professor of the Theory and Practice of Medicine at Harvard Medical School, presented on “Pulmonary Arterial Hypertension: New Concepts in Pathobiology and Treatment.” Other speakers included Robert Rosenson, M.D., of the Mount Sinai School of Medicine, who presented “Statins: So Good for All, So Hard To Tolerate for Some. How To Manage the Latter;” Zohra Ali-Khan Catts, MS, of Christiana Care’s Helen F. Graham Center & Research Institute; Christiana Care Cardiology Consultants physicians Robin Horn, Michael Stillabower, Henry Weiner and Sandra Weiss; and Peter Kowey, M.D., system division chief, cardiovascular disease, for Main Line Health System, who argued for eliminating aspirin as a stroke prophylaxis tool in atrial fibrillation in the afternoon’s debate. He was opposed by Roger Kerzner, M.D., director of Electrophysiology Research at Christiana Care.
After introducing the program and its chief planner, Timothy Gardner, M.D., medical director of the Center for Heart & Vascular Health at Christiana Care, praised the depth and diversity of the update’s agenda.
“Drew Doorey’s leadership has been so important,” Dr. Gardner said. “Each year, he picks things that are really relevant to the everyday practice of these physicians. There’s a steady increase in new information and new clarifications, and these attendees are working five days a week and need this kind of opportunity. This year was more of the same—great choices of topics, great choices of speakers.”