🫀 The Spleen–Heart Axis: Could the spleen hold a missing clue to coronary artery disease?
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🫀 Could the spleen hold a missing clue to coronary artery disease? Kamineni et al. used deep learning to extract 107 splenic MRI features in >42,000 UK Biobank participants. 🔬 Ten were associated with CAD, while genomics identified 219 loci—including the enigmatic 9p21 CAD locus. 🧬 The intriguing message: splenic texture—not simply size—may reflect a hematopoietic–inflammatory–genetic axis underlying CAD. ⚠️ External clinical replication was limited, so this is mechanistic discovery, not yet a clinical risk tool.
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🚨❤️ Pregnancy as a Cardiovascular Stress Test: A Window Into Lifelong Cardiovascular Health
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🤰❤️ Pregnancy may be one of our earliest cardiovascular stress tests. A Lancet editorial reminds us that cardiovascular disease complicates up to 15% of pregnancies and accounts for up to one-third of maternal deaths. Gestational hypertension predicts a 6× higher risk of later chronic hypertension, while pre-eclampsia is associated with up to a 3.5× higher risk of heart failure. 💡 The message for physicians: adverse pregnancy outcomes are cardiovascular warning signals—not endpoints. Think preconception ➡️ pregnancy ➡️ postpartum ➡️ lifelong prevention. 🫀
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Great Doctors Series: Pietro d’Abano⚕️ The Great Reconciler
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🔥 Medicine, Heresy & the Stars: Pietro d’Abano Meet Pietro d’Abano (c.1257–1315/16)—physician, philosopher, astrologer, and one of medieval medicine’s great intellectual boundary-crossers. 🩺📚 Drawing on Aristotle, Avicenna and Averroes, his Conciliator tried to reconcile medicine with natural philosophy. His willingness to question accepted explanations eventually collided with the Inquisition. ⚖️🔥 A fascinating reminder that medical progress has always depended on curiosity—and sometimes courage. 🎙️ Great Doctors Series | Where Curiosity Meets Clarity!
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🔥 Drop Aspirin? Not So Fast in High-Ischemic-Risk Patients
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🩸 Drop aspirin after 12 months? A-CLOSE says: not so fast. In 3,203 high-ischemic-risk patients after drug-eluting stenting, clopidogrel alone was noninferior to extended DAPT for net clinical events (5.0% vs 5.1%). But beneath that reassuring composite was a striking trade-off: ischemic events were higher with clopidogrel alone (3.7% vs 1.6%; HR 2.33), while bleeding was lower (1.8% vs 4.1%; HR 0.43). ⚖️ The lesson: “noninferior” does not mean clinically interchangeable. Individualize ischemic versus bleeding risk. ❤️
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💉 Lysis Before Collapse: PRAGUE-26 Changes the PE Conversation
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🫁 Stable—but not safe. Should we intervene before patients crash? PRAGUE-26 randomized 558 patients with intermediate-high–risk acute pulmonary embolism to catheter-directed low-dose alteplase + anticoagulation or anticoagulation alone. The 7-day composite of death, recurrent PE, or cardiorespiratory decompensation/collapse fell from 6.8% to 0.7% (RR 0.10; P<0.001)—mainly through fewer episodes of decompensation. 🎯 Major bleeding was not increased, although 2 intracranial hemorrhages occurred with thrombolysis. 🩸 💡 The emerging paradigm: prevent the crash rather than...
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💊 Food as Medicine—from Beneath the Waves
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🦪 Small Creatures, Mighty Nutrition, Global Impact Could aquatic invertebrates help close the global micronutrient gap? 🌊 A fascinating Nature study finds that current production supplies the equivalent annual requirements of vitamin B12 and selenium for >5 billion people—and copper, omega-3 fatty acids, iodine and zinc for >1 billion. 🦐 💡 Bivalves are particularly rich in iron, iodine, zinc and B12. But nutrition on paper is not nutrition on the plate: sustainability, safety, access, affordability and bioavailability matter. Tiny creatures. Enormous nutritional potential....
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🔌 Unplugging Pulmonary Hypertension: Can Denervation Change Heart Failure?
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🫀 Cut the Signal, Cut the Risk? Could pulmonary-artery denervation change the trajectory of heart failure–related pulmonary hypertension? In PADN-HF-PH, 264 symptomatic patients were randomized to denervation + guideline-directed medical therapy or medical therapy alone. Clinical worsening at 2 years: 25.7% vs 51.5% (HR 0.49; P=0.006). ⚡ A provocative concept: pulmonary sympathetic overactivity may be a modifiable therapeutic target. 🎯 But no sham control, China-only enrollment, and mortality benefit remains unproven
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🧬 Semaglutide, Senescence & Survival: Can GLP-1 Slow Ageing?
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🧬 Could semaglutide do more than treat obesity and diabetes? A fascinating study in aged female mice suggests that late-life semaglutide may act partly as a calorie-restriction mimetic—improving cognition, physical function and glucose control while attenuating multiple hallmarks of ageing. 🐭⏳ Most strikingly, median lifespan increased from 742 to 834 days. The biology implicates nutrient sensing, NAD⁺–sirtuin and insulin–IGF1 pathways.
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30% Fewer Cardiovascular Events: Statins Still Matter After age 70
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🫀 Should we start a statin after age 70? STAREE delivers an important answer. In 9,971 adults ≥70 without cardiovascular disease, diabetes, or dementia, atorvastatin 40 mg reduced major cardiovascular events by 30% over 5.9 years (HR 0.70; NNT 37). 💊 Yet it did not prolong disability-free survival (HR 0.94). The benefit was driven largely by fewer myocardial infarctions and coronary revascularizations. 🎯 Take-home: age alone should not close the door on cardiovascular prevention—but preventing events is not the same as extending healthy life.
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✍️ The Great Translator: How Constantine of Africa Carried Medicine Across Cultures
Dr. RR Baliga's 'Podkast for the Kurious Doc'. Where Curiosity meets Clarity!
🌍 The Monk, the Manuscripts, the Medical Bridge How did Arabic medical knowledge reach medieval Europe? 📚🩺 Meet Constantine the African (c. 1010–1087)—North African physician, multilingual translator, and Benedictine monk at Monte Cassino. His Latin translations of major Arabic medical works helped transmit centuries of scholarship to Salerno and beyond. 🌉 His enduring lesson: medicine advances when knowledge crosses borders. 🎙️ Great Doctors Series — Dr RR Baliga’s Podkast for the Kurious Doc. Where Curiosity Meets Clarity!
info_outlineCoronary CT angiography-guided management of patients
with stable chest pain: 10-year outcomes from the SCOT-
HEART randomised controlled trial in Scotland
Michelle C Williams, Ryan Wereski, Christopher Tuck, Philip D Adamson, Anoop S V Shah, Edwin J R van Beek, Giles Roditi, Colin Berry,Nicholas Boon, Marcus Flather, Steff Lewis, John Norrie, Adam D Timmis, Nicholas L Mills, Marc R Dweck, David E Newby, on behalf of theSCOT-HEART Investigators*
Summary
Background The Scottish Computed Tomography of the Heart (SCOT-HEART) trial demonstrated that management
guided by coronary CT angiography (CCTA) improved the diagnosis, management, and outcome of patients with
stable chest pain. We aimed to assess whether CCTA-guided care results in sustained long-term improvements in
management and outcomes.
Methods SCOT-HEART was an open-label, multicentre, parallel group trial for which patients were recruited from
12 outpatient cardiology chest pain clinics across Scotland. Eligible patients were aged 18–75 years with symptoms of
suspected stable angina due to coronary heart disease. Patients were randomly assigned (1:1) to standard of care plus
CCTA or standard of care alone. In this prespecified 10-year analysis, prescribing data, coronary procedural
interventions, and clinical outcomes were obtained through record linkage from national registries. The primary
outcome was coronary heart disease death or non-fatal myocardial infarction on an intention-to-treat basis. This trial
is registered at ClinicalTrials.gov (NCT01149590) and is complete.
Findings Between Nov 18, 2010, and Sept 24, 2014, 4146 patients were recruited (mean age 57 years [SD 10], 2325 [56·1%] male, 1821 [43·9%] female), with 2073 randomly assigned to standard care and CCTA and 2073 to standard care
alone. After a median of 10·0 years (IQR 9·3–11·0), coronary heart disease death or non-fatal myocardial infarction
was less frequent in the CCTA group compared with the standard care group (137 [6·6%] vs 171 [8·2%]; hazard ratio
[HR] 0·79 [95% CI 0·63–0·99], p=0·044). Rates of all-cause, cardiovascular, and coronary heart disease death, and
non-fatal stroke, were similar between the groups (p>0·05 for all), but non-fatal myocardial infarctions (90 [4·3%] vs
124 [6·0%]; HR 0·72 [0·55–0·94], p=0·017) and major adverse cardiovascular events (172 [8·3%] vs 214 [10·3%];
HR 0·80 [0·65–0·97], p=0·026) were less frequent in the CCTA group. Rates of coronary revascularisation procedures
were similar (315 [15·2%] vs 318 [15·3%]; HR 1·00 [0·86–1·17], p=0·99) but preventive therapy prescribing remained
more frequent in the CCTA group (831 [55·9%] of 1486 vs 728 [49·0%] of 1485 patients with available data; odds ratio
1·17 [95% CI 1·01–1·36], p=0·034).
Interpretation After 10 years, CCTA-guided management of patients with stable chest pain was associated with a
sustained reduction in coronary heart disease death or non-fatal myocardial infarction. Identification of coronary
atherosclerosis by CCTA improves long-term cardiovascular disease prevention in patients with stable chest pain.