Studies look at nerve stimulation, TAVR vs. SAVR, and how doctors prescribe drugs for heart risk
Comparing aortic valve replacement procedures
Many patients with aortic stenosis, a narrowing of the valve that supplies the body’s largest artery, also have atherosclerosis, or hardening of the arteries. Aortic stenosis is commonly treated with a minimally invasive procedure called transcatheter aortic valve replacement (TAVR) or a traditional procedure known as surgical aortic valve replacement (SAVR). Although the use of TAVR has grown significantly in recent years, how its outcomes compare to SAVR for patients with both aortic stenosis and systemic atherosclerosis – defined as involvement of two or more atherosclerotic vascular beds, including coronary artery disease, peripheral arterial disease, or cerebrovascular disease – has not been assessed.
Researchers, including two from UT Southwestern, found answers using the Nationwide Readmissions Database, which tracks data from 14 million U.S. hospital admissions each year. Results from 545,409 hospitalizations for aortic valve replacements between 2016 and 2020, reported in Cardiology and Therapy, showed patients with systemic atherosclerosis who received TAVR were significantly less likely than those who received SAVR to die in the hospital or have a heart attack, stroke, or major bleeding. However, TAVR patients were more likely to receive a pacemaker and/or have nonelective 90-day readmissions. The authors suggest more research is necessary to explore interventions to decrease TAVR complications in this high-risk patient population.
Anthony Bavry, M.D., M.P.H., Professor of Internal Medicine at UT Southwestern, and Dharam Kumbhani, M.D., Professor of Internal Medicine and Section Chief/Director of Interventional Cardiology, contributed to the study.
Deciding between drugs to lower cardiovascular risk
Patients with both Type 2 diabetes and atherosclerosis are at increased risk of heart attacks, strokes, and other major adverse cardiovascular events (MACE). Two classes of drugs, known as sodium glucose co-transporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs), have shown equal effectiveness in reducing this risk. However, why doctors prescribe one over the other has been unclear.
In a study published in Frontiers in Cardiovascular Medicine, researchers led by a team from UT Southwestern used the hospital’s electronic health records to create a registry of 573 patients who had Type 2 diabetes and atherosclerosis and were prescribed drugs from one of the two classes between January 2019 and October 2024. An analysis of the patients showed those who received prescriptions from a cardiologist were more likely to receive a SLGT2i, while those who received their prescriptions from an endocrinologist, had a higher body mass index, or had a higher glomerular filtration rate (a measure of kidney function) were more likely to receive a GLP-1RA. Future research is needed to understand the most appropriate use of these drug classes for patients beyond their cardioprotective benefits, the authors say.
UTSW researchers who contributed to the study are first author Shubham Agarwal, M.B.B.S., Endocrinology Clinical Fellow; senior author Ildiko Lingvay, M.D., M.P.H., M.S.C.S., Professor of Internal Medicine and in the Peter O’Donnell Jr. School of Public Health; Daniel Heitjan, Ph.D., Professor in the O’Donnell School of Public Health; Mujeeb Basit, M.D., M.M.Sc., Associate Professor of Internal Medicine; Michael Bowen, M.D., Associate Professor of Internal Medicine, Pediatrics, and Public Health; Christine Mai, B.S., Business Analyst; Kelsea Marble, M.S., Programmer/Architect Lead; and Zichang Xiang, Ph.D., Consultant.
Dr. Lingvay receives personal consulting compensation from Boehringer Ingelheim Pharmaceuticals.