Tom Hyde

Posted with permission. 57 male screening CTCA after heart concern. Asymptomatic. Rx OMT - ACE-I Statin ASA. CMR - Lifestyle advice given. Any other suggestions? @DrDerekConnolly @DrScottMurray @LondonCardiacCT @NickCurzen @mirvatalasnag @ColinBerryMD @HRahbi @danmckenzie73

@venkmurthy It seemed to show it leads to more preventative therapy in patients with coronary calcium. Maybe something in this approach. Outcome data not there yet, agreed but prevention is a laudible aim.

Randomized evidence that CAC leads to more downstream investigations pubmed.ncbi.nlm.nih.gov/36342823/

@khurramn1 @minhaskh Maybe they just wanted a score, I think a score can be approximated from a non gated scan using software. The key is communicating the message to patients and healthcare workers that there is a prevention opportunity

Don't understand the dichotomy on this issue in the cholesterol management guidelines. 1. CAC>100: Class 1 rec intensive LLT management, LDL target <70 (AGREE) 2. Moderate to severe incidental CAC on non gated , where almost exclusively you will have close to create than >100 on gated: Class II for same LDL goals <70 (DISAGREE WITH CLASS REC) Any thoughts on this?

@pabeda1 @DrRyanPDaly @khurramn1 Yes, 💯, it's possible to post analyse Lung Cancer Scans with Coreline to score and make LLT recommendations in primary care it's on our to do list, we hope the UK NICE guidelines can embrace calcium soon.

@DrRyanPDaly @khurramn1 🎯

@khurramn1 , in this section, the guidelines consider "intensifying LLT" upon identification of incidental CAC by CT. 👇

@FCademartiri Great study, thanks We have seen this anecdotally with plaque healing and intensive rx. This may explain the low event rates in the OMT only arms of recent revasc trials such as ISCHEMIA. Is there a way of being more precise, which plaques will still cause events despite Rx?

🫀📉 Can more intensive LDL-lowering improve CT-FFR in stable chest pain? This new JACC study evaluates whether intensive lipid-lowering therapy (statin + ezetimibe) alters CT-derived fractional flow reserve (FFR-CT) — a noninvasive marker of lesion-specific ischemia — in patients with stable chest pain and coronary atherosclerosis. 🔍 Study essentials Patients with stable angina and coronary plaque on CT angiography were managed with aggressive lipid-lowering using statins plus ezetimibe, targeting substantial LDL-C reduction. FFR-CT was measured at baseline and on follow-up to assess functional changes in coronary physiology attributable to therapy. 📈 Key message The core focus — integrating structural and functional imaging — points to a key concept: lipid-lowering can potentially improve lesion physiology, not just plaque burden. By using FFR-CT (a validated surrogate for invasive FFR), the authors are examining whether aggressive LDL-reduction actually shifts physiological indices toward less ischemia. 🧠 Why this matters Lipid-lowering benefits have traditionally been shown at the event level (MI, death). Structural plaque regression with statins/ezetimibe is documented in IVUS and CT studies. But fewer data exist on functional improvement in coronary blood flow with therapy. Linking lipid therapy to improved FFR-CT suggests that LDL-lowering may not only slow plaque progression but also improve coronary physiology — a potential mechanistic bridge to clinical benefit. 📌 Bottom line: Intensive lipid-lowering might influence not only plaque morphology but lesion-specific ischemia as assessed noninvasively, expanding our understanding of how therapies translate into physiological improvement.

@mitcharj @CaristoHeart @ESC_Journals Interesting data, so 38% of patients with Normal CTCA had a high or very high CariHeart score, these would normally be reassured and scanned in 10 years, if at all. Do we know if this is a typical rate of elevation? Just curious.

Coronary inflammation and AI-Risk scores from cardiovascular computed tomography: impact on risk prediction and clinical management in a real-world setting academic.oup.com/ehjimp/article… #AI #risk #prevention #JerseyHeartTeam #FAI @CaristoHeart @ESC_Journals

@drjohnm It's evidence of plaque, which is part of the human condition. Some would say when that plaque causes symptoms, or a heart attack then it is disease so not black and white. More calcium more risk.

Disagree

@FCademartiri @vineetcardio Great article. We generally treat patients not plaques. In the asymptomatic patients. Optimal prevention, serial imaging and shared decision making. There's no rush to stent. Some will try expand the indication a for PCI to plaque sealing "just in case". We have more to learn

🫀⚖️ High-risk coronary plaques: intervene early—or hold the line? This 2026 EuroIntervention Viewpoint by Mintz & Collet delivers a sober, evidence-driven answer to one of interventional cardiology’s most debated questions: should we prophylactically stent “high-risk” plaques, or manage them medically and wait? 🔍 What defines a high-risk plaque? Across invasive and non-invasive imaging, features such as large plaque burden, small MLA, thin-cap fibroatheroma, large lipid core, low-attenuation plaque, positive remodelling, napkin-ring sign, and spotty calcification consistently associate with future events. Lesions with multiple features are riskier—but here’s the catch 👇 📉 Absolute risk is low Despite ominous imaging, annual hard event rates (death/MI) are ~1%, and most plaque ruptures are clinically silent, contributing to progression rather than ACS. This reframes the entire preventive-PCI debate. 🧪 What do randomized trials show? PROSPECT ABSORB and PREVENT tested preventive PCI vs optimal medical therapy (OMT). PCI improved lumen dimensions and reduced future revascularizations, but did not reduce death or MI at 2, 4, or 7 years. In PREVENT, 739 PCIs prevented only 20–36 later PCIs—a poor trade-off. Meta-analysis confirms: benefits are driven by fewer procedures, not fewer hard events. ⏳ What happens if we wait? Long-term follow-up (PROSPECT II, PREVENT) shows very low event rates with OMT and delayed PCI when symptoms arise, avoiding most upfront interventions without penalty. 🧠 Where the field is heading The authors advocate a “hold-the-line” strategy: Detecting high-risk plaque should trigger intensified medical therapy and surveillance, not automatic PCI. Future precision may come from integrating imaging + physiology + inflammation, to identify the rare plaques whose rupture truly matters. 🔮 Bottom line Until we can predict **which plaques will cause death or MI—not just progression—**the data favor medical therapy first, PCI later if needed. Seeing risk ≠ fixing it with a stent 🚀

@DrAjaykishore82 @InocaInternati1 @jckaski @DrMarthaGulati @CardioOBDoc @ehj_ed @worldheartfed @Servier @Hragy @BenSaaud @Sudanheartgroup @cvrints @girishviswa @CardioIAN @Marta33717088 @Tebaldi_Matteo @estelais @sminaev2015 @ramonlopezpalop @DrCCaroli @fikkumamoto @Ahmed43101178 You always have our support ❤️😎👍

@InocaInternati1 @jckaski @DrMarthaGulati @CardioOBDoc @ehj_ed @worldheartfed @Servier @Hragy @BenSaaud @Sudanheartgroup @cvrints @girishviswa @CardioIAN @CotsCardiology @Marta33717088 @Tebaldi_Matteo @estelais @sminaev2015 @ramonlopezpalop @DrCCaroli @fikkumamoto @Ahmed43101178 🙏🏻

💥 SOMETHING BIG IS COMING...! 💥 Our next INOCA International newsletter will be launching very soon - and you won't want to miss this one as it includes ⭐ A MAJOR INOCA ANNOUNCEMENT ⭐ ⭐ A LANDMARK MOMENT FOR INOCA ⭐ ✅ Subscribe - contact@inocainternational.com #INOCA

@vgaldana @SABOURETCardio @DrDerekConnolly @JosephLDixon1 @LipidLover1030 @ExpertLipid @lipo_fan @RadhaJoseph @BevTchangMD @titu_helen @rblument1 @stecacMD @OungSavly @Anton_Arumairaj @Pooh_Velagapudi @azinkh96 @khurramn1 @Marta33717088 @PopiolekKalisz Great work, individualised care leads to benefits. One size does not fit all. A bit like shoes.

@SABOURETCardio @DrDerekConnolly @JosephLDixon1 @LipidLover1030 @ExpertLipid @lipo_fan @RadhaJoseph @CotsCardiology @BevTchangMD @titu_helen @rblument1 @stecacMD @OungSavly @Anton_Arumairaj @Pooh_Velagapudi @azinkh96 @khurramn1 @Marta33717088 @PopiolekKalisz Heterogeneity of Lipoprotein(a) Levels Among Hispanic or Latino Individuals Residing in the US jamanetwork.com/journals/jamac…

#Lipoprotein(a) and Cardiovascular Risk in #Asian Populations: pubmed.ncbi.nlm.nih.gov/40492182/

Great Ron, we 'got' this in the @NHSEngland in our language, we are in the process of getting this for all in the UK. @DrDerekConnolly @HarrisSital @DrScottMurray @Paddy_Barrett

Cheers Ron.🍵

Thanks Boss, @drjohnm

Khurram we are planning this in the UK we have @CorelineSoft lined up. 1.4 million scans, let's see what we can do @BirkhoelzerS @DrDerekConnolly @HarrisSital @DrScottMurray @RonKarlsbergMD @TheBHF @BritishCardioSo @DailyMail

@BritishCardioSo Most enjoyable, Thankyou, Tom 👍😎🍕🩷 @HarrisSital @BirkhoelzerS

🚨🚨 Don't forget that our next BCS webinar takes place tonight from 6:30pm - 8pm! This time we'll be talking 'Hot Topics in Ischaemic Heart Disease Management' with our expert panel. You'll also be able to ask questions during the designated Q&A segment after the talks. Not booked your place yet? It's free, and registration is open until 4pm > tinyurl.com/IHDWebinar #CardioTwitter #Cardiology #CardioEd

@BirkhoelzerS @BritishCardioSo 🩷👠thanks Sarah👍😎

A must watch for us all @BritishCardioSo

@HarrisSital @RonKarlsbergMD @DrDerekConnolly @DrScottMurray @DHSCmedia @MyHeartPrevent @DrRiyazPatel @mdstbarts This looks interesting, how about cutting edge technology for coronary disease prevention. Could work 🤔 Any suggestions hive mind #FOAM @society_eas @SABOURETCardio @ProfKausikRay @DrAsifQasim @Medscape @drkevinfernando @drpatrickholmes @DrRaniKhatib

We can do this for coronary disease @HarrisSital @RonKarlsbergMD @DrDerekConnolly @DrScottMurray @DHSCmedia, were here to help, and willing @MyHeartPrevent trials "oven ready" @DrRiyazPatel @mdstbarts

…s.britishcardiovascularsociety.org.uk/events Looking forward to this, looks interesting, open for all @HarrisSital @BirkhoelzerS 👍🩷😎

We can do it for common diseases as well, coronary artery disease for starters @TheBHF @BritishCardioSo, I think there's a webinar tomorrow night??