Are Weight-Loss Medications Following a Seasonal Trend Like Gym Memberships?

 Key Takeaways

• GLP-1 drugs show seasonal demand, peaking in early months and slowing later in the year.
• Eli Lilly’s earnings misses may be partly due to this pattern, not declining demand.
• Investor expectations must factor in seasonality when evaluating sales trends.

---

Seasonal Trends in GLP-1 Demand

• Unlike chronic disease treatments, GLP-1 drugs behave more like gym memberships, with higher demand in the first half of the year.
• People set weight-loss resolutions in January, leading to spikes in prescriptions for Ozempic, Wegovy, Mounjaro, and Zepbound.
• New patient sign-ups slow in the second half, similar to fitness trends where gym memberships surge early and drop later.
• Evercore ISI analyst Umer Raffat found this trend dating back to 2016, indicating a consistent pattern.

---

Implications for Eli Lilly’s Growth

• Eli Lilly missed earnings projections twice in a row due to lower-than-expected GLP-1 sales.
• The stock dropped after these earnings reports, confusing investors who expected steady growth.
• If seasonality explains part of the decline, it means demand remains strong, just cyclical.
• Projections suggest Mounjaro and Zepbound could reach $25 billion in sales in 2025, pushing total revenue beyond $62 billion.
• This would put Eli Lilly’s revenue at the upper end of its $58B-$61B forecast.

---

Beyond Seasonality: Barriers to GLP-1 Access

• Unlike gym memberships, obtaining GLP-1 drugs is complicated:
  • Insurance restrictions and high costs limit access.
  • Employer reluctance to cover expensive weight-loss drugs is a major barrier.
  • List prices exceed $1,000 per month, making out-of-pocket costs unaffordable for many.
• Only half of large employers cover GLP-1 medications, and smaller businesses rarely do.

---

What’s Next?

• Eli Lilly might see a strong rebound in Q1 and Q2 of 2025, but should temper expectations.
• If the company raises revenue forecasts too aggressively, it risks another earnings miss later in the year.
• Investors should factor in seasonality when evaluating sales trends, as GLP-1 usage may follow annual weight-loss cycles.

🔹 Bottom Line: The GLP-1 market isn’t slowing—it’s seasonal. Drugmakers and investors must adjust expectations accordingly.

How Ozempic and Legal Weed Are Changing What America Eats

 Key Findings

• GLP-1 drugs like Ozempic reduce snack sales by 6%-9%, reshaping the food industry.
• Cannabis legalization boosts junk food purchases by 9%, fueling the munchies effect.
• Food companies are adapting, launching products catering to both trends.

---

The Ozempic Effect: Appetite on Pause

• Drugs like Ozempic and Wegovy help people lose weight by suppressing appetite.
• GLP-1 users spend less on snacks, pastries, and ice cream while buying more yogurt and vegetables.
• Food industry leaders worry about the drug's impact on sales, with companies like Nestlé and Danone adjusting product lines.
• Walmart reports that households with GLP-1 users buy less food overall.
• The GLP-1 market is projected to hit $100 billion by 2030.

---

Cannabis Legalization: The Munchies Are Big Business

• Recreational cannabis is now legal in 24 states.
• Snack, cookie, and candy sales jumped 9% in states with legalized marijuana.
• Marijuana users are driving demand for high-calorie comfort foods.

---

A Collision of Cultural Forces

• GLP-1 drugs promote weight loss, while cannabis legalization fuels junk food consumption.
• Food companies are responding with new products:
  • High-protein, portion-controlled meals for GLP-1 users.
  • Indulgent snacks for cannabis consumers.
• Nestlé and Conagra are leading this shift, balancing both consumer demands.

---

Economic and Health Impacts

🔹 Cannabis legalization benefits:

• Increased tax revenue (Colorado and California have earned billions).
• Job creation and economic growth.
• Fewer arrests and a shift in law enforcement priorities.

🔹 Public health concerns:

• Substance use has increased slightly in some states.
• Some studies show cannabis may reduce opioid deaths and alcohol consumption.

🔹 GLP-1 drug challenges:

• Industries reliant on indulgent eating must rethink strategies.
• Long-term effects on consumer behavior remain unknown.

---

What’s Next?

• Will GLP-1 drugs lead to healthier lifestyles, or will the munchies win out?
• Both trends are reshaping industries, forcing companies to innovate like never before.
• The food industry must adapt to a changing market driven by health-conscious and cannabis-using consumers.

GLP-1 Users Are Spending Less on Groceries and Fast Food, Study Finds

 Key Findings

• Households with GLP-1 users reduced grocery spending by 5.5% in the first six months.
• Higher-income households showed a larger reduction (8.6%) in food spending.
• Spending on ultra-processed foods, snacks, and sweets declined the most.
• Fast food and coffee shop purchases dropped, especially at breakfast and dinner times.
• Purchases of nutrient-dense foods like yogurt, fresh produce, and nutrition bars remained stable.
• Spending reductions plateau at six months but remain significant after 12 months.

---

Study Details

• Published on December 27, 2024, the study used Numerator data from 150,000 households tracking GLP-1 medication use and food purchases.
• It included off-label users, offering a comprehensive view of spending trends.
• The difference-in-differences framework compared GLP-1 users vs. non-users across 40 product categories.

---

Changes in Food Spending

🔻 Decreased Spending On:

• Ultra-processed foods like chips, sweets, and high-calorie snacks.
• Impulse purchases at grocery stores.
• Dining out, particularly at fast food chains and coffee shops.

🔺 Stable or Increased Spending On:

• Nutrient-dense foods like yogurt, fresh produce, and protein bars.

---

Implications for the Food Industry

• Food brands are adapting, with new high-protein, high-fiber products hitting the market.
• Restaurants, especially fast food chains, may need to adjust menus to appeal to health-conscious consumers.
• Long-term effects suggest GLP-1 use is reshaping consumer food demand rather than being a temporary trend.

"GLP-1 medications are significantly changing how people shop for food, a shift that will impact the food industry as adoption continues to grow," researchers concluded.

NT-proBNP Cutoffs for HFpEF Diagnosis May Need Adjustments

Key Points

• Current NT-proBNP cutoffs for diagnosing heart failure with preserved ejection fraction (HFpEF) may not be optimal in outpatient settings.
• Obesity impacts NT-proBNP thresholds, requiring lower values for accurate HFpEF diagnosis.
• Atrial fibrillation (AF) itself is a strong marker of HFpEF, making NT-proBNP less useful in these patients.

---

Study Findings

• Current NT-proBNP threshold of <125 pg/mL to rule out HFpEF had:
  • 77% sensitivity overall.
  • 82% sensitivity in patients with BMI < 35 kg/m².
  • 67% sensitivity in patients with BMI ≥ 35 kg/m².
• Lowering the cutoff to <50 pg/mL improved sensitivity to:
  • 97% in BMI < 35 kg/m².
  • 86% in BMI ≥ 35 kg/m².
• To rule in HFpEF, the cutoff should be:
  • ≥ 500 pg/mL for BMI < 35 kg/m² (85% specificity).
  • ≥ 220 pg/mL for BMI ≥ 35 kg/m² (88% specificity).

---

Key Implications

• Current cutoffs may lead to misdiagnosis, especially in obese patients with HFpEF.
• Lower NT-proBNP values (30-50 pg/mL) may be necessary to truly rule out HFpEF.
• Nearly all AF patients in the study (98%) also had HFpEF, making NT-proBNP less helpful in diagnosing HFpEF in this group.

---

Why This Matters

• HFpEF treatments are now effective, so accurate diagnosis is crucial.
• Missing HFpEF due to incorrect NT-proBNP thresholds could delay life-saving treatment.

---

Call for Further Research

• New biomarkers, such as endothelin-1 and adrenomedullin, may be better for HFpEF diagnosis, as they are not affected by obesity.
• Larger, multicenter studies with invasive validation are needed to confirm findings.

This study suggests that clinicians should reconsider NT-proBNP cutoffs for HFpEF, particularly in obese patients, to improve diagnosis and treatment outcomes.

"Higher Lp(a) Levels Linked to Greater Risk of Coronary Stenosis in Chest Pain Patients"

 The Story:

• Elevated lipoprotein(a) (Lp(a)) levels are associated with a higher chance of finding coronary stenosis in patients with stable chest pain and suspected coronary artery disease (CAD).
• This study suggests that Lp(a) measurements may improve the way clinicians evaluate CAD risk, especially when combined with coronary computed tomography angiography (CCTA).

Key Findings:

• The study analyzed data from over 4,000 patients with chest pain.
• Normal Lp(a) levels were present in about half the population, while moderately elevated, high, and very high levels were found in the remainder.
• Higher Lp(a) levels were linked to more cases of coronary stenosis (narrowed arteries) and multivessel disease.

Rates of Coronary Stenosis and Multivessel Disease:

• Normal Lp(a): 23.5% had coronary stenosis; 10.4% had multivessel disease.
• Very high Lp(a): 33.9% had coronary stenosis; 18.1% had multivessel disease.
• The likelihood of stenosis increased as Lp(a) levels rose, even after adjusting for factors like age, sex, and other risk factors.

Why This Matters:

• Patients with elevated Lp(a) may benefit more from CCTA, which helps detect atherosclerosis, assess risk, and guide treatment.
• High Lp(a) levels often indicate more plaque in the arteries and higher risk of CAD, even when other risk factors are considered.

Looking Ahead:

• Researchers aim to explore whether Lp(a) can improve current models for predicting coronary stenosis.
• Studies are also needed to determine if lowering Lp(a) can slow plaque buildup or reduce CAD risk.

Take-Home Points:

1. Lp(a) is an important marker for coronary artery disease risk, particularly in patients with chest pain.
2. Higher Lp(a) levels are linked to a greater chance of coronary stenosis and multivessel disease.
3. CCTA is a valuable diagnostic tool for patients with elevated Lp(a), as it helps assess both plaque burden and risk stratification.
4. Measuring Lp(a) should prompt more aggressive management of other risk factors like cholesterol, blood pressure, and lifestyle changes.
5. Future studies will focus on integrating Lp(a) into predictive models and evaluating the effects of Lp(a)-lowering therapies on CAD outcomes.

"Sarcopenia and Sarcopenic Obesity: Risks for Older Adults"

 The Story:

• Sarcopenia (loss of muscle strength and mass) and sarcopenic obesity (a mix of low muscle and high fat) are common in older adults and linked to higher death rates.
• These conditions are becoming more common as people live longer and face changes in body composition, such as more body fat and less muscle.

Key Findings:

• A study analyzed data from a large group of older adults over a 10-year period.
• 11% of participants showed signs of muscle loss (probable sarcopenia), while 2% had confirmed sarcopenia.
• 5% of participants had sarcopenic obesity with one altered body component (like high fat), and 1% had two altered components (low muscle and high fat).
• People with sarcopenic obesity were more likely to die earlier than those without it.

What Increases the Risk?

• Sarcopenia alone raised the chance of death by 29%.
• Sarcopenic obesity with one altered body component increased the risk by 94%, while two altered components nearly tripled the risk.
• These risks remained the same regardless of age, sex, or body weight.

Why Does It Matter?

• Sarcopenic obesity combines the harmful effects of weak muscles and high body fat, worsening health outcomes.
• These conditions often go unnoticed, even though they are preventable with early action.

How Can We Help?

• Screening muscle strength (like handgrip tests) can help identify people at risk early.
• Nutrition and exercise programs can slow down or even reverse muscle loss and fat gain.
• A mix of non-medical approaches (healthy eating and fitness) and medical treatments may be the best way to address sarcopenic obesity.

Take-Home Points:

1. Sarcopenia and sarcopenic obesity are serious risks for older adults, increasing the likelihood of early death.
2. Combining low muscle strength and high body fat amplifies health problems.
3. Early screening for muscle function is critical for identifying at-risk individuals.
4. Exercise and balanced nutrition are key to preventing and managing these conditions.
5. A combined approach of lifestyle changes and medical care can improve outcomes for older adults facing these challenges.

"Polypills: A Cost-Effective Solution for Cardiovascular Disease Prevention in Underserved Communities"

 The Story:

• A polypill-based strategy may provide a cost-effective method for primary prevention of cardiovascular disease (CVD) in historically underserved U.S. communities.
• The estimated cost ranges from $8,560 to $13,400 per quality-adjusted life-year (QALY) gained, offering high value for populations with limited healthcare access and low income.

Research and Findings:

• The analysis was based on two simulated U.S. cohorts:
  1. Southern Community Cohort Study (SCCS): Included 100,000 individuals representing a population of low-income adults, primarily Black, with limited healthcare access.
  2. Trial-eligible cohort: Included 3.6 million non-Hispanic Black adults eligible for primary prevention.
• In the SCCS cohort, the polypill provided 1,190 additional QALYs compared to usual care, at an average cost of $8,560 per QALY.
• In the larger trial-eligible cohort, the polypill yielded an estimated cost of $13,400 per QALY, remaining a high-value intervention.

How the Polypill Works:

• The polypill combines fixed doses of medications for blood pressure (BP) and LDL cholesterol (LDL-C) management, improving adherence and reducing the need for dose adjustments.
• In the SCCS trial, the polypill significantly lowered systolic BP and LDL-C levels compared to usual care, addressing critical risk factors for CVD.
• The estimated cost of the polypill was $463 annually, with potential healthcare cost savings if priced below $443 annually.

Why the Polypill is Cost-Effective:

• Fewer physician visits are required due to improved BP control among treated patients.
• Polypills enhance health equity by addressing disparities in CVD prevention across low-income, underserved populations.
• Despite its exclusion from Medicare price negotiations, expanding Medicare’s negotiation remit could further enhance its cost-effectiveness.

The Need for Regulatory Approval:

• Poverty is a pervasive social determinant of health, and its association with CVD is epidemic in underserved U.S. communities.
• Regulatory approval and implementation of the polypill would provide a disruptive solution to address both CVD prevention and health disparities.

Take-Home Points:

1. The polypill offers a cost-effective strategy for primary CVD prevention in underserved communities, with costs as low as $8,560 per QALY.
2. Combining BP and LDL-C management medications in a single pill improves adherence and reduces healthcare costs.
3. The polypill addresses health disparities, promoting health equity for populations disproportionately affected by CVD.
4. Regulatory approval and expanded pricing negotiations are essential to ensure accessibility and affordability of the polypill.
5. A polypill strategy represents a step forward in addressing the dual crises of poverty and cardiovascular disease in the U.S.

"Social Media Strategies for Physicians: Building Your Brand and Practice Professionally"

 The Story:

• Social media has become a powerful tool for physicians to connect with patients, combat misinformation, and build their personal brand.
• With over 80% of internet users aged 18-49 seeking health information on social platforms, physicians are increasingly encouraged to embrace this form of communication.

Why Physicians Should Be on Social Media:

• Social media allows physicians to educate patients, advocate for their specialty, and attract new clientele.
• It provides a platform to combat misinformation, particularly from unqualified influencers.
• Physicians can share their expertise, showcase procedures, and highlight medical conditions they treat, creating trust and relatability with potential patients.

Best Platforms and Content Tips:

• Platforms like Instagram are user-friendly and versatile for linking to various resources.
• Videos (reels) are engaging and allow for creative expression with music, captions, and voiceovers.
• A mix of before-and-after photos, professional insights, and collaborations with peers can help build a strong following.
• Authenticity is key—physicians should remain true to their personality, as patients value genuine representation.

How to Create a Professional Profile:

• Highlight credentials and specialty training in the bio to establish credibility.
• Showcase diversity by including images of patients from different backgrounds to demonstrate inclusivity.
• Engage with comments and collaborate with other healthcare professionals to grow your network.

Monetizing Social Media Presence:

• Physicians can explore partnerships with brands but should be selective, only endorsing products they genuinely believe in.
• Contracts with brands should be carefully reviewed to avoid conflicts of interest and legal issues.
• Transparency is critical—mark posts as paid content to maintain trust and comply with platform rules.

Social Media Don’ts:

• Avoid discussing politics, religion, or using controversial content that could alienate followers.
• Refrain from posting unprofessional photos or videos, such as those involving alcohol or improper conduct in medical settings.
• Always obtain written consent from patients before sharing their images and ensure posts adhere to privacy regulations.
• Do not include identifiable details about patients in posts to avoid breaches of confidentiality.

Handling Negative Feedback:

• Block and delete hateful comments to maintain a positive online environment.
• Address negative reviews by identifying the patient (if possible), resolving their concerns, and asking them to remove the comment.
• Respond thoughtfully to unresolvable issues, seeking legal advice before posting replies.

Final Advice:

• Focus on engaging content rather than chasing numbers—every view represents an opportunity to educate and connect.
• Enjoy the process and use social media as a way to enhance your practice while staying professional and true to your values.

Take-Home Points:

1. Social media is a valuable tool for physicians to build their brand, educate patients, and combat misinformation.
2. Platforms like Instagram provide versatility for sharing professional and relatable content.
3. Authenticity and professionalism are critical for gaining and maintaining trust.
4. Physicians can monetize their presence responsibly while avoiding legal pitfalls and maintaining transparency.
5. Addressing negative feedback constructively and protecting patient confidentiality are essential to a successful online presence.

"Morning Coffee: A Brew for Better Health and Longevity"

 The Story:

• New research highlights the importance of coffee timing, showing that morning coffee consumption may significantly reduce risks of all-cause and cardiovascular disease (CVD) mortality.
• Data was analyzed from 40,725 adults in the National Health and Nutrition Examination Survey (1999–2018) and 1,463 adults from the Lifestyle Validation Study.

Key Findings:

• Two coffee-drinking patterns were identified:
  1. Morning-type pattern (36% of participants).
  2. All-day-type pattern (14% of participants).
• During a median follow-up of 9.8 years, there were 4,295 all-cause deaths, 1,268 cardiovascular deaths, and 934 cancer deaths.
• Compared to non-coffee drinkers, the morning-type pattern was associated with:
  • A 16% lower risk of all-cause mortality (HR: 0.84; 95% CI: 0.74–0.95).
  • A 31% lower risk of CVD mortality (HR: 0.69; 95% CI: 0.55–0.87).
• Higher coffee intake was beneficial only for morning coffee drinkers, not for those with the all-day-type pattern (P-interaction = 0.031).

Commentary:

• Morning coffee consumption shows health benefits, irrespective of the amount consumed or other confounders, according to this study in the European Heart Journal.
• “This is the first study testing coffee timing patterns and health outcomes,” 
• Previous research linked coffee to reduced risks of type 2 diabetes, CVD, and premature death, but this study suggests timing is a critical factor.

Mechanisms Behind the Findings:

• Morning coffee consumption may reduce risks by aligning with circadian rhythms, avoiding disruptions to melatonin and other hormones.
• Coffee contains antioxidants that neutralize free radicals, reducing inflammation and cardiovascular risks.
• Anti-inflammatory effects may be strongest in the morning, when inflammatory markers in the blood are highest.

Considerations and Limitations:

• The study was observational, so it shows associations but not causal relationships.
• Recollection biases in dietary data and lack of genetic information could affect findings.
• Morning coffee drinkers may have healthier lifestyles, such as exercising and eating fewer ultra-processed foods, which might partially explain the results.

Practical Tips for Adjusting Coffee Intake:

• If transitioning to morning-only coffee, ensure adequate sleep or consult a sleep specialist if necessary.
• Dilute daytime coffee servings or pair them with water for hydration.
• Check for underlying causes of fatigue, such as thyroid issues or iron deficiency.

Conclusions:

• Drinking coffee in the morning is associated with better health outcomes, particularly a lower risk of premature death and cardiovascular disease.
• Timing of coffee consumption may play a key role in its cardioprotective benefits.

Take-Home Points:

1. Morning coffee consumption is linked to lower risks of all-cause and cardiovascular mortality.
2. Circadian rhythm alignment and anti-inflammatory properties may explain the timing-related benefits.
3. Timing of coffee intake is a modifiable factor for promoting longevity.
4. Practical adjustments, such as restricting coffee to mornings and addressing sleep issues, can maximize health benefits.
5. Further research is needed to explore causal relationships and refine dietary guidance for coffee consumption.

"Ultra-Processed Foods: A Hidden Threat to Cardiovascular Health"

Story:

• Poor dietary habits are a critical determinant of cardiovascular health and a modifiable risk for cardiovascular disease (CVD).
• Plant-based, Mediterranean, and DASH diets have demonstrated significant cardioprotective benefits.
• The standard American diet remains high in ultra-processed foods (UPF) and low in fruits, vegetables, whole grains, and lean proteins.

What Are Ultra-Processed Foods?

• UPFs are highly processed, calorie-dense, nutrient-poor foods developed for palatability, durability, and affordability.
• They are high in fat, sugar, salt, and preservatives, with little to no nutritional value.
• Examples include prepackaged snacks, processed meats, fried foods, and sweetened beverages.

NOVA Classification System:

• The NOVA system categorizes foods into four groups based on their processing level:
  1. Unprocessed or minimally processed foods: Natural foods altered minimally (e.g., fresh fruits, vegetables, grains, and milk).
  2. Processed culinary ingredients: Extracted substances used for cooking (e.g., oils, butter, sugar, and salt).
  3. Processed foods: Foods modified with ingredients like sugar or salt (e.g., canned vegetables, fruits in syrup, and cheese).
  4. Ultra-processed foods (UPFs): Industrial formulations with little to no whole foods, often containing additives (e.g., soft drinks, packaged snacks, and frozen meals).

The Impact of UPFs on Health:

• High UPF consumption (42.8-49.6% of daily calories) increases the risk of CVD by 17% and coronary heart disease by 23%.
• UPFs disrupt the gut microbiome, impair caloric regulation, and trigger overeating.
• Diets rich in UPFs are linked to hypertension, type 2 diabetes, stroke, and metabolic syndrome.

Social Determinants of UPF Consumption:

• Food insecurity affects 18 million households in the U.S., limiting access to nutritious foods.
• Communities with lower incomes often rely on affordable but nutrient-poor UPFs.
• Residents in food deserts have limited access to grocery stores, relying on convenience stores with fewer fresh options.
• Food marketing disproportionately targets low-income Black and Hispanic communities, promoting sugary drinks and snacks.

Global and U.S. Efforts:

• Some countries regulate UPFs through dietary guidelines, taxes, and warning labels.
• In the U.S., regulations focus on high-fat, sugar, and salt (HFSS) foods but often exclude UPFs.
• Integrating UPF criteria into HFSS regulations could improve efforts to reduce unhealthy food production.

The Way Ahead:

• Replace UPFs in hospital menus (currently 25%) with nutrient-dense meals.
• Educate patients and families through nutritionist-led sessions on affordable, healthy alternatives.
• Advocate for policy changes to improve access to healthy foods in vulnerable communities.
• Raise awareness about the severe health and financial burdens caused by UPFs.

Take-Home Points:

1. Ultra-processed foods are a major contributor to cardiovascular disease and other chronic illnesses.
2. Social and economic factors drive UPF consumption in vulnerable populations.
3. Efforts to reduce UPFs require public health advocacy, education, and regulatory changes.
4. A multi-faceted approach can address the health inequities caused by diet-driven diseases.
5. Targeting UPFs is essential for improving nutrition, reducing healthcare burdens, and promoting health equity.

"Cardiology’s Nobel-Worthy Innovations: Transforming the Field of Cardiovascular Medicine: 2025"

 Story:

• As 2025 approaches, the Nobel Prize committee considers honoring advancements in cardiology, a field experiencing a rapid evolution in research and patient care.
• The focus is not on whether cardiology deserves recognition, but on identifying the most influential contributors in this transformative discipline.

Pioneers in Cardiology:

1. Eugene Braunwald

   • Known as the father of modern cardiology, he revolutionized cardiovascular medicine by pioneering large-scale clinical trials through the TIMI Study Group.
   • His work established evidence-based medicine as the foundation for cardiology practices today.

2. Nanette Kass Wenger

   • A trailblazer in recognizing and addressing gender disparities in heart disease.
   • Her research transformed the understanding of heart disease in women, promoting gender-specific prevention and treatment strategies.

3. Julio C. Palmaz

   • Inventor of the coronary stent, a device that transformed interventional cardiology and saved countless lives.
   • His innovation remains a cornerstone in cardiovascular treatment globally.

4. Richard Allen Williams

   • A pioneer in highlighting racial disparities in cardiovascular health, focusing on African American communities.
   • He addressed systemic inequities and championed social determinants of health as critical factors in patient outcomes.

5. Elizabeth M. McNally

   • A leader in genetic research, she has advanced the understanding of inherited cardiovascular disorders and developed gene-editing therapies to tackle these diseases.

6. Robert M. Califf

   • Revolutionized clinical trials by introducing large-scale, multi-institutional methodologies, setting the gold standard for medical research.
   • His leadership continues to influence the evaluation of medical interventions globally.

7. Martin B. Leon

   • Pioneered the development and global adoption of TAVR (transcatheter aortic valve replacement), transforming care for patients with aortic stenosis.
   • His work enabled life-saving procedures for those previously deemed inoperable.

8. Harvey Feigenbaum

   • The father of echocardiography, he introduced and popularized cardiac imaging techniques that have become the foundation of cardiovascular imaging worldwide.

Take-Home Points:

1. Collaboration and innovation have propelled cardiology into a leading field of medical research and patient care.
2. Trailblazers in clinical trials, gender-specific care, racial equity, and genetics have redefined the understanding and treatment of cardiovascular diseases.
3. Breakthrough technologies, including the coronary stent, TAVR, and echocardiography, continue to save lives and improve quality of care.
4. Honoring pioneers in cardiology highlights the multifaceted contributions of individuals who have transformed this life-saving field.

"Emerging Trends in Cardiovascular Medicine: A Transformative Era: Year 2025"

 Story:

• The field of cardiovascular medicine is witnessing a groundbreaking transformation driven by innovative technologies and new approaches.
• From prevention to diagnosis to treatment, these trends are reshaping the management of cardiovascular diseases.

Anti-Obesity Drugs: Beyond Weight Loss

• Anti-obesity drugs, such as semaglutide and tirzepatide, are proving to provide significant cardiovascular benefits.
• Clinical trials reveal up to 20% reductions in major adverse cardiovascular events for patients with obesity and preexisting heart conditions.
• The SUMMIT trial showed tirzepatide reduced rates of heart failure and improved cardiac function.
• In the SELECT trial, semaglutide consistently lowered cardiovascular risk, especially in patients with a history of bypass surgery.
• These therapies highlight the dual benefits of weight loss and cardioprotection, transforming treatment for patients with obesity and heart disease.

AI in Cardiology: Precision and Predictive Power

• Artificial intelligence (AI) is revolutionizing diagnostics, risk assessment, and personalized care in cardiovascular medicine.
• AI models can detect subtle cardiac abnormalities, predict future conditions, and guide precise treatment strategies.
• Tools like the GRACE 3.0 score improve risk prediction for patients with acute coronary syndromes, incorporating complex factors and demographic variations.
• AI-driven innovations, such as AI-ECG systems, enable accurate detection of conditions like hypertrophic cardiomyopathy and atrial fibrillation.

Inflammation and Cardiovascular Risk

• Inflammation is now recognized as a major driver of atherosclerosis and cardiovascular disease.
• Emerging therapies target inflammatory pathways to reduce cardiovascular events beyond traditional lipid-lowering approaches.
• Cross-disciplinary efforts aim to synergize research and accelerate therapeutic advancements, promoting collaboration across medical domains.

CRISPR Gene Editing: A New Era

• CRISPR technology is unlocking new possibilities for treating hereditary cardiovascular conditions like familial hypercholesterolemia.
• Recent trials, such as with nexiguran ziclumeran, showed significant reductions in transthyretin levels, demonstrating promise for genetic-based therapies.
• CRISPR offers a permanent approach to therapy, opening doors for precise, disease-targeted interventions.

Amyloidosis: Advances in Diagnosis and Treatment

• Once considered rare, cardiac amyloidosis is now better understood, with improved diagnostic tools and novel treatments.
• Therapies like tafamidis, acoramidis, and RNA-based treatments (e.g., patisiran and vutrisiran) have enhanced survival and quality of life.
• Experimental innovations, including CRISPR-Cas9 and monoclonal antibodies, are leading to precision medicine for amyloidosis.

Take-Home Points:

1. Anti-obesity drugs provide significant cardioprotective benefits, extending beyond weight loss.
2. AI is transforming cardiovascular care with precise diagnostics and personalized treatment planning.
3. Inflammation is a critical factor in cardiovascular disease, with targeted therapies showing promising results.
4. CRISPR technology is ushering in a new era of genetic-based interventions for heart conditions.
5. Advances in amyloidosis treatment highlight the importance of precision medicine and equitable access to care.

CMS Temporarily Increases Reimbursement for Coronary CT Angiography in 2025

The Centers for Medicare and Medicaid Services (CMS) has temporarily reassigned coronary CT angiography (CCTA) codes 75572-75574 from ambulatory payment classification (APC) 5571 to APC 5572 under the 2025 Outpatient Prospective Payment System (OPPS) final rule.

This change increases national reimbursement rates for CCTA from $175.06 in 2024 to $357.13 in 2025.

The reassignment is temporary and dependent on future billing data, emphasizing the need for hospital revenue cycle and billing departments to be educated and adjust their practices accordingly.

Hospitals should update clinical charge masters to ensure CCTA services are linked to cardiology revenue codes like 0489x (Cardiology – Other) or 0409x (Other Imaging Services), which reflect higher cost-to-charge ratios.

Outdated "Return to Provider" edits (#19) that previously prevented facilities from using cardiology revenue codes have been removed.

Hospitals may need to update internal software or clearinghouse edits to allow the use of cardiology-specific revenue codes for CCTA billing.

These updates will not impact how revenue is tracked across hospital service lines but will ensure more accurate reporting of the greater resources required for cardiac CT imaging compared to general CT services.

This change is the result of advocacy by the American College of Cardiology (ACC), the Society for Cardiovascular Computed Tomography (SCCT), and other stakeholders, who argued that prior coding rules suppressed cost inputs for CCTA.

Until December 2023, hospitals could only bill CCTA using general CT scan (035x) or diagnostic radiology (032x) revenue codes, which underreported the costs of these resource-intensive services.

CMS conducted a simulated cost analysis, finding that if 50% of CCTA codes were billed with cardiology revenue codes, the services would qualify for the higher APC (5572).

CMS acknowledged that while the coding edit was removed, it could take years for hospitals to adopt the new billing practices, prompting the agency to adjust payments temporarily using an alternative methodology.

The agency expects it will take three to four years for the data to fully reflect new billing practices. If no significant changes are observed after this period, CMS will revert CCTA payments to the standard OPPS payment methodology.

---

Take-Home Points:

• CMS temporarily increased reimbursement rates for CCTA to $357.13 in 2025 by reassigning it to a higher APC (5572).
• Hospitals must update billing practices to use cardiology revenue codes (0489x or 0409x) to reflect the true costs of CCTA.
• Outdated coding edits that restricted the use of cardiology revenue codes have been removed, facilitating these updates.
• Accurate billing and education are critical to ensure CMS receives sufficient data to make the reassignment permanent.
• The reassignment follows years of advocacy by stakeholders, who highlighted the resource intensity of CCTA compared to general CT services.
• CMS will monitor data over the next three to four years and may revert payments if hospitals fail to adjust billing practices.

Learn More

Aircraft Noise Exposure Linked to ‘Thicker, Weaker, and Stiffer Hearts

Exposure to aircraft noise, especially for those living near airports or under flight paths, is linked to worse heart structure and function, according to a study in the United Kingdom.

Participants exposed to high aircraft noise levels were found to have thicker, weaker, and stiffer hearts, which triples the risk of heart failure, stroke, or death.

A JACC study shows an association, not causation, but suggests noise exposure contributes to obesity and hypertension, both of which are known to worsen cardiac remodeling.

Data from 3,635 adults living near major UK airports, including Heathrow and Gatwick, revealed significant differences in heart function measured through cardiac magnetic resonance imaging (CMR).

Participants exposed to nighttime aircraft noise had larger left ventricular (LV) volumes, thicker heart walls, and worse LV dynamics.

Those who lived in high aircraft noise areas at night had a quadrupled risk of major adverse cardiovascular events (MACE) over time.

Body mass index (BMI) accounted for up to 54% of the observed association between noise exposure and heart changes, while hypertension mediated up to 36% of the effects.

Individuals who remained in high-noise areas had 10% to 20% worse heart function compared to those who moved away.

The study isolates the effects of aircraft noise from other noise and air pollutants, emphasizing its independent role in worsening cardiac health.

Noise pollution is expected to increase globally due to growing reliance on transportation, further exacerbating these health risks.

---

Call for Action:

• Individuals exposed to aircraft noise should proactively manage other cardiovascular risk factors, such as blood pressure, weight, and exercise levels.
• Policymakers should address noise pollution by investing in technologies like satellite-guided flight paths, noise barriers, and restrictions on older, noisier aircraft.
• Expansion of airports should occur in tandem with measures to mitigate noise pollution’s health effects.

---

Take-Home Points:

• Aircraft noise exposure is linked to worse heart structure and function, increasing risks of heart failure, stroke, and death.
• High noise exposure contributes to cardiac remodeling, mediated by factors like obesity and hypertension.
• The effects of noise pollution on cardiovascular health are expected to worsen as global transportation needs grow.
• Clinicians should inquire about environmental factors, including noise, and monitor patients’ cardiovascular health accordingly.
• Policies addressing aircraft noise and raising awareness are urgently needed to protect vulnerable populations.

Johnson & Johnson Halts Varipulse Pulsed-Field Ablation Cases in the US

Johnson & Johnson Medtech has temporarily paused all Varipulse pulsed-field ablation (PFA) cases in the United States after four neurovascular events were reported during an external evaluation study.

The pause, initiated out of caution, allows the company to investigate the root cause of these complications.

The system used in the US evaluation involved a unique platform configuration, so the pause does not affect Varipulse commercial activity outside the US, where over 3,000 cases have been successfully completed.

This setback follows FDA approval for Varipulse in November 2024, supported by the admIRE trial, which had previously raised concerns about stroke and transient ischemic attack (TIA) risks.

Some physicians, like Sumit Verma, view the pause as a hindrance to broader PFA adoption, potentially pushing centers to explore alternative systems.

Others, like Jonathan Piccini, believe the pause highlights how much is still unknown about the safe and effective delivery of PFA technology.

Speculation around the reported neurovascular events includes possible causes such as:

• Air emboli or gas bubbles generated by high-voltage electrical currents during procedures.
• Clots formed during transseptal procedures.
• Heat-induced embolic particles from tissue ablation.

Experts agree that these issues could stem from initial challenges in managing large-profile catheters and procedural workflows.

Despite these concerns, many operators involved in the US evaluation reported no neurovascular issues in their centers.

Globally, the Varipulse system has shown promise, with more than 130 cases performed by 40 operators across 14 US sites as part of the external evaluation.

Physicians like Dhanunjaya Lakkireddy believe the complications are manageable and expect to resume using Varipulse once the investigation concludes.

The situation underscores the need for continued learning and refinement of PFA technology, even as it remains a promising treatment for conditions like paroxysmal atrial fibrillation.

---

Take-Home Points:

• Johnson & Johnson has paused US Varipulse PFA cases to investigate neurovascular events reported in an external evaluation study.
• The pause does not affect commercial activities outside the US, where over 3,000 cases have been completed.
• Potential causes of complications include air emboli, clots, and heat- or current-induced embolic particles.
• Physicians emphasize that effective workflow and catheter management are critical to minimizing risks.
• The pause reflects the importance of refining PFA technology and addressing safety concerns as its use expands.

Sugary Drinks Fueling Diabetes and Cardiovascular Disease Globally

 Consumption of sugar-sweetened beverages (SSBs) is significantly contributing to the global burden of type 2 diabetes and cardiovascular disease (CVD).

A global study suggests that 1 in 10 new diabetes cases and 1 in 30 new CVD cases are linked to sugary drink consumption, amounting to over 300,000 deaths annually.

Regions like sub-Saharan Africa, Latin America, and the Caribbean experienced the largest increase in disease burdens related to sugary drinks between 1990 and 2020.

Sub-Saharan Africa, previously less impacted by Western diets, now sees 20% of diabetes cases attributed to sugary drinks, with South Africa reporting 27%.

Among the 30 most populous countries, Mexico, Colombia, and South Africa showed the highest numbers of diabetes and CVD cases caused by sugary drinks.

Globally, adults consumed an average of 2.6 servings of sugary drinks per week, ranging from 7.3 servings in Latin America to 0.7 servings in South Asia.

Men and younger individuals consumed slightly more sugary drinks compared to women and older adults.

In 2020, sugary drinks were responsible for 2.2 million diabetes cases, 1.2 million CVD cases, and over 338,000 deaths worldwide.

Regions like Latin America, the Caribbean, the Middle East, and North Africa had the highest disease burden linked to sugary drinks, while Southeast Asia and East Asia had the lowest.

People in their mid-40s faced the greatest absolute burden of diabetes, while those aged 25-29 had the highest proportional risk.

Education and urbanization also played a role, with urban and highly educated populations in sub-Saharan Africa and Latin America bearing the greatest burden of disease.

---

Call for Action:

The study highlights the urgent need for policies and interventions to curb the impact of sugary drinks on global health.

Potential strategies include:

• High taxes on sugary drinks: Nations with taxes as high as 20-100% have seen reductions in consumption.
• Warning labels: Clear labeling to educate consumers on the health risks of sugary drinks.
• Restricting sales: Prohibiting sugary drink sales in schools, hospitals, and government workplaces.

Public health efforts must combine multiple approaches, as single measures like taxes alone are insufficient to address the problem.

---

Take-Home Points:

• Sugar-sweetened beverages are a major driver of diabetes and CVD, contributing to hundreds of thousands of deaths each year.
• Regions like sub-Saharan Africa and Latin America are experiencing the fastest-growing disease burdens from sugary drinks.
• Policies like taxes, warning labels, and sales restrictions are crucial to reducing sugary drink consumption globally.
• Public awareness campaigns are needed to inform people of the health risks associated with sugary drinks.
• Coordinated global action is essential to prevent further health damage caused by the growing consumption of sugary beverages.

Private Equity Acquisitions and Patient Care: Worsening Experiences

Private equity firms acquiring hospitals have been linked to a decline in the patient care experience, according to US survey data.

Patients at hospitals acquired by private equity firms reported lower levels of satisfaction compared to those at non-acquired hospitals.

Key measures like the percentage of patients giving a hospital a top rating or recommending it dropped significantly after private equity acquisitions.

By the third year post-acquisition, patient care experience scores were 5 percentage points lower in acquired hospitals compared to non-acquired ones, a change considered substantial.

The responsiveness of hospital staff was the primary area of decline, worsening further over time.

This decline in patient experience following private equity takeovers exceeded the national deterioration observed during the COVID-19 pandemic.

Lower patient satisfaction has broader implications, as poor experiences are associated with slower recovery, nonadherence to treatment, and greater healthcare utilization.

Private equity firms have been rapidly acquiring hospitals and healthcare facilities, raising concerns about prioritizing profits over patients.

Although some studies suggest private equity acquisitions may improve certain clinical outcomes, the overall evidence shows a decline in patient experience and an increase in adverse events in many cases.

A study involving 73 acquired hospitals and 293 matched control hospitals found that satisfaction scores remained stagnant or dropped in acquired hospitals, while scores improved slightly in control hospitals.

Private equity’s ‘flip-and-strip’ mentality, focused on maximizing profits quickly, has been flagged as a potential threat to quality care.

As private equity increasingly targets cardiology practices and ambulatory surgical centers, the concerns extend beyond hospitals.

Experts emphasize the urgent need for greater transparency, regulatory oversight, and policy interventions to protect patient care quality.

Potential solutions include:

• Transparency in private equity acquisitions.
• Stronger fraud and abuse protections.
• Enhanced Federal Trade Commission powers to monitor transactions.
• Limits on the percentage of debt used in private equity acquisitions.

The study underscores the need for a multipronged policy strategy to safeguard patients in an increasingly corporatized healthcare landscape.

---

Take-Home Points:

• Patient care experience worsens significantly after private equity firms acquire hospitals.
• Satisfaction with hospital care, particularly staff responsiveness, declines within three years of acquisition.
• Poor patient experience has long-term implications, including slower recovery and increased healthcare utilization.
• Private equity’s growing influence in healthcare highlights an urgent need for transparency and regulatory oversight.
• Policymakers must implement strategies to prioritize patient care over financial interests in a corporatized healthcare system.

Alcohol Consumption and Cancer Risk: Key Insights

The definitions of heavy drinking and moderate (or some) drinking vary slightly depending on the context or study, but the following general definitions are commonly used in research and public health guidelines:

Heavy Drinking

• For Men: Consuming more than 4 drinks per day or more than 14 drinks per week.
• For Women: Consuming more than 3 drinks per day or more than 7 drinks per week.
• Heavy drinking is often associated with binge drinking (drinking large amounts in a short period) or chronic excessive alcohol use.

Some Drinking (Moderate Drinking)

• For Men: Up to 2 drinks per day.
• For Women: Up to 1 drink per day.
• Moderate drinking is generally considered to have lower health risks compared to heavy drinking and is sometimes associated with potential health benefits in certain studies (e.g., heart health), although these benefits are still debated.

Standard Drink Size

The definition of a "drink" varies by country, but in the United States, a standard drink contains about 14 grams of pure alcohol, which is equivalent to:

• 12 ounces of beer (5% alcohol content).
• 5 ounces of wine (12% alcohol content).
• 1.5 ounces of distilled spirits or liquor (40% alcohol content).

These definitions are used to categorize alcohol consumption levels when analyzing health risks, including cancer risks, in studies like the one summarized.

Alcohol is a known risk factor for several cancers, including those of the oral cavity, pharynx, oesophagus, colorectum, liver, larynx, and female breast.

Its impact on other cancers remains uncertain, but evidence is emerging about its association with additional cancer types.

Researchers analyzed data from 572 studies, covering 486,538 cancer cases, to evaluate alcohol’s impact on 23 cancer types using meta-analysis and dose-response models.

Key Findings:

• Heavy drinkers (compared to nondrinkers/occasional drinkers) had significantly higher risks of:

  • Oral and pharyngeal cancer: Relative risk (RR) 5.13.
  • Oesophageal squamous cell carcinoma: RR 4.95.
  • Colorectal cancer: RR 1.44.
  • Laryngeal cancer: RR 2.65.
  • Breast cancer: RR 1.61.

• For these cancers, there was a clear dose-risk relationship, with risks increasing as alcohol intake increased.

• Heavy drinkers also showed elevated risks of:

  • Stomach cancer: RR 1.21.
  • Liver cancer: RR 2.07.
  • Gallbladder cancer: RR 2.64.
  • Pancreatic cancer: RR 1.19.
  • Lung cancer: RR 1.15.

• Indications of positive associations were observed for melanoma and prostate cancer.

• Interestingly, alcohol consumption was inversely associated with risks of Hodgkin’s and Non-Hodgkin’s lymphomas.

---

Conclusions:

• Alcohol significantly increases the risk of cancers of the oral cavity, pharynx, oesophagus, colorectum, liver, larynx, and female breast.
• There is growing evidence linking alcohol consumption to cancers of the pancreas, prostate, and melanoma.
• The relationship between alcohol and some cancers, such as lymphomas, may differ, suggesting a need for further research.

---

Take-Home Points:

• Alcohol consumption is a major risk factor for several cancers, particularly those of the digestive system and breast.
• Heavy drinking substantially increases cancer risk, with a dose-risk relationship observed in many cases.
• Emerging evidence points to alcohol’s role in additional cancers, such as pancreatic, prostate, and melanoma.
• Limiting alcohol intake is crucial for reducing cancer risks and promoting better health.

Cardiorespiratory Fitness: A Key Indicator of Health

 Cardiorespiratory fitness (CRF) is a crucial measure of overall health and physical performance.

It reflects the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity.

CRF is not only vital for athletic performance but also reduces the risk of cardiovascular disease, stroke, hypertension, and diabetes.

CRF is primarily measured by VO2 max, which is the maximum rate of oxygen consumption during intense exercise.

VO2 max is expressed in milliliters of oxygen consumed per minute per kilogram of body weight (ml/kg/min).

A higher VO2 max indicates better CRF and is linked to improved health outcomes.

Several factors influence CRF, including:

• Lung capacity and heart volume: The ability of the lungs to intake oxygen and the heart to pump oxygenated blood.
• Capillary delivery: The circulatory system's efficiency in transporting oxygen to muscles.
• Muscle efficiency: The capacity of muscles to extract and use oxygen from the blood.

Measuring VO2 Max:

1. Laboratory Testing:
   The gold standard involves a cardiopulmonary exercise test, performed on a treadmill or bike while wearing a mask to measure oxygen consumption.

2. Field Tests (simple alternatives):

   • One-mile walk test: Walk one mile as quickly as possible without running.
   • Three-minute step test: Step up and down on a platform for three minutes.
   • 1.5-mile run/walk test: Cover 1.5 miles as quickly as possible.

3. Fitness Trackers:
   Modern devices estimate VO2 max using heart rate data and other metrics.

4. Resting Heart Rate Method:
   A rough estimation using resting heart rate and age.

Improving Cardiorespiratory Fitness:

Regular aerobic exercise is essential to enhance CRF. Effective strategies include:

• High-Intensity Interval Training (HIIT): Short bursts of intense exercise followed by recovery.
• Endurance Training: Activities like running, cycling, or swimming at moderate intensity.
• Progressive Overload: Gradually increasing exercise intensity or duration.
• Cross-Training: Engaging in various aerobic activities to target different muscles.

Benefits of Cardiorespiratory Fitness:

Good CRF provides numerous health advantages:

• Increased Lifespan: Lower mortality rates from various causes.
• Reduced Disease Risk: Lower risk of cardiovascular disease, type 2 diabetes, and some cancers.
• Improved Mental Health: Enhanced cognitive function and reduced anxiety and depression.
• Better Bone Health: Maintains bone density and reduces osteoporosis risk.
• Weight Management: Effective for burning calories and maintaining a healthy weight.

---

Take-Home Points:

• CRF is a critical measure of overall health and physical performance.
• VO2 max is the primary measure of CRF, reflecting the body’s oxygen utilization capacity.
• CRF can be assessed through laboratory tests, field tests, fitness trackers, or heart rate methods.
• Regular aerobic exercise, including HIIT and endurance training, is key to improving CRF.
• Maintaining good CRF offers significant health benefits, such as a longer lifespan, reduced disease risk, and better mental health.
• Regular assessment and targeted improvement of CRF should be prioritized for better overall health and fitness.

Cardiorespiratory Fitness, Body Mass Index, and Mortality: Key Insights

Cardiorespiratory fitness (CRF) and body mass index (BMI) together influence the risk of death from cardiovascular disease (CVD) and all causes.

In this analysis, individuals were categorized as:

• Fit: Those with high cardiorespiratory fitness, measured by their performance on a VO2peak exercise test (which measures the maximum amount of oxygen the body can use during intense exercise).
• Unfit: Those with low cardiorespiratory fitness, indicated by poor performance on the same tests.

Fitness is typically measured using:

1. VO2peak Tests: A test done during exercise (often on a treadmill or cycle) to determine the maximum oxygen uptake by the body.
2. Maximal Exercise Tests: Tests that require individuals to exercise to their maximum capacity to assess endurance and cardiovascular function.

Researchers analyzed data from 398,716 participants, grouping them by BMI (normal weight, overweight, obese) and fitness level (fit, unfit).

Fit individuals, regardless of weight, had much lower risks of death compared to unfit individuals.

Unfit individuals—whether normal weight, overweight, or obese—had 2–3 times higher risk of death from CVD and all causes compared to fit individuals.

Being fit reduced risks for overweight and obese people but did not eliminate them entirely.

CRF is a strong predictor of CVD and all-cause mortality, highlighting the importance of improving fitness through exercise, regardless of BMI.

Take-Home Key Points:

• Fitness matters more than weight in predicting mortality risk.
• Fit individuals have a significantly lower risk of death from CVD and all causes, regardless of their BMI.
• Unfit individuals, whether normal weight, overweight, or obese, face 2–3 times higher mortality risks.
• Improving cardiorespiratory fitness through exercise is critical for reducing health risks, even for those who are overweight or obese.
• Regular exercise that improves CRF, such as activities increasing endurance and oxygen use, can save lives.

Ultra-Processed Foods and Mortality: Evidence From a Pan-European Study

Consumption of ultra-processed foods (UPFs) has been linked to a higher risk of death from various causes.

This study explored how the degree of food processing, categorized using the Nova classification, relates to overall and specific mortality risks.

Data were drawn from the European Prospective Investigation into Cancer and Nutrition.

Deaths were analyzed based on causes such as cancer, circulatory diseases, digestive diseases, Parkinson’s disease, and Alzheimer’s disease.

Advanced statistical models were used to identify associations between food processing and mortality risks.

Substitution analyses examined the benefits of replacing UPFs with minimally processed foods.

Higher consumption of UPFs was associated with an increased risk of all-cause mortality.

Significant associations were observed between UPF consumption and deaths from circulatory diseases, including cerebrovascular disease and ischemic heart disease.

An increased risk of death was also linked to digestive diseases and Parkinson’s disease.

No associations were found between UPFs and deaths from cancer or Alzheimer’s disease.

Replacing UPFs with unprocessed/minimally processed foods was associated with a lower risk of death.

Higher UPF consumption is associated with an increased risk of death from specific diseases, including circulatory diseases, digestive diseases, and Parkinson’s disease.

Replacing UPFs with unprocessed foods may significantly reduce the risk of death.

The study highlights the potential health benefits of consuming fewer UPFs and increasing unprocessed food intake.   Learn More

BMI vs. BRI: A Shift in Assessing Obesity and Health Risks

 The 2024 Olympic Games in Paris, France, showcased incredible athletic talent.

One standout was a 27-year-old member of Team USA’s women’s rugby sevens, whose combination of speed and strength captivated audiences.

As she powered downfield, stiff-arming opponents, it seemed inconceivable to consider her overweight.

However, she revealed on TikTok that her weight of 200 pounds at 5 feet 10 inches classifies her as overweight by the body mass index (BMI).

BMI, a traditional metric for assessing obesity, measures height and weight but provides limited insight.

For athletes, BMI may be elevated despite minimal central adiposity, rendering it an inadequate tool, according to experts.

Another metric, the body roundness index (BRI), offers an alternative by excluding weight and focusing on waist and hip circumference relative to height.

BRI ranges from 1 to 20, estimating visceral adipose tissue and providing a nuanced assessment of body shape.

Studies link BRI to risks of metabolic syndrome, type 2 diabetes, cardiovascular disease, and all-cause mortality.

Despite its advantages, experts caution against replacing BMI entirely with BRI.

BMI remains a simple, accessible screening tool that initiates discussions about obesity.

In cases of borderline or high BMI, adding waist circumference or calculating BRI refines risk assessment.

BRI provides insights into fat distribution, particularly visceral adiposity, which poses significant health risks.

However, it cannot distinguish between visceral and subcutaneous fat, limiting its utility as a standalone measure.

BMI has historical roots dating back to 1832 and has long been criticized for its simplistic approach.

The American Medical Association (AMA) recognized BMI’s limitations, particularly its inability to account for racial, gender, and age variations.

The AMA recommends supplementing BMI with other measurements like waist circumference, body composition, and visceral fat assessments.

For midsection adiposity, a comprehensive approach includes clinical evaluation, waist-to-hip measurements, and possibly imaging.

Metrics like waist-to-height ratio can further enhance risk prediction for metabolic and cardiovascular conditions.

Primary care clinics often fail to accurately measure waist and hip circumferences, highlighting a need for improved practices.

---

Take-Home Points:

• BMI is a simple screening tool but has significant limitations in assessing obesity and health risks.
• BRI is a promising alternative that focuses on body shape and fat distribution rather than weight.
• Visceral adiposity poses greater health risks than subcutaneous fat and should be assessed carefully.
• Supplementing BMI with waist-to-hip or waist-to-height ratios improves risk evaluation.
• A comprehensive, individualized approach is essential for accurate obesity assessment and management.

GLP-1 Drugs: A Game-Changer for Weight Loss in Non-Diabetic Individuals

• A variety of  GLP-1 receptor agonists is helping individuals without diabetes achieve weight loss.
• These medications, initially designed for type 2 diabetes, are showing efficacy in managing overweight and obesity.
• Among the 12 agents studied, three have been FDA-approved for chronic weight management: semaglutide, liraglutide, and tirzepatide.
• Nine other investigational drugs were found to induce significant weight reduction in randomized, placebo-controlled trials.
• The review, involving over 15,000 participants, revealed consistent BMI reductions and improvements in waist circumference and blood pressure.
• Among FDA-approved drugs, the most weight loss was seen with tirzepatide (up to 17.8%), followed by semaglutide (13.9%) and liraglutide (5.8%).
• Retatrutide, an investigational drug, showed the highest weight loss of 22.1%, but the data was limited.
• GI side effects, such as nausea, vomiting, and diarrhea, were common but usually mild and transient.
• Serious adverse events, such as pancreatitis and psychiatric symptoms, were rare.
• Concerns include weight regain after stopping the medication, potential muscle mass loss, and limited long-term safety data.
• On the positive side, these medications demonstrate cardiorenal protective effects, reducing kidney disease progression and improving cardiometabolic health.
• Emerging oral formulations and combination therapies may improve adherence and broaden treatment options.

Take-Home Points:

1. GLP-1 receptor agonists provide a promising tool for addressing the obesity epidemic.
2. These drugs are effective, relatively safe, and improve cardiometabolic health.
3. GI side effects are common but manageable, and close monitoring is essential.
4. The development of oral and combination therapies may enhance patient adherence and expand accessibility.
5. Ongoing research is critical to addressing long-term safety concerns and optimizing usage.

Draft Scientific Report for the 2025-2030 Dietary Guidelines for Americans

 Overview:

• A scientific report providing evidence-based guidance for the 2025-2030 Dietary Guidelines for Americans has been submitted to federal agencies.
• The REPORT emphasizes plant-based diets and is now open for public comment until February 10, 2025, with an oral comment meeting scheduled for January 16, 2025.

---

Key Recommendations:

• A healthy dietary pattern includes:
  • Higher intake of:
    • Vegetables, fruits, legumes (beans, peas, lentils), nuts, whole grains, fish/seafood, and vegetable oils high in unsaturated fats.
  • Lower intake of:
    • Red/processed meats, sugar-sweetened foods and beverages, refined grains, and saturated fats.
• Specific Guidelines:
  • Limit saturated fat to <10% of daily calories, replacing it with polyunsaturated fats.
  • Reduce starchy vegetables (e.g., potatoes) and increase legumes.
  • Encourage plain water as the primary beverage, limiting sugar-sweetened drinks.
  • Reorganize the protein foods group to prioritize:
    1. Beans, peas, lentils.
    2. Nuts, seeds, soy products.
    3. Seafood.
    4. Meats, poultry, eggs.

---

Controversies:

• Plant-Based Focus: Recommendations to reduce meat, poultry, and eggs have drawn criticism, particularly from the food industry.
• Protein Group Changes: Moving legumes to the protein group and prioritizing plant-based proteins over animal-based sources sparked debate.
• Ultra-Processed Foods: While interest in the health effects of ultra-processed foods is growing, the report does not yet provide specific recommendations.

---

Call to Action for Clinicians:

• Comment on the Report: Engage in the public comment process to influence final guidelines.
• Use the finalized guidelines to address diet-related illnesses with patients and promote personalized nutrition strategies.
• Support the focus on plant-based proteins, hydration via water, and culturally diverse dietary options.

---

Next Steps:

• Federal agencies will use the report, public feedback, and agency input to develop the final 2025-2030 Dietary Guidelines for Americans.
• Clinicians will play a key role in implementing these guidelines to improve public health outcomes.

---

Key Takeaways:

1. The report highlights a Mediterranean-style dietary pattern, focusing on plant-based foods and reducing red meat and saturated fats.
2. Legumes are now emphasized as a primary protein source rather than starchy vegetables.
3. Plain water is recommended as the main beverage; sugar-sweetened beverages should be limited.
4. Clinicians are encouraged to participate in the public comment process and use the guidelines to address diet-related diseases.
5. While ultra-processed foods are recognized as a concern, concrete recommendations are still lacking.

What is Modifier 25?

• Definition: Used to report a significant, separately identifiable Evaluation and Management (E/M) service performed on the same day as another procedure by the same physician or qualified healthcare professional.

Appropriate Use:

• Applies when an E/M service is distinct from the procedure or usual pre/postoperative care.
• Can be appended to E/M codes (99202–99215) when paired with a procedure (e.g., 93015 Cardiovascular stress test).
• Does not require different diagnosis codes for E/M and the procedure.
• Documentation must clearly support the medical necessity for both services.

Examples:

• Appropriate Use: Patient has an E/M visit for chest pain and undergoes a cardiovascular stress test the same day. Use Modifier 25 with the E/M code.
  • Example coding: 99214, 25 and 93015.
• Inappropriate Use: Patient comes in solely for a scheduled stress test. Only the test should be coded (e.g., 93015).

Rules to Remember:

• Documentation: Must substantiate the E/M service as separate and significant from the procedure.
• Link Modifier 25 to the E/M CPT code.
• Modifier 25 is valid for minor surgical procedures (000 or 010-day global period) or non-global indicator (XXX) procedures.
• Do not use Modifier 25:
  • For services during a postoperative period if related to prior surgery.
  • When only an E/M service is performed without a procedure.
  • For major surgeries (90-day global period) unless unrelated to the surgery.

Additional Notes:

• Proper use informs payers to reimburse for both E/M and the procedure.
• Audits often result in payment rescission for inadequate documentation or incorrect coding.
• Modifier 25 can be used for outpatient, inpatient, ambulatory surgery centers, and emergency department visits.

New CMS G Codes for ASCVD Risk Assessment and Management (2025)

 The Centers for Medicare and Medicaid Services (CMS) introduced two new G codes in the 2025 Medicare Physician Fee Schedule to reimburse for ASCVD risk assessment and management services.

The codes are inspired by the CMS Innovation Center’s Million Hearts® Cardiovascular Disease Risk Reduction model, which reduced all-cause death rates by 4% and cardiovascular event death rates by 11% for medium and high-risk patients.

The ASCVD risk assessment code, G0537, involves a standardized, evidence-based risk assessment for patients with ASCVD risk factors, lasting 5-15 minutes, and is billable once every 12 months.

This service applies to patients without a cardiovascular disease diagnosis or history of heart attack or stroke but with at least one predisposing condition like obesity, high blood pressure, or diabetes.

The risk assessment requires current laboratory data, a validated ASCVD risk assessment tool, demographic factors, modifiable risk factors, and possible risk enhancers to produce a documented 10-year ASCVD risk estimate.

Tools like the ACC ASCVD Risk Estimator meet these requirements, and the G0537 code is assigned a work RVU of 0.18.

The ASCVD risk management code, G0538, is for managing intermediate, medium, or high-risk patients identified through an ASCVD risk assessment.

The management service involves creating and implementing an ASCVD-specific care plan that incorporates shared decision-making and addresses risk factors like blood pressure, cholesterol, smoking, and nutrition.

These services include medication management, care coordination, non-face-to-face communication options, and individualized electronic care plans targeting modifiable risk factors.

The G0538 code, assigned a work RVU of 0.18, may apply monthly, but cost-sharing may be required since the service is not classified as preventive.

CMS emphasizes that patient consent is necessary for these services, which can be performed by physicians or qualified health professionals.

Further guidance and resources from CMS for using these codes will be shared by the ACC in the coming weeks.

Take-Home Points: 

• Two new codes (G0537 and G0538) reimburse ASCVD risk assessment and management.
• G0537: Annual risk assessment (5-15 minutes) for patients with predisposing conditions (e.g., obesity, hypertension). Requires a lipid panel and a validated tool like the ACC ASCVD Risk Estimator.
• G0538: Monthly risk management for patients identified as intermediate/high risk. Includes care plans addressing ABCS (Aspirin, Blood pressure, Cholesterol, Smoking cessation) and shared decision-making.
• Patient consent is required; cost-sharing applies to management services.
• Inspired by the Million Hearts® model, which reduced cardiovascular mortality by 11%.

Workforce Challenges in Cardiovascular and Stroke Nursing: Insights from the AHA Scientific Statement 2025

Workforce retention and support are critical in addressing challenges faced by cardiovascular (CV) and stroke nurses, worsened by the pandemic.

The AHA scientific statement  highlights the need for improved workload policies, salaries, mentoring, and autonomy to sustain the nursing workforce.

Burnout and intent to leave the nursing profession were significant issues before the pandemic and have now reached a crisis point.

The pandemic exacerbated workforce challenges, shifting preferences towards work-life balance and remote roles, particularly for younger nurses.

2021 saw the largest nurse exodus in four decades, with over 100,000 nurses leaving the profession, particularly affecting those under age 35.

Educational program limitations hinder the entry of new nurses, with thousands of candidates turned away annually due to capacity issues.

The shortage of senior nurses threatens mentorship for newer nurses, potentially impacting patient outcomes.

Common burnout drivers include excessive workloads, long hours, low compensation, exposure to suffering, moral distress, and high-pressure environments.

The statement identifies four stress categories—patient care, organizational, academic, and research—affecting clinical, academic, and scientific nursing roles.

Interventions like mindfulness training, communication techniques, and therapeutic group sessions can help reduce burnout and improve well-being.

Building a culture of resilience through gratitude, safety huddles, and recognition activities can enhance nursing engagement and satisfaction.

Flexible scheduling and initiatives like self-care workshops and job redesign are effective strategies to reduce emotional exhaustion.

Academic educators face unique stressors, including teaching demands, work-life imbalances, lower salaries, and power dynamics.

Support for academic faculty well-being includes flexible work policies, mental health resources, and broad academic performance criteria.

A renewed focus on nursing wellness emphasizes work-life balance, research support, and professional development opportunities.

Nurse scientists struggle with heavy teaching loads, funding pressures, and limited time for research, leading to stress and burnout.

Institutional support like startup funding, research assistance, and interdisciplinary collaboration can alleviate stress for nurse scientists.

Low salaries remain a universal stressor, prompting legislative and institutional efforts to improve pay and working conditions.

The Nurse Faculty Shortage Reduction Act of 2024 aims to close the pay gap between clinical nurses and educators by increasing funding for salaries.

Public awareness and legislative initiatives are vital to addressing the nurse educator pay gap amidst university budget constraints.

Take-Home Points

• The pandemic has intensified pre-existing challenges of burnout and workforce shortages in CV and stroke nursing, requiring urgent attention.
• Improved workload policies, salaries, mentoring, and autonomy are critical for retaining and supporting nurses across clinical and academic roles.
• The 2021 nurse exodus highlighted a crisis, with young nurses facing the highest turnover and lowest job satisfaction.
• Addressing burnout drivers like excessive workloads and low compensation through resilience-building interventions and flexible work policies can improve retention.
• Academic nursing faces unique challenges, including stress from teaching demands, pay disparities, and research pressures, requiring tailored solutions.
• Legislative initiatives like the Nurse Faculty Shortage Reduction Act of 2024 aim to address pay gaps and workforce sustainability.
• Public awareness and support for better funding and working conditions are essential to ensure the resilience and effectiveness of the nursing profession.