TRED-ing on Thin Ice: Withdrawal of Therapy in Recovered Cardiomyopathy and Icosapent Ethyl for Hypertriglyceridemia

Paxton Bach and Samantha Young, both general internists in Vancouver are back on The Rounds Table!  Together they are covering the withdrawal of heart failure treatments in patients with recovered dilated cardiomyopathy and icosapent ethyl for cardiovascular risk reduction in patients with hypertriglyceridemia.

There is good evidence behind our guidelines for the management of heart failure, however we know little about how to make treatment decisions in patients with recovered ejection fraction. Sam first covers the TRED-HF trial, in which medications were withdrawn for patients with dilated cardiomyopathy whose symptoms and cardiac function had improved.  The authors assessed the relapse rate in the first 6 months for these patients.

Icosapent ethyl is a highly purified eicosapentaenoic acid ethyl ester or omega-3 fatty acid – patients often inquire if there are cardiovascular benefits to supplements such as this.  Paxton reviews the REDUCE-IT trial in which the authors studied patients with hypertriglyceridemia who were already on a statin.  They compared the use of icosapent ethyl, versus placebo, and the risk in terms of cardiovascular outcomes, namely ischemic events.

Finally, the Good Stuff segment.  Sam discusses an account of a Harvard medical student who had rheumatic heart disease in the 1930’s and his journaling of his experience with subacute bacterial endocarditis.  Paxton tells us about an experiment to remove sweets from cash registers at UK supermarkets and the effects of minimizing the ‘impulse-buy.’

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Paxton Bach @paxbach and Sam Young @syoungmd.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. TRED-HF: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32484-X/fulltext

2. REDUCE-IT: https://www.nejm.org/doi/full/10.1056/NEJMoa1812792

Good Stuff

1. Subacute bacterial endocarditis: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC137358/

2. Removing sweets from checkouts: https://www.sciencedaily.com/releases/2018/12/181218171553.htm

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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