Manesh Patel, MD: Lessons Learned from the Beaumont Conference

Manesh R. Patel, MD

Beaumont Health’s 29^th Annual Cardiovascular Conference in Beaver Creek, CO, this February built on its own tradition of discussing cardiometabolic care collaboration—while also keeping an eye toward the future of the field.

The annual meeting hosted a mix of conversation on new LDL-targeting agents, the role of telehealth in patient screening and monitoring, and even discussion on optimal diet management for at-risk patients. That final discussion was headlined by a session from Manesh R. Patel, MD of the Duke University School of Medicine.

In an interview with HCPLive®, Patel discussed the major talking points of the Beaumont meeting, while delving into the current clinical understanding of diet in cardiovascular care.

HCPLive: What was discussed in your discussion on diet in cardiovascular prevention at the Beaumont meeting?

Patel: Maybe one of the most exciting—and maybe why it's one of the earlier sessions this year—is that we were able to look and think about just how fast cardiovascular disease prevention is changing. And it is an area where there's just such great interest, and there's certainly a variety of debates that can be had.

But maybe the first and most interesting thing people are thinking about are all the drugs that are coming out for patients with cardiovascular disease. We've had statin medications for a long time to reduce cholesterol, but now with the PCSK9 inhibitors, we've demonstrated there's even an opportunity to lower LDL more and improve people's outcomes.

It's actually delved into inclisiran, an RNA inhibitor that can actually get into the liver, and a twice-a-year injection can lower your LDL. The outcomes trials that are coming for that will likely be an important game-changer in our clinical practice, I think.

The variety of things we can now do for triglycerides and cardiovascular disease—Vascepa and other therapeutics now, but certainly that's the main one that was demonstrated to reduce cardiovascular events. That's been a pretty powerful for patients with triglycerides between 199-500.

And then there's the prevention of other cardiovascular morbidity and mortality: upstream prevention of AFib; coronary CTA (computed tomography angiography) for screening, or at least understanding what the atherosclerotic plaque is. And I have the pleasure of speaking about the cardiovascular diet.

When we think about cardiovascular diet, it's always a question of, 'Is the diet aimed to improve your cardiovascular outcomes, or is it aimed to make you lose weight?' And ideally, it would do both.

But it's interesting that the studies which show that significant weight reduction improves your cardiovascular health seems intuitive—but we don't have strong data. We do have data that says certain diets lead to better cardiovascular outcomes, and they tend to be associated with lower weights.

And so, what I go into is what I think is an interesting discussion around the importance of what in the past was called the 'fat hypothesis,' trans-saturated fats, the Mediterranean diet, the ketogenic diets with high protein—starting with South Beach and others—Atkins, and then finally ending more vegetarian-based, intermittent fasting with some protein and reduced carbohydrates.

Those are themes around dietary trends I think are important, but the session is really interesting because we just go through broad-ranging cardiovascular prevention: a lot around nutrition and cholesterol.

HCPLive: Is there a lag from interpreting clinical diet and weight management outcomes and actual practice among patients with cardiovascular risk?

Patel: I would say it's the most transformative and important science that we could be doing right now. But it's been really hard to do, as you can imagine. And it's because it's hard to randomize people to behave and eat differently. I do believe that some version of using the daily clock to say, 'This is what I'm eating, this is when I'm not eating,' can be valuable to help you understand the calories consumed versus the energy used.

The AHA (American Heart Association) recommends a plate with certain things on it. The Mediterranean diet could be argued to have different versions, but probably has weight management and cardiovascular outcomes tightest to it. But what we haven't demonstrated is what's actually feasible, sustainable, and works on a population and personal level. And that's why I think simple solutions are going to be needed, and there's going to be no one-off on, 'You can eat this food, you can't eat that food.' It will be more on systematic theory of what types of energy you need.

So, if you need burst energy, then you need less complex carbohydrates. You need simple carbohydrates to do an activity. If you have long-standing, long energy needs, then you might need more complex fiber or other energy. And if you can do that without taking in a lot of other calories or fatty calories, then you will feel satiated while having energy for the long run.

HCPLive: What other clinical discussions are featured at Beaumont?

Patel: I think the great thing about Beaumont is that it's a fun meeting where you get to interact with people that are thought leaders, both practicing cardiologists and clinicians. And you get to interact with them in a small, intimate environment, where questions are asked and people are debating things.

So, we go everywhere from what's the newest way in which you should be managing the different types of heart failure to what's the cutting-edge way to think about mitral valve disease or TAVR—all the way to what is state of the art for peripheral interventions or coronary physiology: how do we interpret ischemia for patients? I think all of those are important.

And we certainly have some really amazing speakers. Past FDA (US Food and Drug Administration) chair Rober Califf, MD, was there. He is now with Google, and he talked about, 'Is misinformation killing your patients, and what can we do about it?' That was a great talk on patient information, debates about artificial intelligence, all the way back to, 'How do I maximize how my patients are adhering to medications?'

So, the great thing about Beaumont is that in the span of 2-3 days, you can cover a watershed of cardiovascular care.