Kevin Kunzmann

The state of medical meetings are in flux in 2021. Previous successes in mitigating COVID-19 spread, afforded by early vaccine-induced immunity, provided organizers confidence to schedule in-person conference through this fall.

But with COVID-19 cases surging in past months, some meetings reverted to fully virtual capacity. Others sought to retain some semblance of in-person presentation.

 at the conclusion of The Metabolic Institution of America (TMIOA) Heart in Diabetes sessions in New York, NY this weekend, meeting organizer Yehuda Handelsman, MD, discussed the intricacies that go into preparing a hybrid conference amid COVID-19.

Handelsman, the Medical Director and Principal Investigator for TMIOA, also discussed how this year’s iteration of cardiovascular and metabolic meetings—such as the European Society of Cardiology (ESC) and American Diabetes Association (ADA)—informed strategies for this year’s unique Heart in Diabetes sessions.

He stressed the meeting’s successes were based on TMIOA’s lesser following than such large-scale meetings, an appreciation for in-person sessions among a “Zoom fatigued” audience and, to an extent, luck. All presenters who initially committed to the in-person sessions did attend in New York; their virtual

“Virtual has its limits, even though it sounds easy,” Handelsman said. “We had several hundred people registered to come in person. I initially predicted that (registrants) would want no more than 150-200 people in attendance to get sort of (COVID-19 related) safety. We had just about 200 here.”

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The TMIOA Medical Director and Principal Investigator discusses the idea behind hosting a mixed in-person and virtual conference for this year's Heart in Diabetes.

Yehuda Handelsman, MD: Organizing a Hybrid Cardiometabolic Meeting in 2021

The Metabolic Institute of America’s (TMIOA) 2021 Heart in Diabetes sessions in New York, NY this weekend highlighted the booming fields of research propelling the collaborative fields of 

Discussions throughout the meeting mainly focused on the advancement such research could deliver to clinical practice in the US. There was, however, underlying themes fixed on real-world delays. Presentations and reviews, at times, touched on a recurring theme: does the US health care system have a buildup of therapeutic indications because discovery outpaces deliberation?

 during the meeting, Christie Ballantyne, MD, Director of the Center for Cardiometabolic Disease Prevention at Baylor College of Medicine, discussed the possible issues his field sees in the rate of innovation and research relative to the process of regulation.

One such example he noted was the the awaited US FDA indication for promising investigative therapy inclisiran. Though part of its regulatory delay was due to inspection incapabilities brought on by the COVID-19 pandemic, it may also be at a detriment in real-world application because of US health care systems’ lessened value of lipid management in would-be eligible patients.

“There are some things we need to address in regards to implementation science to improve quality of care, which is just as important as making new therapies,” Ballantyne said.

Ballantyne also discussed the “disappointing” nature of new trial evidence lagging behind US real-world application datasets, and the need to better wield currently available therapies while awaiting ones yet to become authorized.

“Let’s work hard on the other things,” Ballantyne said. “Just because you can’t control one thing, it just means you’ll have to work harder on everything else.”

An expert considers the buildup of cardiovascular and cardiometabolic innovation, and the role of regulatory delays in it.

Christie Ballantyne, MD: Better Implementing Cardiovascular Research

 pharmacology has evolved so significantly in the last decade that the concept of disease management has looked beyond the standard definitions of diabetic care toward multifactorial benefit with a single agent.

But this “tremendous amount of progress,” Christie Ballantyne, MD, explained, has yet to even reach its fullest potential.

 during The Metabolic Institute of America’s (TMIOA) 2021 Heart in Diabetes sessions in New York, NY this weekend, Ballantyne, Director of the Center for Cardiometabolic Disease Prevention at Baylor College of Medicine, discussed the influence of newer cardiovascular prescribing strategy on the potential of cardiometabolic care in patients with type 2 diabetes.

As he explained, cardiovascular treatment guidelines haver evolved to prioritize an “aggressive approach” in lipoprotein and hypertension management, with emphasis on combination therapy.

“Why do we do it? Because it works,” Ballantyne said. “It’s effective. In diabetes, we need to get into it more.”

Ballantyne discussed the potential of bempedoic acid and inclisiran in the management of LDL-C in patients with or without diabetes; the former as an add-on therapy could provide up to 40% reduction in statin-intolerant patients, and the latter could provide PCSK9 inhibition with twice-annual injection therapy.

The expert also shared his own clinic’s strategies toward adopting better cardiometabolic management practices in patients with diabetes, as well as rationale for why implementation of already-available drug classes.

“We don’t have to wait for the new therapies,” Ballantyne said. “We’ve got therapies in our hands right now that are extremely effective.”

How inclisiran, bempedoic acid, and other investigative therapies may contribute to cardiometabolic disease management.

Christie Ballantyne, MD: Promising Cardiovascular Agents in Diabetes

The CARDIA study, initiated in 1985, has been delivering cardiovascular risk development and outcome data for the same young adult population for 4 decades now.

Among the key contributing findings from the 5100-plus cohort is the interpreted risk of cardiovascular disease development in women who were diagnosed with gestational diabetes mellitus (GDM) during pregnancy.

Though the CARDIA study continually benefits expert understanding of cardiovascular disease development and risk factors to this day, its trial design and execution may not be easily replicated.

 during The Metabolic Institute of America’s (TMIOA) 2021 Heart in Diabetes sessions in New York, NY this weekend, Erica P. Gunderson, PhD, MS, MPH, Senior Research Scientist, Kaiser Permanente Northern California Division of Research, discussed the GDM-specific outcomes derived from the CARDIA cohort.

Gunderson also discussed the value, and inherent hurdles, in conducting long-term, diverse cohort assessment in cardiology:

“I think observational studies are challenging and these large cohort studies are extremely difficult to do in a pragmatic sense, but also in terms of coordination and funding. And NHLBI really has put in a huge investment in the study, and it's yielded some very unique data and findings. It’s a valuable observational cohort. And for these types of questions around pregnancy, you can’t randomize people to GDM pregnancy or an adverse outcome. You can’t randomize people to lactation or not. You have to do the most rigorous observational study design with multiple rigorous measurements of confounders and analytic techniques that are involved—time to event, careful follow-up timing for outcomes, and really high-quality measures of risk factors or changes.”

A discussion on the winning qualities of the CARDIA study, and why it's also hard to replicate.

Kevin Kunzmann

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