A New Heart Disease Prevention Strategy: Combining Ezetimibe & Statins
Statement by Kirk Garratt, M.D., Medical Director of ChristianaCare's Center for Heart & Vascular Health "A new study is challenging the current approach to preventing heart disease by showing that combining ezetimibe (Zetia) with statins could be a highly effective treatment for all high-risk patients, not just those who can’t tolerate higher doses of statins. Ezetimibe works by blocking the absorption of dietary fats before they reach the liver, while statins block the conversion of these fats into bad cholesterol. Clinical studies have already shown that combining moderate doses of statins with ezetimibe works as well as high doses of statins alone.
This new research, which used a sophisticated method to combine results from many studies, demonstrates the potential of using this combination more routinely. The impact could be significant—potentially avoiding thousands of heart attacks and saving many lives each year.
Ezetimibe has minimal side effects and is available in generic form, offering a treatment option with few barriers to widespread use. However, patients should speak with their doctor to discuss whether this combination is right for them."
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Center for Heart & Vascular Health Recognized for Continued Excellence with American College of Cardiology HeartCARE Center Designation
For the fifth consecutive year, ChristianaCare’s Center for Heart & Vascular Health has earned the premier recognition from The American College of Cardiology (ACC) – the HeartCARE Center National Distinction of Excellence award – for its commitment to comprehensive, high quality cardiovascular care.
ChristianaCare was the first hospital system in Delaware and one of only a handful in the U.S. to attain this recognition when it was first awarded in 2020 from the ACC, a nonprofit medical association representing more than 50,000 cardiovascular specialists.
“We are proud to be a regional leader for cardiovascular care with the most advanced medical, surgical and minimally invasive specialty care, technology and research,” said Kirk Garratt, M.D., medical director of ChristianaCare’s Center for Heart & Vascular Health. “Congratulations to our entire team and all who collaborate seamlessly to deliver care 24/7. As a result, those living in Delaware and neighboring states can receive the highest quality cardiovascular care from the Center for Heart & Vascular Health.”
Hospitals that have earned an ACC HeartCARE Center designation have met a set of criteria, including participating in at least two ACC accreditation services programs, national cardiovascular data registries and targeted quality improvement campaigns designed to close gaps in guideline-based care. In addition to being a current recipient of the HeartCARE Center designation, ChristianaCare participates in the ACC’s chest pain MI with PCI (heart attack with angioplasty) and resuscitation accreditation, cath lab accreditation and the Society of Thoracic Surgeon database.
“ChristianaCare has demonstrated its commitment to providing the community with excellent heart care,” said Deepak L. Bhatt, M.D., MPH, FACC, chair of the ACC accreditation management board. “ACC accreditation services is proud to award the Center for Heart & Vascular Health with the HeartCARE Center designation.”
Hospitals receiving the HeartCARE Center designation have demonstrated their commitment to consistent, high-quality cardiovascular care through comprehensive process improvement, disease and procedure-specific accreditation, professional excellence and community engagement. ChristianaCare has proven to be a forward-thinking institution with goals to advance the cause of sustainable quality improvement.
The Center for Heart & Vascular Health is among the largest, most capable regional heart centers on the East Coast. It is among the few centers in the region that integrates cardiac surgery, vascular surgery, vascular interventional radiology, cardiology and interventional nephrology in a single location. Its expert clinical staff performed nearly 200,000 patient procedures last year.
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3 min
Improving Care for Black Patients With Heart Failure and Hypertension
ChristianaCare’s Center for Heart & Vascular Health has dramatically improved the clinical outcomes of Black patients living with heart failure and hypertension by using a digital hybrid platform that provides patients with a dedicated health coach to ensure their care plan is followed and treatment goals are achieved.
Through this innovative approach, ChristianaCare achieved a significant improvement in the number of Black patients adhering to prescribed doses of guideline-directed medical therapy (GDMT) for heart failure.
“At ChristianaCare, we are deeply committed to eliminating disparities and achieving health equity in the communities we serve,” said Kirk Garratt, M.D., medical director of the Center for Heart & Vascular Health.
“We are proud that we have been able to significantly improve the health outcomes of our patients, especially addressing health disparities in the Black population for patients with heart failure and hypertension.”
Approximately 32% of ChristianaCare’s heart failure patient population identify as Black, which is a higher percentage compared to the Black population nationally (12.4%).
Historically, Black Americans have experienced racial disparities in heart failure treatment and experience worse patterns of adherence to guideline-directed medical therapy (GDMT) . Additionally, Black Americans have a 30% greater risk of death from heart disease than white Americans.
Combining technology and human-powered guidance This novel approach to care is powered by Story Health, a leading health technology services company.
Its digital platform and health coaches have been able to deliver superior outcomes for ChristianaCare’s patients regardless of race. Black patients in particular have made remarkable gains:
6 times improvement on target doses of beta blockers (76%). 7 times improvement on target doses ACE/ARB/ARNIs (54%). 2 times improvement on target doses of MRAs (57%). ChristianaCare was also able to achieve improvement in Black patients taking SGLT2 inhibitors, rising from a 32% baseline to 74%. Despite their vital role in treating heart failure, SGLT2 inhibitors are historically underprescribed and see lower adherence – largely due to affordability challenges, as costs can be $500 per month or more.
Helping patients overcome cost barriers is critical, which is why the health coaches directly engage with patients to identify those who may need assistance and will work on their behalf to qualify for prescription assistance programs.
“Along with their digital platform, the health coaches from Story Health understand the unique needs of our patients and have helped us create deeper, more accessible relationships with our patients to help improve their health and outcomes,” said Sourin Banerji, M.D., medical director of Advanced Heart Failure and Mechanical Circulatory at ChristianaCare.
The health coaches serve as an extension of the clinician to identify and resolve challenges such as medication adherence, lab work coordination, transportation arrangement and even prescription assistance that cause disruptions in a patient’s care journey and lead to negative outcomes.
Improved control of hypertension In addition to heart failure patients, ChristianaCare’s collaboration with Story Health supported patients with hypertension, delivering significant reductions in blood pressure for those enrolled regardless of race.
Among Black patients specifically, there were significant decreases in average absolute systolic and diastolic blood pressure levels (17 mm Hg and 8 mm Hg, respectively) after 120 days, compared to 8 mm Hg and 5 mm Hg decreases for uncontrolled hypertensives in another digital program after 12 months.
As a result of this initial success, ChristianaCare’s Center for Virtual Health is expanding the use of this care model beyond cardiology to support all patients in the population. Many of these patients struggle to manage high blood pressure, and the use of a continuous care program will be an important tool to help with medication management and addressing social barriers.
“Health equity is an incredibly important initiative, and we see our mission as critical to helping specialty and primary care providers drive more equitable care,” said Story Health Co-founder and President Nita Sommers.
“As an industry leader, ChristianaCare understands that every individual deserves compassionate care that is accessible, so we are honored to be working with its cardiology team and now the Center for Virtual Health to improve the health of patients.”
ChristianaCare has been recognized numerous times for high-quality heart care. Among the many achievements are the American College of Cardiology HeartCARE National Distinction of Excellence Award for three consecutive years (2020-2023) and being named among Healthgrades top 100 hospitals for heart care in the U.S. for the past two years (2022-2023).
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Biography
Dr. Kirk Noel Garratt oversees one of the nation's busiest heart and vascular programs.
Renowned in the field of heart disease for his achievements in the clinical, academic and research aspects of interventional cardiology, Dr. Garratt joined ChristianaCare in 2015. He was appointed in 2016 as ChristianaCare’s John H. Ammon Chair of Cardiology.
Previously, Dr. Garratt spent 17 years at the Mayo Clinic and was a member of the team of physicians who first performed minimally invasive heart procedures there.
Dr. Garratt serves on medical advisory boards, task forces and steering committees and presents at conferences and symposiums worldwide. He has participated in clinical research for more than 30 years, authored more than 300 publications and is a reviewer and editor for multiple medical journals.
In terms of heart attack volume, ChristianaCare is No. 45 nationwide in terms of inpatient admissions for heart attack patients with Medicare.
Areas of Expertise
Cardiology
Cardiovascular Disease
Heart Health
Education
University of California College of Medicine, Irvine
Association of Cognitive Impairment With Treatment and Outcomes in Older Myocardial Infarction Patients: A Report From the NCDR Chest Pain-MI Registry
Journal of the American Heart Association
Terrence Donnelly, Kirk Garratt, et al.
2019-09-03
Background Little is known regarding use of cardiac therapies and clinical outcomes among older myocardial infarction (MI) patients with cognitive impairment. Methods and Results Patients ≥65 years old with MI in the NCDR (National Cardiovascular Data Registry) Chest Pain-MI Registry between January 2015 and December 2016 were categorized by presence and degree of chart-documented cognitive impairment...
Occupational health hazards of interventional cardiologists in the current decade: Results of the 2014 SCAI membership survey
Catheterization Cardiovascular Interventions
Lloyd W. Klein, Yolande Tra, Kirk N. Garratt, Wayne Powell, Georgina Lopez‐Cruz, Charles Chambers, James A. Goldstein
2015-03-24
Interventional cardiologists and staff are subject to unique physical demands that predispose them to distinct occupational health hazards not seen in other medical disciplines.
Adoption of Radial Access and Comparison of Outcomes to Femoral Access in Percutaneous Coronary Intervention
Circulation
Dmitriy N. Feldman, Rajesh V. Swaminathan, Lisa A. Kaltenbach, Dmitri V. Baklanov, Luke K. Kim, S. Chiu Wong, Robert M. Minutello, John C. Messenger, Issam Moussa, Kirk N. Garratt, Robert N. Piana, William B. Hillegass, Mauricio G. Cohen, Ian C. Gilchrist, Sunil V. Rao
2013-06-11
Radial access for percutaneous coronary intervention (r-PCI) is associated with reduced vascular complications; however, previous reports have shown that
Predictors of Long-Term Survival After Coronary Artery Bypass Grafting Surgery Results From the Society of Thoracic Surgeons Adult Cardiac Surgery Database (The ASCERT Study)
Circulation
David M. Shahian, Sean M. O'Brien, Shubin Sheng, Frederick L. Grover, John E. Mayer, Jeffrey P. Jacobs, Jocelyn M. Weiss, Elizabeth R. DeLong, Eric D. Peterson, William S. Weintraub, Maria V. Grau-Sepulveda, Lloyd W. Klein, Richard E. Shaw, Kirk N. Garratt, Issam D. Moussa, Cynthia M. Shewan, George D. Dangas, Fred H. Edwards
2012-02-23
Most survival prediction models for coronary artery bypass grafting surgery are limited to in-hospital or 30-day end points. We estimate a long-term survival model using data from the Society of Thoracic Surgeons Adult Cardiac Surgery Database and Centers for Medicare and Medicaid Services.
Prediction of Long-Term Mortality After Percutaneous Coronary Intervention in Older Adults
Circulation
William S. Weintraub, Maria V. Grau-Sepulveda, Jocelyn M. Weiss, Elizabeth R. DeLong, Eric D. Peterson, Sean M. O'Brien, Paul Kolm, Lloyd W. Klein, Richard E. Shaw, Charles McKay, Laura L. Ritzenthaler, Jeffrey J. Popma, John C. Messenger, David M. Shahian, Frederick L. Grover, John E. Mayer, Kirk N. Garratt, Issam D. Moussa, Fred H. Edwards, George D. Dangas
2012-02-23
The purpose of this study was to develop a long-term model to predict mortality after percutaneous coronary intervention in both patients with ST-segment elevation myocardial infarction and those with more stable coronary disease.
