iwMPN 2025 | Cardiovascular health in patients with MPNs: risk stratification and management strategies

So I spoke today about the importance of cardiovascular health in patients with myeloproliferative neoplasms. We know from previous studies that up to 40% of these patients die of cardiovascular disease and the underlying blood disorder, the PV or ET, is actually driving vascular disease through a range of different mechanisms. So it’s really important to coordinate cardiology care as well as hematology care to give these patients the best outcomes. I presented a model of doing a vascular baseline risk assessment where you take a standard 10-year baseline risk score. These vary according to where you practice in the world, so there’s the SCORE and SCORE-OP, the scores for the Europeans, and in America the ACC and AHA, ASCVD scores and these give a 10-year risk and break down patients into a low, an intermediate or a high risk group. Now we know if you look at MPN patients there’s additional risk factors based on their hematocrit, based on having the JAK2 mutation which is associated with increased vascular events and now more and more emerging data on the role of CHIP mutations is also increasing risk. So I think if you have an MPN patient at diagnosis, you can use the standard risk scores with the caveat they haven’t been validated in MPN patients specifically, then add these additional MPN vascular risk factors to give you a feel of whether somebody is low, medium or high. And then we discussed the concept of starting statin therapy in addition to aspirin in the medium and high risk group. And for the low risk group, I talked about the role of vascular imaging, that’s CT coronary angiography and carotid Doppler ultrasound to really ensure they truly are low risk as if they do have atheroma in each of those important blood vessels, then I would start them on statin therapy as a primary prevention as their risk is not truly low. So it’s tuning it that the intermediate patients are probably higher risk, the high risk patients need everything we can do and then for low risk patients really using modern vascular imaging to ensure they truly are low because there’s some false positives where we see a residual risk even in what are called low risk patients using the 10-year score and hopefully that will all come together to help prevent problems and finally in the high and very high risk patients people maybe who have had previous coronary disease with stenting or bypass surgery or stable angina and they’ve come to the haematology clinic with a new diagnosis of MPN that as well as statins and aspirin we should be thinking about other ways to minimize their risks and there are two complementary approaches. One is in addition to aspirin thinking of a second drug either and it’s dual antiplatelet or a low dose of a DOAC and we have the COMPASS trial which shows in the general population of higher vascular risk patients the addition of low dose rivaroxaban 2.5 milligrams twice daily to the aspirin reduced vascular events and I think that would be a very reasonable approach for a high risk MPN patient although ideally we’d like some studies to prove that’s the safest thing to do as well. And secondly modern lipid lowering therapies so we’ve had statins for 40 years we know they work very well that we know they a high dose of a good statin can lower cholesterol by about 50% but that’s only 50% and 10% of people can’t take statins because of side effects and therefore I discussed the role of modern lipid lowering therapies and in particular PCSK9 inhibitors which can lower the bad LDL cholesterol by about 70% on their own and if you add them to a statin down to 90%. And they’re really seeing some of the lowest cholesterols we’ve ever seen in humans using these treatments. So both in general cardiology for high-risk patients and for the MPN patients at high risk I think that’s the modern approach to their lipid management.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.