Dr. Benny's Heartsmart

05/09/2026

❤️ Lipoprotein(a): Lowering the Number Is Not the Same as Lowering the Risk

Most people know about LDL or “bad cholesterol.” But there is another important—and much less well-known—cardiovascular risk factor called Lipoprotein(a), or Lp(a).

Lp(a) is largely inherited, with levels mostly determined by our genes. Unlike LDL cholesterol, lifestyle changes such as diet and exercise usually have little effect on it. Approximately 1 in 5 people worldwide has an elevated Lp(a) level. Higher levels are associated with increased risk of coronary artery disease, heart attack, stroke and calcific aortic valve disease.

Because genetic and epidemiological evidence strongly supports Lp(a) as a causal cardiovascular risk factor, there has been great excitement about new medications capable of dramatically lowering it.

🧬 So, does lowering Lp(a) prevent heart attacks and strokes?

We have just received an important—and somewhat unexpected—answer from the Lp(a)HORIZON trial.

This landmark Phase III study enrolled 8,323 patients who already had cardiovascular disease and elevated Lp(a). They received either pelacarsen, an antisense therapy specifically designed to reduce production of Lp(a), or placebo, in addition to contemporary guideline-directed cardiovascular treatment.

Pelacarsen successfully lowered Lp(a).

But here comes the surprise:

👉 Lowering Lp(a) did not translate into a statistically significant reduction in cardiovascular events.

The trial therefore did not meet its primary endpoint of reducing cardiovascular death, non-fatal heart attack, non-fatal stroke or urgent coronary revascularisation.

Does this mean Lp(a) doesn’t matter?

No.

This is an important distinction. The trial does not establish that Lp(a) is unimportant or that lowering Lp(a) can never reduce cardiovascular events. It tells us that lowering Lp(a) with pelacarsen, under the conditions studied, did not significantly reduce events in the overall trial population.

We now need the complete trial results to understand the magnitude and duration of Lp(a) reduction, baseline Lp(a), subgroup effects and individual cardiovascular endpoints. Novartis has stated that the full data will be presented at an upcoming medical congress.

And the Lp(a) story is far from over. Other powerful Lp(a)-lowering therapies, including olpasiran and lepodisiran, are being evaluated in cardiovascular outcome trials. Their results will help answer the fundamental question:

Can sufficiently profound and sustained reduction of Lp(a) actually prevent heart attacks and strokes?

Until then, elevated Lp(a) remains an important marker of cardiovascular risk, and identifying it can help us recognise people who may require particularly aggressive management of all their modifiable risk factors—LDL cholesterol, blood pressure, diabetes, smoking, weight and physical activity.

Science progresses not only when a trial confirms what we expect, but also when a well-designed trial challenges our expectations.

❤️ Dr. Benny’s Heartsmart
Evidence today for a healthier tomorrow.

03/09/2026

🏋️‍♀️ Strength training may help your heart age better — not just your muscles. ❤️

We often associate resistance training with maintaining muscle, strength and independence as we grow older. This interesting 2-year randomized controlled trial suggests that its benefits may extend to the structure and function of the heart itself.

Researchers followed 64 women aged 60 years or older. Half participated in supervised progressive resistance training three times per week, while the others did not undertake the training program.

After two years, the differences were striking. Compared with the non-training group, women who performed regular resistance exercise showed less thickening of the heart muscle, lower left atrial volume and more favorable measures of the heart’s relaxation and filling function.

In simple terms: the heart, like skeletal muscle, remains remarkably responsive to exercise even later in life.

This does not prove that weight training prevents heart attacks, heart failure or prolongs life—the study examined echocardiographic changes rather than clinical outcomes. But it adds another compelling reason to include appropriately prescribed strength training as part of healthy ageing.

And importantly, the message isn’t about lifting extremely heavy weights. Regular, progressive and appropriately supervised resistance exercise is what matters.

Strong muscles. Stronger ageing. And perhaps a younger-functioning heart. ❤️

Original reference:
Rodrigues RJ, et al. Long-Term Resistance Training Improves Cardiac Structure and Function in Older Women: A 2-yr Randomized Controlled Trial. Med Sci Sports Exerc. 2026;58(6):1288–1299. PMID: 41572515.

For background on age-related cardiac remodeling: Cheng S, et al. Circ Cardiovasc Imaging. 2009;2(3):191–198. PMID: 19808592.

28/08/2026

Coronary Angioplasty through Radial Artery

21/08/2026

Happy to share that I have been invited as a faculty member at ICCCON '26

21/08/2026

ALCOHOL AND HEALTH: NO LONGER A REASON TO DRINK FOR THE HEART

For many years, light or moderate alcohol consumption—particularly red wine—was believed to protect the heart and improve longevity. However, newer analyses have challenged this assumption.

Why did earlier studies appear to show benefit?

Many observational studies included former drinkers in the “non-drinking” group. Some had stopped drinking because of illness—the so-called “sick-quitter” effect. Moderate drinkers also tended to differ from abstainers in income, exercise, diet, healthcare access and other health behaviours.

When these confounding factors are addressed, the apparent survival advantage of light drinking largely disappears.

A major 2023 meta-analysis involving 107 studies and nearly 4.8 million participants found:

• Occasional and low-volume drinking did not significantly reduce all-cause mortality compared with lifetime abstinence.
• At genuinely low consumption, there was also no clearly detectable increase in overall mortality.
• Mortality increased as consumption rose, with women generally reaching harmful levels at a lower intake than men.

This leads to an important distinction:

“Light drinking may not measurably increase overall mortality” does not mean “light drinking is completely harmless.”

All-cause mortality combines numerous competing outcomes. Even when the overall mortality curve appears relatively flat at low intake, alcohol may still increase particular risks, including:

• Certain cancers
• Hypertension
• Atrial fibrillation
• Haemorrhagic stroke
• Liver disease
• Sleep disruption
• Accidents and injuries

Cancer risk is especially important. Alcohol is a recognised carcinogen, and no completely risk-free threshold has been established for several alcohol-related cancers. The type of beverage does not eliminate this risk: wine, beer and spirits all contain ethanol.

What should we conclude?

• Alcohol should not be started or continued for presumed cardiovascular protection.
• Red wine is not a health supplement. Its polyphenols can be obtained more safely from grapes, berries, nuts and a Mediterranean-style diet.
• For someone who already drinks occasionally, a single infrequent drink is unlikely to produce a large absolute increase in risk.
• Nevertheless, less is better: include several alcohol-free days, avoid daily drinking and avoid concentrating multiple drinks into one occasion.

The modern message is balanced:

Light drinking has no proven longevity benefit. Very low intake may carry only a small absolute risk, but that risk is not zero—and it increases with both the amount consumed and the frequency of exposure.

References:
Zhao J, et al. JAMA Network Open. 2023;6:e236185.
World Health Organization/International Agency for Research on Cancer: Alcohol and cancer.

Dr. Benny Tharukutty Panakkal
Senior Consultant Interventional Cardiologist

14/08/2026

From anatomical landmarks to real-time precision: ultrasound-guided femoral access

I am a radial-first interventional cardiologist, with more than 90% of my PCI procedures performed through the radial route. ( doing angioplasty from the wrist)

However, femoral access ( the groin approach) remains essential in selected situations—particularly when larger 7 Fr or greater systems are required for dedicated two-stent bifurcation procedures, CTO PCI, mechanical circulatory support devices, or when the radial arteries are unsuitable.

Previously, I obtained femoral arterial access using anatomical landmarks. Although I fortunately did not encounter major access-related complications, landmark-guided puncture inevitably carries some uncertainty because every patient’s anatomy is different.

Whenever hypotension occurred during or after a femoral procedure, one concern would always remain at the back of my mind: could there be concealed bleeding from an excessively high puncture?

I have now routinely moved to ultrasound-guided femoral arterial access whenever the femoral route is required.

Using my wireless handheld GE Vscan Air connected to an iPad, I can directly visualize:

• The common femoral artery and adjacent vein
• The femoral bifurcation
• The vessel’s course and depth
• The relationship to the femoral head
• Anterior-wall calcification or atherosclerotic plaque
• The needle tip entering the artery in real time
• The guidewire within the arterial lumen

This allows me to select an optimal, healthy segment of the common femoral artery—avoiding punctures that are too high or too low and minimizing guesswork.

The dual-headed handheld device is particularly convenient in the catheterization laboratory: its linear transducer facilitates vascular imaging, while the phased-array transducer is immediately available for focused cardiac assessment when required.

For me, the greatest benefit is not only technical precision but also peace of mind. I know exactly where the artery has been entered.

No guesswork. Better precision. Greater confidence—and a stronger focus on patient safety.

An excellent open-access educational article by Bernardi and colleagues, titled “A Six-Step Approach for Optimizing Ultrasound-Guided Femoral Artery Access,” provides a systematic framework for achieving an optimal common femoral artery puncture. The authors emphasize vessel identification, defining the CFA boundaries, visualizing the femoral head, selecting the target, tracking the needle and confirming guidewire position.

Credit and recommended reading:
Fernando Luiz de Melo Bernardi, Guilherme Luiz de Melo Bernardi, Julio Roberto Barbiero, et al. A Six-Step Approach for Optimizing Ultrasound-Guided Femoral Artery Access. Catheterization and Cardiovascular Interventions. 2025;106(2):1023–1031. Open-access article⁠

14/08/2026

A journey of more than two decades

When I joined Badr Al Samaa in 2003, it was still a small and humble healthcare establishment in Ruwi, built upon an ambitious vision. Over the years, I have had the privilege of witnessing that vision grow into one of the GCC’s most respected healthcare groups, with an extensive network of hospitals and medical centres.

At the heart of this extraordinary journey have been our Managing Directors, Dr. P. A. Mohammed Dr. V. T. Vinod and Mr. Abdul Latheef Uppala. From modest beginnings, their vision, perseverance, courage and commitment to accessible healthcare have established them as highly respected business leaders in Oman and across the region.

Mr. Abdul Latheef also created history in 2022 by becoming the first expatriate investor elected to the Board of the Oman Chamber of Commerce and Industry—a remarkable recognition of his leadership and contribution to Oman’s business community.

My own journey has remained closely connected with theirs. After many formative years with Badr Al Samaa and a subsequent chapter in Canada, I returned to serve as Chief of Cardiology and Group Medical Director—proud to contribute once again to an institution that has been such an important part of my professional life.

The recent inauguration of Oman’s first AI-powered cardiac catheterisation laboratory with OCT and IVL technology in the private healthcare sector, at Badr Al Samaa Royal Hospital, represents another special milestone in this shared journey. With high-resolution intravascular imaging using Optical Coherence Tomography and advanced coronary calcium-modification technology through Intravascular Lithotripsy, the Badr Royal Heart Centre is helping bring a new level of precision and capability to complex coronary intervention in Oman. Badr Al Samaa Royal Hospital⁠

More than two decades later, our relationship represents far more than a professional association. It is a shared journey founded on trust, mutual respect, loyalty and the determination to grow without forgetting where we began.

My heartfelt congratulations to Dr. P. A. Mohammed and Mr. Abdul Latheef on everything they have accomplished. I deeply admire their remarkable journey and remain sincerely grateful for their trust, friendship and support throughout the years. It has been an honour to grow alongside them and to remain part of the continuing Badr Al Samaa story.

10/08/2026

10/08/2026

A new era in advanced cardiac care begins at Badr Al Samaa Royal Heart Centre, Badr Al Samaa Royal Hospital, Muscat.

Our newly inaugurated AI-enabled Cath Lab, supported by advanced technologies including Optical Coherence Tomography (OCT) and Intravascular Lithotripsy (IVL), enhances our ability to perform complex coronary interventions with greater precision, safety and confidence.

A proud milestone for our hospital—and a major step forward in delivering state-of-the-art cardiac care in Oman.