Great points on Prevent Trial:

3% ARR, 89% RRR!

Results no longer significant at 4 years.

Possibility of bias exists (possible ⬆️admission for angina or revascularizarion in those not stented)

How much of benefit is due to ⬆️P2Y12 use in PCI arm?

podcasts.apple.com/us/podcast/thi…

It is incredible to me how many people think orange juice is healthy. They are trying to make healthy choices, but just are misinformed. No juice is healthy for you!!

GLP1's should be studied in a-fib:

Those with BMI > 27 who lost >10% body weight had 6x greater probability of arrhythmia-free survival compared to those who lost < 10% of their weight.

pubmed.ncbi.nlm.nih.gov/25792361/

Just had an insurance company decline rosuvastatin and state the patient has to try a different statin first. Another example of an insurance company pointlessly getting in the way of patient care.

Is anyone aware of a paper showing statins reduce IL6 in humans? I have seen in vitro papers but not actual in vivo/in clinical trials.

Stop thinking of GLP-1 medicines (eg semaglutide) as weight loss drugs.

Start thinking of them as health promoting medicines.

They not only help people do the lifestyle they know they should do, but also have effects beyond weight that improve health.

Fantastic summary of most of the major trials from #ACC2024 Thank you Saad Ur Rahman

I keep telling my patients, in 10-20 years 5 mg rosuva will be OTC and there will be a craze online of influencers recommending this OTC option to lower LDL. We’ve known the benefits and safety for decades. Might as well start it now and reap the compounding benefits of time.

Does the lack of a sham-PCI in this trial bother anyone? Much of the benefit was in ischemia driven target lesion revascularization - I would think pt’s who knew they had ⬆️risk plaque that wasn’t stented would be more likely to seek revascularizarion for borderline symptoms.

Why not (yet) quantify the amount Lp(a) contributes to our LDL?

1. 'Cholesterol content of Lp(a) has been shown to be highly variable'.
2. Using molar concentrations of Lp(a) for correction of LDL-C for Lp(a)-C requires further clinical validation.

sciencedirect.com/science/articl…

Great discussion of the much awaited DanGer Shock trial.

Want to talk about the 'All-cause mortality (45.8% Impella vs. 58.5% control) at 180 days' part.

50% mortality from acute MI/shock *despite* use of some of the most powerful tools we have in the modern era.

More…

'We found that the odds of developing CAC were increased by 81% in patients with hyperuricemia.' ncbi.nlm.nih.gov/pmc/articles/P…

More promising data on inclisaran. I wish we could fast forward to 2026 when ORION-4 will be completed, to see if this translates into improved CV outcomes.

The results of the ROSE-2 trial sure look impressive for obicetrapib. But as always, need to wait for the outcomes data before we declare it a new member of our toolkit.

1/ There’s a movement to discredit LDL-c as a valid measure for primary prevention of MACE, particularly in high risk ppl (LDL-c ≥ 190 mg/dL).

Let’s examine the data.

One of the best ways to assess risk related to LDL-c is by lowering it (with meds) & seeing what happens. 🧵

Really enjoyed John Mandrola, MD commentary on statins and diabetes risk here:

podcasts.apple.com/us/podcast/thi…

Exhibit A as to why doctors need to be active on social media

“As compared with moderate-dose statin therapy, the NNH for intensive-dose statin therapy was 498 for new-onset DM2 while the NNT per year for intensive-dose statin therapy was 155 for CV events.”

jamanetwork.com/journals/jama/…

Copenhagen General Population Study: the Lp(a) level associated with a 50% increased risk for MI was 193 nmol/L (89.5 mg/dL) and for calcific AS was 154 nmol/L (71.3 mg/dL).
sciencedirect.com/science/articl…

'For each increase of 1 mg/dL of serum uric acid level, the risk of CAC progression was increased by 31%. ncbi.nlm.nih.gov/pmc/articles/P…