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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 02/04/2025

No 'additive' cardioprotective effect of GLP-1RA on background use of SGLT2i in HARMONY, AMPLITUDE-O and most recently SOUL. Cardioprotective effects of GLP-1RA are 'independent' of SGLT2i ahajournals.org/doi/epdf/10.11… 10.1016/j.jacc.2023.05.048

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 29/03/2025

Warrior trial PEP result shown below. Is this a NULL trial or a NEGATIVE trial? Trial powered for HR 0.80 which was excluded by 95% CI How many null or negative PRAGMATIC trials before we seriously consider/scrutinize the utility of such trials?

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Reposted by @kaulcsmc.bsky.social

Florian Zores @fzores.eurosky.social · 16/03/2025

Very proud of this work with @kaulcsmc.bsky.social just published in Progress in Cardiovascular Diseases Are ORBITA trials practice-changing? We discuss whether the enthousiasm of some after ORBITA-2 is really justified. www.sciencedirect.com/science/arti... #medsky #cardiosky

sciencedirect.com

Are ORBITA trials practice-changing?

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 16/02/2025

Are the Device Approval Standards Lax? JACC Cardiovasc Interv. 2025 Feb 10;18(3):380-384. doi: 10.1016/j.jcin.2024.08.037. PMID: 39939040. Device Approval in the United States: The FDA Is on Target. JACC Cardiovasc Interv. 2025 Feb 10;18(3):385-387. doi: 10.1016/j.jcin.2024.10.044. PMID: 39939041.

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Reposted by @kaulcsmc.bsky.social

Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 13/01/2025

Editorial on the renal results of FINEARTS HF in @jaccjournals.bsky.social from @kaulcsmc.bsky.social and moi Free link: authors.elsevier.com/a/1kQ%7Ec2d9... #NephSky #CardioSky #Finerenone

So, why did finerenone not favorably impact kidney
outcomes despite a 30% reduction in UACR? To
put this in context, a 30% reduction from a baseline
level of 18 translates into a modest absolute reduction
of 5. By contrast, a 30% reduction from a baseline
UACR of 514 observed in the pooled FIDELITY
analysis translates into an absolute difference of 154.
The higher the baseline UACR (reflecting greater
kidney damage), greater might be the potential for
kidney benefit for a given UACR reduction. Unlike
those trials, FINEARTS-HF was primarily a HF trial
that was not enriched to include patients with a
greater degree of kidney damage. Only 10% had
baseline UACR $300 in whom the kidney outcome
risk was not different from the overall cohort.
Possibly the mechanism of albuminuria is different in
CKD characterized by intraglomerular hypertension
vs HF where intraglomerular hypotension might be
more prevalent. The volume, hemodynamic, or
vascular effects of MRA that are independent of
UACR reduction, may play a greater role in mediating
HF benefits than their potential impact on inflammation
and fibrosis, pathways through which kidney
disease progression is more likely to be mitigated in
CKD. Thus, inhibition of MR activation while protective
for the heart might turn out to be harmful for
the kidneys in HF as demonstrated consistently in 3
MRA trials.3,5

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 19/12/2024

Imagine if I excluded centers in a multicenter trial of SAVR vs TAVR where TAVR outperformed SAVR, I could show that SAVR was superior to TAVR in high-risk patients with AS (PARTNER-1A).

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 27/11/2024

Should Heart Failure Trials routinely report on all-cause hospitalizations? Should clinicians, guidelines & payers favor interventions that favorably impact cause-specific & all-cause outcomes? jamanetwork.com/journals/jaman… jamanetwork.com/journals/jaman

jamanetwork.com

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 20/11/2024

1/ Is LDL-C lowering by CETP inhibitor cardioprotective? Brief history ACCELERATE (Evacetrapib), N=12092, F/U: 28m Mean LDL 81; LDL⬇️37%, Lp(a)⬇️22% PEP (MACE-5): 12.9% vs 12.8% HR 1.01, 0.91-1.11 Trial stopped early due to futility x.com/mdavidsonmd/...

x.com

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 16/11/2024

1/ OPTION LAAC device vs DOAC post a fib ablation N=1600, f/u 3y PEP (death, stroke or SE) NI margin 5% RD, 1.5 RR Result: 41 vs 44, 5.3% vs 5.8% (c/w 10% assumed), RD: -0.5%, UL 1.8%; HR 0.91, 0.59-1.39 NI met for RD and RR margin www.nejm.org/doi/full/10....

nejm.org

Left Atrial Appendage Closure after Ablation for Atrial Fibrillation | NEJM

Oral anticoagulation is recommended after ablation for atrial fibrillation among patients at high risk for stroke. Left atrial appendage closure is a mechanical alternative to anticoagulation, but ...

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 16/11/2024

1/ SUMMIT Torzepatide in HFpEF in patients with BMI>30 (N=731) F/U 2y PEP: 1. CV death or worsening HF 2. Change in KCCQ-CSS Key results: PEP, HR 0.62, 0.41-0.95, p=0.03 kCCQ improved along with 6MWD, weight loss, SBP, & CRP. Slight ⬆️ in HR GI AEs ⬆️ www.nejm.org/doi/full/10....

nejm.org

Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity | NEJM

Obesity increases the risk of heart failure with preserved ejection fraction. Tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor...

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 16/11/2024

1/ BPROAD (N=12821) F/U 4.2y SBP delta: 16.7 (118.3 vs 135 median) A1C at 48m = 7.6% PEP (CV death, MI, stroke or HF): 393 vs 492, 0.79, 0.69-0.90 ARD = 1.55% (6.13% vs 7.68%) PEP driven by stroke: 284 vs 356, HR 0.79, 0.67-0.92 Stroke dominated PEP No diff. in serious AE

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 15/11/2024

1/ Key trials at AHA 2024 BPROAD Intensive BP lowering (SBP<120) vs standard treatment (SBP <140) in diabetes. PEP: 4-MACE (CV death, MI, stroke or HHF) ACCORD failed to validate the hypothesis that SBP target of <120 was the optimal target in diabetes.

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kaulcsmc.bsky.social @kaulcsmc.bsky.social · 13/11/2024

Albuminuria is a strong ‘prognostic’ biomarker for kidney and CV risk across a wide spectrum of CKM syndrome. Is it a reliable ‘predictor’ biomarker (lowering it reduces risk) for: 1. Kidney & CV (including HF) risk in CKD? 2. Kidney and HF risk in HF? www.ahajournals.org/doi/10.1161/...

ahajournals.org

Albuminuria: An Underappreciated Risk Factor for Cardiovascular Disease | Journal of the American Heart Association

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