Jonathan Afilalo

A remix for those living in the SI world @ThanassoulisMD

Particularly impressed by bleeding risk reduction of apix > riva in older VTE patients (RR 0.33!) 👏 Kudos to investigators from @CIUSSS_COMTL @LadyDavisJGH @cusm_muhc @RodgerMarc @SusanRKahn1

In an international, randomized trial involving patients with acute venous thromboembolism, the risk of clinically relevant bleeding was significantly lower with apixaban than with rivaroxaban during the 3-month treatment period. Full COBRRA trial results: nejm.org/doi/full/10.10…

How should LV filling pressures be estimated in patients with MAC? #ASEchoJC

Multivitamin supplementation slows biological aging. Older adults taking a daily multivitamin for 2 years reduced their pace of epigenetic aging by 0.1–0.2 years compared with placebo. The effect was strongest in people with accelerated biological aging. Interestingly, cocoa flavanol supplementation showed no effect on epigenetic aging in the same trial. The effect is small, but it adds to evidence from the COSMOS trial, where multivitamin supplementation improved cognitive function, despite showing no clear benefits for cancer, cardiovascular disease, or all-cause mortality. The data challenge the idea that multivitamins are “completely useless," even if their benefits appear modest and context-dependent.

Now in @JACCJournals: Insights from the FUTURE-HFII trial by #HFC members @FudimMarat, Tre Martyn et al. show ambulatory IVC congestion monitoring enabled physician-directed self-management and increased signal-driven interventions. sciencedirect.com/science/articl…

BELIEVE it or not… this obesity trial suggests we may finally separate fat loss from muscle loss. In the BELIEVE trial (Nature Medicine): 🔹 Semaglutide alone → ~15.7% weight loss 🔹 Combination therapy → ~22% weight loss (~24 kg) 🔹 Total body fat ↓ ~46% 🔹 Visceral fat ↓ ~58% 🔹 Lean muscle largely preserved For decades, weight loss meant losing muscle + metabolic reserve. This approach targets appetite AND muscle biology simultaneously. If confirmed in outcomes trials, this could reshape how we think about: ❤️ cardiometabolic disease 💪 sarcopenic obesity 🫀 surgical risk & frailty We may be moving from weight loss → body composition medicine. #Obesity #CardioMetabolic #GLP1 #Semaglutide #Longevity #HeartHealth #PreventiveMedicine #NatureMedicine #MedTwitter #Cardiology #Endocrinology #DigitalHealth #FutureOfMedicine #HealthyAging #PrecisionMedicine

Dietary polyphenols and sarcopenia: epigenetic mechanisms and geroscience perspectives for muscle health in aging frontiersin.org/journals/aging…

Rethinking frailty, muscle, and protein through the lens of aging biology The dominant narrative around aging and frailty is deceptively simple and wrong: eat more protein + resistance exercise → activate mTOR → build more muscle → reduce frailty. linkedin.com/posts/lfontana…

TLDR IV iron in HF with iron deficiency: 🏥 Reduces HF hospitalizations 31% 🚶 Improves 6MWT 29 meters 🪦 Borderline reduces mortality 14%

Is hypoalbuminemia a causal mediator of adverse outcomes or a tangential byproduct of inflammation, malnutrition, and frailty? This trial suggests the latter although small sample size and trend towards survival curve separation leaves me wondering…

🧵 For patients with complex health needs, the periods between clinical encounters are times of significant vulnerability, during which unobserved risks can escalate into acute events.

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#EpiTwitter How well do you understand "Accuracy"? 4⃣ Entirely different, correct definitions: (1) Linear regression for method comparison (e.g. predict MRI body fat from BIA body fat) Accuracy = fitted slope close to 1 intercept close to 0 i.e. distance from identity line to fitted line (2) Linear regression for predictive modeling (e.g. predict MRI body fat from BMI) Accuracy = N/A 🤯 because no identity line Predictive accuracy = precision i.e. distance from fitted line to data points (3) Logistic regression (e.g. predict heart attack from obesity) Accuracy = ( TP + TN ) / ( TP + TN + FP + FN ) (4) ISO 5725 standards Accuracy renamed “Trueness” Validity renamed “Accuracy”

A tale of 2 NEJM trials... REBOOT-CNIC vs. BETAMI-DANBLOCK Same intervention - Beta Blockers Same indication - 50/50 STEMI/NSTEMI Same treatment - 93% PCI 10-15% mrEF Same patients - 7th decade 1/5th women Different death rate - 11% vs. 4% Different MI rate - 10% vs. 6% Different composite HR - 1.04 vs. 0.85 Different conclusion - neutral vs. useful Subsequent IPD meta-analysis: BB not beneficial if EF >=50% BB beneficial if EF <50% BB also beneficial if needed for HTN or AF

I think that the most probable explanation is simply GLP1 -RA weight loss and metabolic benefits reducing the incidence of multiple chronic conditions, which constitute the bulk of the claims-based frailty index.

Obesity in older adults is rising, and semaglutide & tirzepatide can bring significant weight loss and better heart, liver, and kidney health. Risks for older adults are muscle loss and functional decline. Policy must prioritize coverage + clinical trials for seniors to ensure access and safety. onlinelibrary.wiley.com/doi/full/10.10…

Highest Protein Foods in the World

🔑 point from AACE obesity statement Assessment of body fat % useful to Dx sarcopenic obesity in older individuals with potentially normal BMI Men >25% Women >32%