Gregg Fonarow MD

@djc795 @anish_koka Effect of Evolocumab on Progression of Coronary Disease in Statin-Treated Patients: GLAGOV The primary efficacy parameter, PAV, increased 0.05% with placebo and decreased 0.95% with evolocumab (difference, −1.0% [95% CI, −1.8% to −0.64%]; P < .001) jamanetwork.com/journals/jama/…

@djc795 @anish_koka In the placebo controlled PCSK9i studies on background statin Rx the change in plaque volume is a modest - 1.2% over 52 weeks Incremental plaque stabilization and small amount of regression over statin alone, but not “melting” away plaque jamanetwork.com/journals/jama/…

Apparently someone from Sinai took folks with cad and did IVUS before and after psck9 inhibitors and showed plaque melting away. And yet a 12,000 strong RCT (VESALIUS) of pcsk9 inhibitors in high risk 1º prevention patients had a 13% adverse event rate at 4 years. 🤔

One-Year Outcomes in Patients Hospitalized for Heart Failure With Reduced Ejection Fraction Prescribed Quadruple Medical Therapy at Discharge Patients hospitalized for HFrEF in US clinical practice are at very high risk of poor clinical outcomes, even when prescribed quadruple medical therapy. #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @SJGreene_md @gcfmd @mvaduganathan @ShelleyZieroth @hfcollaboratory @BiykemB @AndrewJSauer @ankeetbhatt jamanetwork.com/journals/jamac…

In US practice, older adults hospitalized for #HFrEF and prescribed quadruple therapy still face 1 in 5 risk of death and 1 in 4 risk of heart failure rehospitalization at 1 year, with high associated health care costs. ja.ma/3MW9a27

In 2025, JAMA Cardiology celebrated its 10th year, receiving >2,700 submissions and achieving an Impact Factor of 14.1. Read“JAMA Cardiology Year in Review, 2025,” by Robert O. Bonow, MD, MS, and Barbara Casadei, MD, DPhil. ja.ma/47ePE85

@gregorykatz @Braindoc_MGH @AHAScience @ericpetersonMD @YingXian21 @American_Stroke @bmj_latest In the CDSS group, a higher proportion of patients with atrial fibrillation received anticoagulants (77.0% v 69.3%, absolute difference >10%), and more patients received dual antiplatelet treatment (76.2% v 69.6%, absolute difference >10%).

Do you think this just says that appropriate antithrombotic therapy improves outcomes? Those K-M curves look very similar to the CHANCE and POINT trials - up front antithrombotic therapy makes a difference in outcomes and then after very short term separation curves look very similar

Use of a stroke CDSS led to a ⬆️ in care quality and ⬇️ in new vascular events Effect of a clinical decision support system on stroke care quality and outcomes in patients with acute ischaemic stroke (GOLDEN BRIDGE II): cluster randomised clinical trial bmj.com/content/392/bm…

Effect of a clinical decision support system on stroke care quality and outcomes in patients with acute ischaemic stroke (GOLDEN BRIDGE II): cluster randomised clinical trial Use of the stroke CDSS in patients with acute ischaemic stroke in China led to a significant decrease in new vascular events at three months. #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @bmj_latest @CMichaelGibson @DrMarthaGulati @hvanspall @Hragy bmj.com/content/392/bm…

Nearly half of patients in a remote #Hypertension management program failed to meet minimum home blood pressure monitoring targets despite receiving free devices and support. ja.ma/4d0G6Bg

@Braindoc_MGH @AHAScience @ericpetersonMD @YingXian21 @American_Stroke @bmj_latest Effect on vascular events

Effect on stroke performance measures

@orion7710 Conclusions: In patients with AHF, a combination diuretic strategy improved early decongestion without affecting prognosis. The use of SGLT2i during index hospitalization was associated with an improvement in all-cause mortality and HF events.

@orion7710 doi.org/10.1002/ejhf.7…

@gcfmd Hi! I have an 82 yr-old w HFpEF (EF 60%) whose Creatinine went from Cr 1.26 to Cr 0.90 after Jardiance 10 mg PO qam was held several days. He does not drink enough during the day due to Mild Cognitive Impairment. He also takes Losartan 25 mg po qam for HTN. 1/

@orion7710 EMPULSE, SOLOIST-AHF, DAPA ACT TIMI 68 are relevant RCTs for SGLTi for AHF/WHF The most optimal approach is as you state….to prevent AHF/WHF in the first place nature.com/articles/s4159… nejm.org/doi/full/10.10… ahajournals.org/doi/10.1161/CI…

@gcfmd Acute CHF is important, but keeping the pt on Jardiance to decrease the risk of CHF and death is extremely important. Also, the pt did not need to go to the hospital, as this was managed in an outpatient setting. :) 5/

@anish_koka Appreciate the point being made about residual risk Yet, of the patients enrolled Current smoking: 27% HTN: 87%, (% Rx to SBP < 130 mm Hg, not reported) Diabetes 59% (% SGLT2i Rx 10%, GLP-1RA <6%) Median BMI: 30 (w/ <6% Rx with GLP1-RA) Opportunity to ⬇️ risk w/ existing Rx

Excerpt: The bigger message to the cardiology research community is one worth taking to heart. Even taking the 4-point MACE outcome in VESALIUS at face value — the most favorable composite, the softest endpoint — the treatment arm still had a 13% event rate despite achieving a median LDL of 45 mg/dL. Thirteen percent of patients on evolocumab, with LDL driven to levels that would have seemed impossibly low to the trialists of the 1990s, still had a major cardiovascular event within five years. The LDL hypothesis has yielded remarkable results — it is one of the genuine success stories of modern preventive cardiology — but the curve is flattening. We may be approaching the limit of what cholesterol lowering alone can accomplish. The residual risk that persists despite aggressive lipid lowering is driven by inflammation, by plaque biology, by factors that circulating LDL levels do not fully capture. That is where the next generation of trials needs to go — not into ever more granular risk stratification of ever lower-risk populations to justify ever more expensive versions of the same mechanism, but toward genuinely new targets. Vesalius did not refine Galenic anatomy. He replaced it. The field may need a similar reckoning.

Empagliflozin in De Novo vs Acute Decompensated Chronic Heart Failure: A Prespecified Analysis From EMPULSE In-hospital initiation of empagliflozin produced similar clinical benefits in NHF and ADHF despite the reduced diuretic response in participants with ADHF and was well tolerated. This supports in-hospital initiation of empagliflozin in all patients with acute HF #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @JACCJournals @ACCinTouch @JavedButler1 @mvaduganathan @dranulala @DrMarthaGulati @hvanspall @AndrewJSauer @ankeetbhatt jacc.org/doi/10.1016/j.…

@SJGreene_md @DCRINews @JAHA_AHA @JavedButler1 @ankeetbhatt @AndrewJSauer @AndrewPAmbrosy @dranulala @drbennisahmed @HanCardiomd @ShelleyZieroth @ShahzebKhanMD Quadruple GDMT use in only 2% 🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘

🚨The latest alarming look at real-world use of #GDMTworks for #HF 🇺🇸Optum database 2020-2023 -Enormous gaps in #GDMT use, across the LVEF spectrum -When initiated, usually only after a substantial delay 🤯🤯🤯 @DCRINews @JAHA_AHA ahajournals.org/doi/10.1161/JA…

@juancbatlle @JCardFail @TradIMYale @YaleCardiology Evidence-based strategies to improve the use and dosing of foundational, disease-modifying, life-extending quadruple GDMT for HFrEF

New editorial! 🚨 No Heart Failure Patient Left Behind: Making GDMT a Reality for All @JCardFail @TradIMYale @YaleCardiology onlinejcf.com/article/S1071-…

Medical treatments at 6 months in hospitalized and ambulatory HFrEF patients in the BRING-UP 3 Heart Failure study In this large nationwide cohort, guideline-directed therapies for HFrEF were widely implemented and maintained over 6 months with excellent treatment persistence. However, dose optimization remains a key unmet need in routine clinical practice. #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @hfcollaboratory @mvaduganathan @ShelleyZieroth @hvanspall @dranulala @safchat @EJHFEiC @ESC_Journals @escardio academic.oup.com/eschf/article/…