Gregg Fonarow MD

🚨 New paper: applied SOUL trial effects to 30 yrs of NHANES data. If every eligible high-risk US adult w/ T2D took oral semaglutide: 6.1M eligible, 118,664 MACE prevented over 4.5 yrs, 28,430 CV deaths averted 🔗 link.springer.com/article/10.118…

Rosuvastatin 20 mg for primary prevention and achieving LDL < 50 mg/dL Clinical benefits>>potential risks Relative risk reductions: large Absolute risk reductions: small per year, but accumulate over time Cost: $31.40 per year $2.61 per month 9 cents a day

In Vivo Base Editing of PCSK9 with VERVE-102 for Hypercholesterolemia | New England Journal of Medicine nejm.org/doi/full/10.10… @kewatson

🧵 Quadruple GDMT in HFrEF saves years of life — but we’re still falling dangerously short. New data from 20,651 patients 👇 📊 GWTG-HF Registry | N=20,651 patients ≥65 years hospitalized for HFrEF | Linked to Medicare Claims Greene SJ et al. Eur J Heart Fail. 2026)

What are the most promising therapies to reduce the residual risk of mortality among patients with HFrEF treated with quadruple GDMT? academic.oup.com/eurjhf/article… @ehj_ed @SJGreene_md @NMHheartdoc @hvanspall @JavedButler1

@JavedButler1 @kejoynt @AnnMarieNavar @NilayShahMDMPH @boback @NealDixit @DrMarthaGulati @paheidenreich @ATSandhu @NMHheartdoc Which other healthcare interventions would have a 8-fold or more return on investment? Invest $3.5 billion to supply SGLT2i to the 47.5 million eligible patients with T2DM, CKD, or HF in the US annually Get $27.6 billion reduction in healthcare expenditures annually Nice

Won’t 💊 cost too much? With generic pricing: $3.5 billion a year Optimal implementation in eligible patients with HF, CKD & T2DM is projected to: 🏥 Reduce billions in CV/HF 🏨s 🫘 Avoid dialysis costs in CKD Not prescribing SGLT2i way more costly #SGLT2i #ValueBasedCare

Optimal US implementation of SGLT2 inhibitors across eligible patients with HF, CKD, and T2DM could: 🫀 Prevent ☠️/🏨/CKD progression One pill Hundreds of thousands of events prevented annually (If RCT efficacy=effectiveness) #SGLT2i #CardioTwitter

@drbennisahmed Rapid and Intensive GDMT “This sense of urgency should apply to both inpatients and outpatients, recognizing that every encounter with a HF patient is a critical opportunity to augment disease-modifying therapy” jacc.org/doi/10.1016/j.… @JACCJournals @SJGreene_md

🫀 Delaying Heart Failure Meds Has Real Consequences Risks of omitting guideline-directed medical therapy (GDMT) ⚠️ Delaying or Omitting GDMT Leads To: • Patients never being initiated on GDMT, or substantial delay • Worse quality of life and health status

doi.org/10.1093/ejhf/x… @EJHFEiC @ESCardioNews

Patients with HFrEF eligible for GDMT in clinical practice Rx: ARNI+BB+MRA+SGLT2i vs 0/1 GDMT Extend median overall survival 64 months (age 65-69) 18 months (age 90+) Despite the multitude of comorbidities, frailties, polypharmacy, and complexities of real life

Medical errors of omission or delay can be as lethal as errors of commission In HFrEF, 3 out of 4 ☠️s are preventable with quadruple-GDMT Yet, <1 in 4 Rxed and 9 out of 10 patients ☠️ prior to being initiated on Q-GDMT Stop delaying initiation of ARNI+BB+MRA+SGLT2i Start NOW

@drbennisahmed Diuretics/enhanced diuretic strategies are not disease-modifying To improve short, intermediate, and long term clinical outcomes ▶️ Rapid initiation: ARNI+BB+MRA+SGLT2i in HFrEF SGLT2i+nsMRA (+ARNI +GLP1RA selectively) in HFpEF Prioritize wisely

Early natriuresis/diuresis guidance enhances biomarker decongestion but doesn’t move the needle on short-term clinical outcomes. The message is clear: we still need to refine and individualize our decongestion strategies in #HeartFailure.

Early and continuous acoramidis treatment in #ATTRCM yields sustained reductions in mortality and cardiovascular hospitalization, stabilizes biomarkers and health status, and exhibits durable safety through 54 months. ja.ma/3PyoW4E

GLP-1 and GLP-1/GIP RAs ⬇️ risk of composite endpoints and worsening HF events in this meta-analysis of RCTs in HFmrEF/HFpEF Further RCTs will be important in establishing the generalizability across a wide variety of HF patients and effect on ☠️ onlinelibrary.wiley.com/doi/10.1002/cl…

The burden of T2DM, CKD and HF in the US is substantial SGLT2i help reduce event risk for all of them, yet remain massively underprescribed The gap between evidence and practice is costing 🏨s and lives 📊 #SGLT2i #CardiorenaMetabolic #T2DM #CKD #HeartFailure #MedTwitter

@gcfmd @drbennisahmed @SJGreene_md @JavedButler1 @UoGHeartFailure @JamesCFangMD @HFSA @mvaduganathan @ankeetbhatt @robmentz @FudimMarat And we are exploring this further (simultaneous early initiation of nsMRA plus SGLT2i) vs usual care in acute HF irrespective of EF: stay tuned for CONFIRMATION-HF, we are nearly 40% enrolled globally in this 1,500 patient RCT.

The highest dose of retatrutide helped patients lose 28.3% of their weight (70.3 pounds) on average over 80 weeks vs 2.2% placebo (patients who stayed on the drug) ~45% of the 2,500 patients in the Phase 3 trial achieved 30% or more weight loss cnbc.com/2026/05/21/eli…

Editor's Note: Oral #GLP1RA therapies offer new options for cardiovascular risk reduction, supporting shared decision-making for patients and clinicians as the landscape evolves beyond injectable agents. ja.ma/4cVffER