Gregg Fonarow MD

Our work was just published in #JACCAdvances! 💻Evaluation of a novel Dashboard Clinic to optimize GDMT in veterans with heart failure: 📍48.5% of patients had GDMT started or recommended 📍Post-intervention GDMT optimization score increased significantly 📍Quadruple therapy use rates jumped from 4.3% to 13.4% The Dashboard Clinic is a viable and potentially effective intervention for improving GDMT optimization in patients with HF, offering a scalable blueprint for dashboard-directed care within a clinical-educational hybrid model 👥 Grateful for the mentorship and guidance from @boback @gcfmd @JeffHsuMD Read more: jacc.org/doi/10.1016/j.… #HeartFailure #Cardiology

@minhaskh @nytimes @kewatson @AnnMarieNavar @rblument1 Enlicitide is intended as an add on therapy to statins, if tolerated and LDL goals not met, rather than a replacement There was a comparative efficacy study vs other non-statin add on therapies enlicitide achieved greater ⬇️ in LDL-C, ApoB, nonHDL-C jacc.org/doi/10.1016/j.…

@gcfmd @nytimes @kewatson @AnnMarieNavar @rblument1 This drug should have been compared with rosuvastatin and not a placebo before approved by FDA

The FDA approved a daily pill PCSK9i enlicitide, (Lipfendra) List price will be $315 for a 30-day supply nejm.org/doi/full/10.10… The F.D.A. Approves a New Pill to Slash Cholesterol Levels nytimes.com/2026/07/16/sci… via @NYTimes @kewatson @AnnMarieNavar @rblument1

Ischemic Heart Disease Deaths in the US 🔝 Top culprits 1990 vs 2003 The same top 3 in rank 🫪 
🩸 High systolic blood pressure — 47% 
🍔 Poor diet — 39% 
🧈 High LDL cholesterol — 29% jamanetwork.com/journals/jamac…

@DrDanMO @nytimes @kewatson @AnnMarieNavar @rblument1 Through AmgenNow direct-to-patient program, Repatha (evolocumab) is available for $239 per month ($2868 per year) This is available to all eligible U.S. patients, including those who are uninsured, have high-deductible health plans, or prefer to pay with cash

For realistic comparison, here are injectable PCSK9 inhibitor costs via Grok…Repatha (evolocumab): Approximately $490–$573 per month (common dosing: 140 mg every 2 weeks or 420 mg once monthly; annual ~$5,850). • Praluent (alirocumab): Similar range, roughly $440–$550+ per month depending on dose (75 mg or 150 mg every 2 weeks; annual often cited ~$5,250–$6,500+). • Leqvio (inclisiran): ~$3,250 per dose (HCP-administered); maintenance dosing is every 6 months after initial loading doses → ~ $542/month average annually (~$6,500/year maintenance; higher in year 1). Discounted Cash-Pay Prices (No Insurance or Using Coupons) These are significantly lower thanks to programs like GoodRx, AmgenNow (for Repatha), or manufacturer initiatives: • Repatha: As low as $239 per month (for the common 2-pen 140 mg every-2-weeks supply). • Praluent: Typically $450–$550 per month with coupons (e.g., ~$532 for two 75 mg pens). • Leqvio: Stays close to list price (~$3,250+ per dose) with limited standard retail discounts.

💉🫀 PCSK9 inhibitors (monoclonal antibodies) across the prevention spectrum: 📉 LDL-C ↓ ~55–59% 
🧪 FOURIER · ODYSSEY OUTCOMES · VESALIUS-CV 
📊 MACE: HR 0.75–0.85 (pooled ~0.83) 
⚰️ All-cause mortality pooled ~0.89 
🧬 Lower LDL → fewer events #Cardiology #LDL #PCSK9

HFrEF 💊 ARNI = lives saved ➕ 🛡️ β-blocker = more lives saved ➕ 🧪 MRA = even more lives saved ➕ 🍬 SGLT2i = even more lives saved Quadruple GDMT: overall survival extended 7-11 years vs no Rx 💊 cost ~ $1 per day ⬇️ 🏨 cost ▶️ saving ~ $64 per day

Withdrawal of Guideline-Directed Medical Therapy in HFiEF : A Systematic Review and Meta-Analysis Withdrawal of HF therapy in patients with improved ejection fraction associated with a higher risk of HF relapse and CV hospitalization @JACCJournals jacc.org/doi/10.1016/j.…

The crisis continues: Nearly 90% of deaths from ischemic heart disease could have been prevented cardiovascularbusiness.com/topics/clinica… @JAMACardio

Approved as an adjunct to diet and exercise to reduce low-density lipoprotein cholesterol (LDL-C) in adults with hypercholesterolemia, including heterozygous familial hypercholesterolemia ⬇️ LDL-C by 56-60% Side effect/tolerability profile similar to placebo @DrMarthaGulati

@hvanspall Yikes

Our lake 3 days ago & today Close to 200 #wildfires in Northern Ontario have made Toronto the city w the poorest #airquality in the 🌎 We are sweltering in unprecedented heat with poor provincial 🔥 prevention policy Expecting people with ⬆️⬆️ CV & resp events this week

@boback @qicong_sheng @JACCJournals @DOM_UCLA @VALosAngeles @JeffHsuMD The Dashboard Clinic is a viable and potentially effective intervention for GDMT optimization, providing a scalable blueprint for dashboard-directed care

Dashboard-Directed Intervention to Improve Guideline-Directed Heart Fa... sciencedirect.com/science/articl… @qicong_sheng @gcfmd @JACCJournals @DOM_UCLA @VALosAngeles @JeffHsuMD

@mvaduganathan @SJGreene_md @NMHheartdoc @robmentz @dranulala @MKeykhaeiMD 💊 ARNI ➕ 🛡️ β-blocker ➕ 🧪 MRA ➕ 🍬 SGLT2i = lives saved 🚀 + beds freed 🏥 + dollars back 💸 Don’t wait. Initiate and titrate quadruple GDMT early. Inaction is the expensive option. ⚡ #CardioTwitter #HeartFailure

@mvaduganathan @SJGreene_md @NMHheartdoc @robmentz @dranulala 💵 Economics: JAMA Cardiology (Keykhaei et al., 2026) modeling 50,000+ Medicare pts full quadruple GDMT could slash HF hospitalizations by ~87% & all-cause by ~61% offsetting ~$10K/patient/yr in hospital costs, landing in NET SAVINGS after drug prices.

💰🫀 The cost of INACTION in #HFrEF is measured in YEARS of life lost AND 💵 dollars lost Every eligible patient with HFrEF without full GDMT is a missed chance: Clinical AND economic⏳

One week left to submit Late Breaking Clinical Research for #HFSA2026. Major trial and registry data that moves the needle in HF care belongs on the plenary stage in Phoenix. Deadline: July 21 👇 hfsa.org/asm/late-break…

In 2023, nearly 89% of #IHD deaths in the US were attributable to modifiable risks, with high blood pressure, diet, and high low-density lipoprotein cholesterol as the top contributors. ja.ma/3SSnECV

📈 GOING THE WRONG WAY (more deaths): 
⚖️ High BMI: +8,900 
🍬 High blood sugar: +8,100 jamanetwork.com/journals/jamac… @JAMACardio @JAMA_current

📊 Which risk factors are killing more Americans' ❤️ and which are killing fewer? ☠️ 1990 → 2023: 🫀 📉 BIG DROPS (fewer deaths): 
🩸 High blood pressure: −87,000
🚬 Tobacco: −42,100
🌫️ Air pollution: −65,600
🧈 High cholesterol: −52,000
🍔 Poor diet: −83,000