CV /HTN TRIALS
The new lipid guidelines use the AHA PREVENT calculator to assess CV risk. This new threshold percentage is now used to consider lipid lowering therapy
What is > or = 3%
In the new lipid guidelines those at very high risk of ASCVD this is the newly recommended LDL goal
What is <55 (previously <70)
in the new lipid guidelines this blood test is recommended to be checked at least once in an adults lifetime to assess CV risk
What is lipoprotein (a) ?
The new lipid guidelines say this about dietary supplements (fish oil, garlic, red yeast rice)
What is recommends against using?
The evidence of CV benefit is lacking
in men with hypogonadism and high risk or existing CVD testosterone replacement therapy had what effect on incidence of major cardiac events?
What is no effect?
In the FINEARTS study, pts with HF and mildly reduced or preserved EF on this drug resulted in a significantly lower rate of composite of total worsening of HF events and death from CV causes
What is Finerenone?
nonsteroidal MRA so less effect on K and creat
3 yr f/u
only 13% on sglt2
In the SURMOUNT-OSA trial, among pts with mod-severe obesity this drug reduced the apnea-hypopnea index, systolic bp and improved sleep related outcomes
What is Tirzepatide?
Similar outcomes with or without CPAP use
The twice-yearly sc use of this drug resulted in a significantly lower incidence of HIV compared to the use of daily po Truvada (F/TDF)
What is lenacapavir?
-very low event numbers in both arms
-injection site reactions
The Wisdom trial compared risk based vs annual breast cancer screening showed non inferiority in the rate of detecting breast cancer, but did not reduce this rate
What is rate of biopsy?
Selection bias as pts chose which arm so not randomized and underpowered as number of cancers detected was low
In this trial pts who had a hx of cv event or were at risk treatment with this drug resulted in significantly lower ldl cholesterol
What is enlicitide -an oral PCSK9 inhibitor?
-half on high dose, half on mod dose statin with baseline ldl 95
-the mean %change in ldl over a year was -57%
In the Vesalius trial Evolocumab (Repatha) led to a lower risk of this event in pts with DM or atherosclerosis but without prior mi or stroke
What is cardiovascular event? MACE 3 and 4
First major trial as primary prevention in high risk pts
Most on high dose statin
Predominantly white pop 4.5 yrs
In pts with prediabetes and overweight or obesity referral to this program was non inferior to referral to a human led diabetes prevention program in terms of composite outcome based on wt loss, physical activity and a1c.
What is a fully automated AI led DPP?
-pts had high digital literacy
-mainly white women only 12 months
In this prospective cohort trial in MSM the HIV incidence did not differ between the use of which 2 regimens?
What is daily PrEP vs on demand pre-prophylaxis?
Study in France Alot of selection bias an confounding (pts chose which arm in trial) with high drop out and low rate of outcome
In this open label RCT called the Caravaggio trial what drug was found to be non inferior to dalteparin for the treatment of cancer associated venous thromboembolism without risk of major bleeding?
What is oral apixiban?
-pts without brain tumor brain mets
-powered for recurrent clot not bleeding
In pts receiving hemodialysis the rate of serious cardiovascular events was lowered with daily use of what medication?
What is Fish oil supplements?
-4 gm pf n-3polyunsaturated fatty acid (EPA and DHA)
in the OCEAN trial pts who had successful catheter ablation of atrial fibrillation, this drug did not lower incidence of stroke/embolism/covert embolic stroke as compared to asa.
What is rivaroxaban?
open label, underpowered with very few strokes due to selection bias with low chadsvasc scores, sample size too small
Used MRI to look for covert embolic strokes
In this FLOW trial pts with T2DM and CKD randomized to this drug had a reduced risk of clinically important kidney outcomes and death from cv causes
What is semaglutide?
Dosage was 1 mg weekly
F/U was 3.4 years trial stopped early
In a single center trial this medication was associated with a reduced risk of SARS-COV-2 respiratory infection.
What is azelastine nasal spray?
Single center in Germany
only 56 days and unclear blinding given taste assoc with the med
In pts with acute thromboembolism the risk of clinically relevant bleeding was significantly lower with this drug as compared to rivaroxaban
What is apixaban?
Large head to head trial xarelto vs eliquis
only 3 months, didn't include cancer pts, 90% white as done in Australia Canada and Ireland
In the Valor CKD trial this drug used in pts with CKD and metabolic acidosis did not slow CDK progression.
What is Veverimer?
-large multicenter RCT, run in period and could use bicarb also
-Lower than expected difference in bicarb between drug and placebo (1 pt) may have interfered with ability to test hypothesis
In the VANISH2 trial pts with ischemic cardiomyopathy and ventricular tachycardia this strategy led to a lower composite outcome than antiarrhythmic drugs.
What is catheter ablation?
-outcome was primarily driven by less shocks and VT storm not mortality
-not blinded, high vol VT centers
-suggests earlier ablation if fail meds, only ICM
In the trial BPROAD, in pts with T2DM the incidence of what condition was significantly lowered with treatment of BP to less than 120 instead of 140 systolic?
What is incidence of major cardiovascular events?
Study in China, not blinded, Intervention did achieve clear difference in BP 121 vs 133
Only 60% on a statin and 4% on GLP1
The use of what medication in a pt after treatment with vaginal metronidazole resulted in lower incidence of recurrent BV as compared to placebo.
What is Lactin-V? (lactobacilus crispatus)
-Phase 2 trial only 12 weeks
-adjunctive preventative rx after an infection not primary rx
The new lipid guidelines newly adds these 2 groups of pts to start statin regardless of 10 year risk. (similar to how we handle diabetes)
What is CKD3-4 and HIV ?
Pitavastatin due to drug drug interactions with antiretrovirals
This drug proved efficacious and safe for lowering BP in pts with treatment resistant HTN
What is Lorundrostat?
Like Baxostrat is an aldosterone synthetase inhibitor. It was compared to placebo not spironolactone.
only 12 weeks