"Pancreatic cancer mRNA vaccine shows lasting results in an early trial: Scientists caution that more research is needed, but nearly all of the patients who responded to the personalized vaccine are still alive six years later."
JAMA editorial published online April 8, 2026, titled "ApoB and Resilient Cost-Effectiveness of Statin Intensity" by Ankur Pandya, PhD, and Jinyi Zhu, PhD. The article discusses statin therapy and ASCVD prevention.
💬 Editorial: Simulation modeling demonstrates #ApoB-guided statin intensification is cost-effective, identifies more clinically meaningful risk, and aligns with 2026 ACC/AHA guidelines.
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Line graph titled 'Cost-Effectiveness of text@1, Non-HDL-C, and LDL-C Goals for Primary Prevention Lipid-Lowering Therapy'. The graph shows cost-effectiveness acceptability curve with 'Optimal probability strategy, %' on the Y-axis and 'Cost-effectiveness threshold (2025 $/QALY gained)' on the X-axis. Lines represent ApoB goal, Non-HDL-C goal, and LDL-C goal.
A computer simulation found #ApoB-guided intensification of lipid-lowering therapy provides the most QALYs and is highly cost-effective compared to #LDL-C or #nonHDL-C targets.
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New mega-analysis showing statin therapy is associated with reduced risk of AD and related out comes, pubmed.ncbi.nlm.nih.gov/41761642/ @nationallipid.bsky.social @aspcardio.bsky.social @fabyollaveras.bsky.social @menopausesociety.bsky.social @eassociety.bsky.social
Essence-CTA: Does Olezarsen Reduce Noncalcified Coronary Plaque Volume?
Check out the results of the 🆕 #ACC26 late-breaking clinical trial: https://bit.ly/4tc0UKH #cvLipids #CardioSky
If you buy into the concept that statin benefit is tied to lipid lowering, traditional epidemiology shows the impact of
elevated lipids varies by duration of exposure (Navar study linked above). In 30-year Framingham data, each decade of exposure to elevated lipids doubles risk. (adj'd HR ~1.5)
Ann Marie Navar has more to say on this topic: youtu.be/DRO5kHfcnz0?...
2. Individuals with one of 2 PTV mutations (PCSK9 or APOB) associated with lower lipids... Lifelong 50mg/dL lower LDL-C vs non-carriers associated with 50% lower CV risk. Consistent in 2 datasets. Risk reduction per unit of LDL lowering ~2x that of short RCTs. jamanetwork.com/journals/jam...
1. Across multiple mechanisms, RCT benefit tracks with level of lipid lowering. And magnitude of benefit much greater with life long lower lipids as seen in MR/genetic studies compared to RCTs.
Me trying to convince Mike of statin legacy effects. bsky.app/profile/fipc...
AHA/ACC/+ Lipid Guidelines - another notable and welcome change: use of long term risk to guide lipid lowering therapy. 30-year PREVENT-ASCVD risk >=10% support use of lipid lowering therapy. (this adds a large number of 30-59yr olds over prior PCE 5%) x.com/fipco/status...
How do statins work? It's largely about reducing atherogenic lipoproteins (LDL and other apoB LPs). The literature for cumulative effects of LDL-C/apoB is pretty extensive. 3 good links... pubmed.ncbi.nlm.nih.gov/29122815/
corserahealth.com/assets/pdfs/...
www.ahajournals.org/doi/10.1161/...
AHA/ACC/+ Guidelines recommend one time Lp(a) test in all adults. /2
ApoB recommendations from the 2026 AHA/ACC/+ lipid guidelines. "reasonable to measure" Yay! /1 www.jacc.org/doi/full/10....
In Novo's head to head trial of Cagrisema 2.4/2.4mg compared to Tirzepatide 15mg, Cagrisema did not show non-inferiority on the primary endpoint of weight loss at 84 weeks. ITT weight loss 20.2% v 23.6%, PP 23.0% v 25.5% for C-S v T. REDEFINE-4 www.novonordisk.com/news-and-med...
Note: apoB price can be close to that of a standard lipid panel. 2 options <=$20 with national labs. CMS zip file link - www.cms.gov/Medicare/Med...
"Recent research suggests that more people should be screened for a protein called apoB. A growing number of doctors agree." #cardiosky
www.nbcnews.com/health/heart...
The formula weights apoB on TRL at 4.5 vs 1 for LDL. There's some uncertainty on the risk of TRLs compared to LDL particles. The PROMINENT trial of pemafibrate implies a 4.2mg/dL lower RW-apoB for the fibrate arm, while the MACE-4 HR was 1.03 (using median values & assuming no Lp(a) difference). /2
Rehman, et al. propose a single risk measure to reflect risk from apoB generally, Lp(a), and TG rich-lipoproteins. "RW-apoB" for "risk weighted". The scale is comparable to current apoB levels. #cardiosky /1
academic.oup.com/eurheartj/ad...
New online! Residual cardiovascular risk in coronary artery disease: from pathophysiology to established and novel therapies #CardioSky
A TRIUMPH for the GCGR-GLP1R-GIPR triple agonist Retatrutide in P3. Participants with #obesity and knee osteoarthritis taking retatrutide 12 mg lost an average of 28.7% of their body weight at 68 weeks. Mild dysesthesias noted #weightloss #arthritis investor.lilly.com/news-release...
... since patients in trial have likely lower achieved EPA vs STRENGTH. However, dialysis patients are different and have different drivers of CV disease.
Mechanisms are uncertain. We should be open to using medicines with convincing RCTs (as with SGLT2s) despite this uncertainty. /2-fin
Open to views of others. I'm hooked based on RCT + supportive trial + limited alternatives.
I'm also a supporter of high dose EPA for secondary CV prevention. That's based in part on theory that high achieved EPA drives benefit. That doesn't apply to PISCES... /1
bsky.app/profile/neph...
Some are reassured by observational epidemiology. But the recent semaglutide Alzheimer's trials did not recapitulate real world simulations. Links via Gregg Fonarow. Corrected
jamanetwork.com/journals/jam...
alz-journals.onlinelibrary.wiley.com/doi/10.1002/...
diabetesjournals.org/care/article...
According to clinicaltrials.gov the baricitinib CV safety trials completed 6 months ago. Perhaps more t's to cross and i's to dot. This EULAR consensus review pointed to these studies as important in assessing JAKi safety. pubmed.ncbi.nlm.nih.gov/36357155/
bsky.app/profile/fipc...
The Economist on apoB. ApoB is inexpensive and more accurate than LDL-C. The measures disagree in 30-40% of individuals. www.economist.com/science-and-... #cardiosky
Just saw this. Good review on uses of apoB testing. In my view, apoB testing has a broader role than envisioned here.
jamesstein18.substack.com/p/when-lipop...
Also believe 10 year risk paradigm of current guidelines misses opportunity for early prevention for those with elevated longer term risk.
Thoughtful, provocative editorial. Some fair points. Respectfully disagree with apoB/CAC examples. IMO evidence base (including health economics) for these support broader use and are incorporated in some guidelines (apoB: EAS/ESC, CCS, NLA statement) #cardiosky
bsky.app/profile/jame...
JAMA graph shows association of eGFR difference with risks of long-term adverse outcomes. Hazard ratio vs. difference between eGFRcys & eGFRcr (%). Lines for death, CVD death, heart failure, ASCVD, KFRT are plotted. Declining risk as difference approaches zero.
Among more than 800 000 CKD-PC participants, discordance between cystatin C and creatinine eGFR values was associated with increased risk of death, cardiovascular events, and kidney failure.
#KidneyWK @asnkidney.bsky.social
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