Statement from Michael and Susan Pretti Parents of Alex Jeffrey Pretti “We are heartbroken but also very angry. Alex was a kindhearted soul who cared deeply for his family and friends and also the American veterans whom he cared for as an ICU nurse at the Minneapolis VA hospital. Alex wanted to make a difference in this world. Unfortunately, he will not be with us to see his impact. I do not throw around the ‘hero’ term lightly. However, his last thought and act was to protect a woman. The sickening lies told about our son by the administration are reprehensible and disgusting. Alex is clearly not holding a gun when attacked by Trump’s murdering and cowardly ICE thugs. He had his phone in his right hand and his empty left hand is raised above his head while trying to protect the woman ICE just pushed down, all while being pepper sprayed. Please get the truth out about our son. He was a good man. Thank you.

Kare 11 local news just read, in full, this statement from Michael and Susan Pretti, the parents of Alex Pretti.

"Please get the truth out about our son."

The moral panic about GLP-1 rebound Scientists and journalists are piling on the misery about the weight regain after medication

If you stop taking blood pressure meds, your BP goes up. We call that medicine.

If you stop taking GLP-1s, your weight goes up. Scientists are calling it "weight recidivism"—a term for convicted criminals.
Why is obesity still treated as a moral failure? #GLP

open.substack.com/pub/overmatt...

While there is so much that is disturbing about this case study in the destruction of academic freedom, one high point is the refusal of the targeted professor to submit

We sent in our letter and I know Min. Joly received it. This was not part of the ask.
Investing directly in tri-council is a better use of these funds.
We already have a recruitment advantage over the US now.
We need to value what we already and invest in Canadian research sovereignty

Canadian scientist here. I don't want this. I want you to fund our excellent early career scientists who do great work in Canada. Fund them properly and that will help 1000x more than recruiting handfuls of cherry picked bigwigs from Harvard, Stanford and MIT who will leave after a few years.

Very similar to the ARB story

Yes those are the 2 options to create an indication: (1) compare to placebo when standard of care (SoC) contraindicated or (2) head2head vs SoC for OG indication. 1 "easier" & addresses a potentially bigger gap. I meant that 1 is ethically justifiable vs placebo instead of SoC, whereas 2 is not

Seeing this incl criterion ("cannot tolerate Spiro") a lot with ongoing nsMRAs/ASIs RCTs. Makes ethical sense since can't offer placebo in spiro-eligible pts, but usual problems are hyperK and dec eGFR; does any1 think these drugs will really be better tolerated? Spiro will not be usurped easily

It'd look like many cardiology drug CI/KM curves and would still impress many!

These results are unquestionably cool, but that might be the most egregiously misleading y axis I've ever seen. It feels like they are doing everything they can to obfuscate the absolute risk reduction here. When do we ever report cumulative incidence with raw event # on the y axis?

Use of a DOAC after a procedure undertaken because you couldn't take a DOAC, to prevent a complication from that procedure

🚨 Just published! This guideline provides multi-disciplinary clinical teams with practical recommendations for SGLT2is, MRAs, ARNI and drugs with GLP-1 receptor agonist activity.

Read the guideline here: onlinecjc.ca/article/S082...

#Cardiosky #HeartFailure

What if We Can't Rely on PubMed? - Absolutely Maybe PubMed is incredibly reliable. And a lot depends on it. It’s an ecosystem built around MEDLINE, the steady feed of new publications…

Also check out @hildabast.bsky.social post on PubMed alternatives

absolutelymaybe.plos.org/2025/02/14/w...

Not with the AI piece, but I find the device and its app very clunky

Comparison of Quadruple Therapy Sequencing Strategies for Heart Failure With Reduced Ejection Fraction | Journal of the American Heart Association

Comparison of Quadruple Therapy Sequencing Strategies for Heart Failure With Reduced Ejection Fraction | Journal of the American Heart Association www.ahajournals.org/doi/10.1161/...

And absolute risk reduction

DIGIT-HF + DIG pooled
(DIG: composite of all-cause death & HF hospitalization calculated using IPD since this endpoint was not originally reported in the trial manuscript):

a woman is wearing a santa hat and saying gretchen stop trying to make fetch happen it 's not going to happen ALT: a woman is wearing a santa hat and saying gretchen stop trying to make fetch happen it 's not going to happen

DIGIT-HF trial - more to say on this later, but my initial thoughts can be summarized in a classic gif. www.nejm.org/doi/full/10....

Differences in indications, contraindications, and prescribing patterns for heart failure between specialties: the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry

Differences in indications, contraindications, and prescribing patterns for heart failure between specialties: the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry
www.sciencedirect.com/science/arti...

Evening Blood Pressure Medication Administration and Cardiovascular Events: Systematic Review and Meta-Analysis Controversy persists whether evening administration of antihypertensive medications reduces cardiovascular events. We aimed to synthesize the randomized evidence comparing the risk of cardiovascular e...

Our meta-analysis that I presented at ESC last year now published & available open-access: Evening Blood Pressure Medication Administration and Cardiovascular Events: Systematic Review and Meta-Analysis - Canadian Journal of Cardiology onlinecjc.ca/article/S082...

Educational Strategies for Clinical Supervision of Artificial Intelligence Use | NEJM Many learners are more facile with the use of large language models in medicine than their supervisors are. The authors provide an approach to clinical supervision that can mitigate the perils and ...

🧠 In @nejm.org, Raja-Elie Abdulnour et al. warn: AI in medical training risks deskilling & mis-skilling. They propose DEFT-AI to teach critical thinking & safe human-AI collaboration. Verify, then trust.
📖 doi.org/10.1056/NEJM...
#ResearchEthics #MedicalEducation

Shared decision-making approach to type 2 diabetes management Objective To provide an online interactive decision aid to facilitate shared decision making in the context of medication choices for patients with type 2 diabetes mellitus (T2DM). Sources of informa...

Apropos of nothing today ;)
(One potential / my) Shared decision-making approach to type 2 diabetes management
www.cfp.ca/content/70/5...

Folic acid supplementation prevents phenytoin-induced gingival overgrowth in children - PubMed This study provides Class I evidence that folic acid supplementation, 0.5 mg/day, is associated with prevention of gingival overgrowth in children taking PHT monotherapy.

Does folate supplementation work here like it does for phenytoin in kids? pubmed.ncbi.nlm.nih.gov/21482950/

7/ Next steps include further validation & impact analysis. It could also be used in some clever analyses of RCTs to assess risk-based heterogeneity of treatment effect. Ultimately, this is a tool to inform patients with CAD of their prognosis: decisionaid.ca/cr-decide can be used for this now

Development and Validation of the CR-DECIDE Models to Predict Major Adverse Cardiovascular Events and Health Status in Stable Coronary Artery Disease Guidelines emphasize individualized care in the management of stable coronary artery disease (CAD). We aimed to develop and validate clinical prediction models for major adverse cardiovascular events ...

6/ The full paper describing the development & (internal & external) validation: www.cjcopen.ca/article/S258...
Highlights:
-Good discrimination internally & in ISCHEMIA
-Slight under-prediction of MACE in ISCHEMIA trial, esp in highest-risk group
-Net clinical utility vs treating all as high risk

5/ We developed models with all predictors & "reduced", simpler models with fewer, readily-available variables. Importantly for the health status models, replacing patient-reported QoL with CCS/NYHA class substantially worsened predictions; there's no substitute for eliciting directly from patients!

4/ We developed the MACE model in a BC-based registry (n=24,990) & the health status models in the APPROACH registry in AB (n=13,312)🇨🇦. We considered known predictors of MACE & CAD-related health status, including history, labs, & coronary anatomy

3/ Unlike with primary CV prevention, there are no widely-used risk calculators in patients with existing CAD to guide decision-making. Everyone with CAD is considered "high risk" with various features used to qualitatively de-risk/up-risk patients.

2/ We set out to develop a set of clinical prediction models ("risk calculators") to predict major adverse cardiovascular events (MACE) @3yr & health status @1yr in patients with stable CAD to help facilitate shared decision-making re: revascularization & secondary prevention medications

We made a new decision aid! Introducing CR-DECIDE: decisionaid.ca/cr-decide/
A brief 🧵 on how we developed it & how it can be used 1/7