Cardiovascular Disease Connect
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8h
Cardiorenal-metabolic therapy in cardiovascular disease: SGLT2 inhibitor and nonsteroidal MRA synergy in heart failure

Cardiovascular disease remains the leading cause of global mortality. SGLT2 inhibitors and GLP-1 receptor agonists have become foundational agents across heart failure, chronic kidney disease, and atherosclerotic cardiovascular risk reduction.

The FINEARTS-HF trial demonstrated that a nonsteroidal mineralocorticoid receptor antagonist (nsMRA) reduces the composite of worsening heart failure events and cardiovascular death in HFmrEF/HFpEF, with consistent benefit irrespective of SGLT2 inhibitor use, supporting additive cardiorenal protection with combination therapy. A comparative real-world study of 364,714 patients with type 2 diabetes at moderate cardiovascular risk found SGLT2 inhibitors superior to GLP-1 receptor agonists for kidney composite outcomes (HR 0.81), with both superior to DPP-4 inhibitors and sulfonylureas. These data support individualized, guideline-directed combination strategies targeting the cardiovascular, renal, and metabolic axes of disease.

Cardiologists, endocrinologists, nephrologists, and primary care physicians managing CVD with cardiometabolic comorbidities will benefit from peer discussion of combination therapy evidence, guideline-directed medical therapy optimization, and individualized cardiorenal risk reduction.

How does emerging evidence for SGLT2 inhibitor and nonsteroidal mineralocorticoid receptor antagonist combination therapy influence your treatment algorithm for patients with HFmrEF or HFpEF? How do you prioritize and sequence SGLT2 inhibitors versus GLP-1 receptor agonists in patients with cardiovascular disease and type 2 diabetes, and what cardiorenal risk factors most influence this decision?

  • 8h
    Choice of GLP-1 when weight is a factor in patients mental and physical health. SGLT2 is when diabetes is present along with CKD and proteinuria and HF. Non-steroid MRA is Show More
  • 3d
    If patients have a lot of weight to lose, and a greater A1c decrease is needed, I preferentially utilize GLP1 therapy over SGLT2 therapies. I certainly would prefer combo SGLT2 Show More

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Yesterday

Did you know? Residual inflammatory risk — independent of LDL cholesterol — contributes significantly to recurrent cardiovascular events after myocardial infarction. The LoDoCo2 Phase 3 trial (n=5,522 patients with chronic coronary disease) demonstrated that low-dose colchicine reduced the primary composite endpoint of cardiovascular death, MI, ischemic stroke, and ischemia-driven coronary revascularization by 31% (HR 0.69; 95% CI 0.57–0.83; p<0.001). The COLCOT trial extended this benefit to patients within 30 days of MI, reducing cardiovascular events by 23%.

Given the emerging evidence for anti-inflammatory therapy in secondary cardiovascular prevention, how are you integrating low-dose colchicine into your post-MI discharge protocols alongside established lipid-lowering and antiplatelet regimens?

NCCN Guidelines

Given the emerging evidence for anti-inflammatory therapy in secondary cardiovascular prevention, how are you integrating low-dose colchicine into your post-MI discharge protocols alongside established lipid-lowering and antiplatelet regimens?

  • Yesterday
    I see low-dose colchicine as an adjunct to, rather than a replacement for, established secondary prevention. For selected post-MI patients, particularly those with persistent inflammatory risk despite optimal LDL lowering Show More
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5d
Influence of cigarette smoking on cardio-inflammatory biomarkers among healthy individuals or cardiopulmonary disorder patients: systematic review and meta-analysis. - PubMed

Influence of cigarette smoking on cardio-inflammatory biomarkers among healthy individuals or cardiopulmonary disorder patients: systematic review and meta-analysis. - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/42603912

Smoking impacts biomarkers like CK-MB and hsCRP, with greater effects in current smokers and males. Former smokers show limited changes, highlighting cessation importance.


Smoking elevates biomarkers like CK-MB, E-selectin, and hsCRP, indicating inflammation and subclinical heart damage, especially in males and current smokers.

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1w
External validation of a top-ranked model from the RSNA pulmonary embolism detection challenge: assessment of generalizability. - PubMed

External validation of a top-ranked model from the RSNA pulmonary embolism detection challenge: assessment of generalizability. - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/42570951

The DL model excelled in detecting central PEs (96.2% accuracy) but was less effective for subsegmental PEs. PE's cardiovascular implications warrant cardiology attention.


The DL model detected central PEs with 96.2% accuracy but struggled with subsegmental PEs. While primarily a pulmonology concern, PE's cardiovascular implications are relevant to cardiology.

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2w
Lymphocyte-to-Neutrophil Ratio and Interleukin-40 as Predictors of Rejection and Survival After Heart Transplantation. - PubMed

Lymphocyte-to-Neutrophil Ratio and Interleukin-40 as Predictors of Rejection and Survival After Heart Transplantation. - PubMed

Source : https://pubmed.ncbi.nlm.nih.gov/42541327

Discover how interleukin 40 levels and lymphocyte-to-neutrophil ratio changes predict acute rejection in heart transplant patients, offering insights into posttransplant care.


Interleukin 40 and lymphocyte-to-neutrophil ratio, especially its change, correlate with acute rejection in heart transplant patients, indicating potential as predictive biomarkers.