Fipco

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
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Residual cardiovascular risk in coronary artery disease: from pathophysiology to established and novel therapies Nature Reviews Cardiology, Published online: 23 January 2026; doi:10.1038/s41569-026-01249-zIn this Review, Galli and colleagues discuss the mechanisms and associated biomarkers of traditional and emerging factors responsible for the residual risk of recurrent adverse cardiovascular events in patients with coronary artery disease, with a focus on new pathophysiological insights and the therapeutic implications.

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
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Some are reassured by observational epidemiology. But the recent semaglutide Alzheimer's trials did not recapitulate real world simulations. Links via Gregg Fonarow. Corrected
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alz-journals.onlinelibrary.wiley.com/doi/10.1002/...
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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/
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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

When Lipoprotein Tests Can Be Helpful, Part I: Apolipoprotein B-100 In my first blog, I expressed skepticism about using additional blood tests for cardiovascular disease (CVD) risk prediction beyond traditional risk factors.

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
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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

ja.ma/4oV4DtU

Shocking first high impact trial of the day. Fish oil reduces CV events in dialysis patients! #Pisces #kidneywk

Simultaneous pub in NEJM

www.nejm.org/doi/full/10....

Empagliflozin, the kidney, and what we still don’t understand — NephJC NephJC short on an empagliflozin meta-analysis

The latest empadata dump: @nephroseeker.medsky.social writes up a #NephJC short on the meta analysis

www.nephjc.com/news/2025/10...

Probably yes, for example lixisenatide - short half-life GLP-1ra dosed once a day was not superior to placebo on MACE (ELIXA). Real world data has some value, but results are all over the place. IMO CVOTs suggest both semaglutide and tirzepatide are good options for secondary prevention.

• start prevention earlier (than current guidelines suggest)
• measure apoB

Editorial by Angela Pirillo and Alberico Catapano #cardiosky
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ICER organization draft: Semaglutide and tirzepatide for obesity are cost effective. For context, a 2014 ACC/AHA task force suggested a less than $50k per QALY threshold as "high value". #cardiosky icer.org/assessment/o...

Key take home: current risk models understate clinical & economic benefit of long term bp/lipid lowering.

Link to slides corserahealth.com/assets/pdfs/...

NATURE-Legacy study compares MR/genetically modeled life long LDL-C and blood pressure lowering (HR 0.32) to short term effects in the HOPE-3 trial (HR 0.71). By Brian Ference, et al. /1 #ESCCongress2025 #cardiosky

Apolipoprotein B outperforms low density lipoprotein particle number as a marker of cardiovascular risk in the UK Biobank - PubMed This study suggests that ApoB is a more accurate marker for cardiovascular risk than LDL-P when discordant, as marked by ApoB levels in excess of LDL-P. Notably, risk was already elevated at as little...

"This study suggests that ApoB is a more accurate marker for cardiovascular risk than LDL-P when discordant, as marked by ApoB levels in excess of LDL-P." Analysis of UK Biobank data by Elizabeth Epstein, et al. #cardiosky pubmed.ncbi.nlm.nih.gov/40887080/

Statin eligibility with PREVENT vs PCE 10 year risk at various thresholds by Sadiya Kahn, et al.
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Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovas…

Lp(a) testing is highly cost effective (cost saving) in this study by Morton, et al. Applies to US and various other countries. #cardiosky #lpa #cea
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Colchicine: Evidence to Treat or Equipoise? - PubMed Colchicine: Evidence to Treat or Equipoise?

Somewhat lukewarm view of colchicine in this editorial. "the CLEAR SYNERGY results have brought considerable clinical equipoise for the prescription of colchicine to reduce ASCVD risk" pubmed.ncbi.nlm.nih.gov/40825059/

From #T2D to #obesity #CVD #OSA and now #MASH The expanding benefits of GLP-1 medicines www.novonordisk.com/news-and-med...

This "living" guideline document will unlive many people with diabetes if applied.

Why are guideline ppl addicted to sulfunylureas/nsulin/metformin ?

Those are useful to lower A1c from stratospheric levels, but if we are thinking hard outcomes improvement, the answer is #flozin & #glp1

#fail

Orforglipron notches double digit #weightloss investor.lilly.com/news-release...

SURPASS CVOT #T2D #Tirzepatide Non inferior but numerically superior for some endpoints #CVD investor.lilly.com/news-release...

Performance of the American Heart Association's PREVENT risk score for cardiovascular risk prediction in a multiethnic population - PubMed The Predicting Risk of Cardiovascular EVENTS (PREVENT) equations, created and endorsed by the American Heart Association, provide cardiovascular risk estimates for the general population, but have not...

Select other populations comparing PREVENT and PCE /2
• pubmed.ncbi.nlm.nih.gov/40615687/ VA-mostly male
• pubmed.ncbi.nlm.nih.gov/40560603/ Sutter
• pubmed.ncbi.nlm.nih.gov/40510258/ UK Biobank (ex-US)
• pubmed.ncbi.nlm.nih.gov/39921505/ Kaiser
• www.jacc.org/doi/10.1016/... Rochester

Looking below the surface... PREVENT equations seem better calibrated vs PCE in other studies compared to recent JACC study. VA, Kaiser, UK Biobank (ex-US), and others. /1

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