The edition · Cardiology
Counting every event, not just the first, changes what evolocumab is worth
A prespecified VESALIUS-CV analysis finds two in five events are repeats and lipid lowering prevents those too; half-dose rivaroxaban cuts silent embolism after appendage occlusion; targeted vitamin D after infarction does nothing for the composite.
The edition in brief
The cardiology desk opens with a prespecified total-event analysis of VESALIUS-CV: among 12,257 high-risk patients with no prior myocardial infarction or stroke, followed a median 4.6 years, there were 1,654 first four-point events and 1,107 subsequent ones. Evolocumab reduced first events by 19% and total events by 20%, a projected 55 events prevented per 1,000 patients over five years. The HALO-SCE trial randomised 164 patients after left atrial appendage occlusion to half-dose rivaroxaban or antiplatelet therapy, and found new silent cerebral embolic lesions in 12.2% against 31.7%, with better cognitive scores at one year. A meta-analysis of four trials of zilebesiran, an RNA interference therapy against angiotensinogen, in 1,412 adults reports a placebo-adjusted office systolic fall of 7.16 mmHg with wide confidence intervals and signs the effect attenuates by six months. TARGET-D randomised 630 patients after myocardial infarction to usual care or vitamin D titrated to a target level, and found no reduction in the composite endpoint over an average 4.2 years. A pearl covers assessing statin intolerance before abandoning the drug. The edition closes with ADHERE-ASCVD, in which adaptive digital outreach to 20,604 non-adherent patients raised 14-day statin refill from 12.0% to 14.4%, with a second message helping and switching the channel not helping.
Two in five cardiovascular events are not the patient's first
In a high-risk patient with no prior infarct, count the events evolocumab prevents across five years, not just the first one — the number roughly doubles.
After appendage occlusion, aspirin may be leaving lesions behind
If an appendage occlusion patient could actually tolerate anticoagulation, the default switch to aspirin at 45 days deserves a second look.
Zilebesiran: large blood pressure falls, wide intervals, and a hint of fade
Treat zilebesiran as promising and unproven: no outcome data, no active comparator, and a potassium signal that matters for a drug you cannot withdraw quickly.
Titrating vitamin D to target after infarction did not reduce events
Stop offering vitamin D as cardiovascular prevention after infarction; treat deficiency on its own merits.
Most statin intolerance is not intolerance to the statin
Before recording a patient as statin-intolerant, rechallenge with a second statin and document what happened.
Send the second message; do not bother changing the channel
If your service sends one statin refill reminder, add a second one to the non-responders on the same channel — that is the whole intervention.
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