TAVR's quality-of-life lead fades by year three, and SGLT2 inhibitors in early pregnancy look reassuring but unproven

The edition in brief

In 943 low-risk PARTNER 3 patients, both transcatheter and surgical aortic valve replacement produced lasting gains in Kansas City Cardiomyopathy Questionnaire scores through seven years. TAVR led by 16.2 points at one month and 1.9 points at two years, with no difference from year three; about 60% in each arm had an excellent outcome at seven years. A meta-analysis of three cohorts (669 exposed pregnancies) found no association between early SGLT2 inhibitor exposure and major congenital malformations versus insulin (RR 0.94, 0.68–1.29), but the intervals are wide and one cohort raised a possible heart-defect signal with exposure in weeks 4–10. In 82,623 people of African ancestry, the CD36 Y325* nonsense variant carried an OR of 4.8 for dilated cardiomyopathy in homozygotes and a population attributable fraction of 9.0%, above titin truncating variants at 3.7%. A meta-analysis of small trials suggested adding a PCSK9 inhibitor to statin after acute ischaemic stroke improved functional independence, with low to moderate certainty. A HELIOS-B analysis found vutrisiran's benefit in transthyretin cardiomyopathy was not modified by tafamidis or heart failure drugs. The pearl covers contraception counselling when prescribing SGLT2 inhibitors to women of reproductive age.