geoffrey modest medical blogs

  A recent study found that aspirin was actually harmful in patients with chronic coronary syndrome who were at high atherothrombotic risk and were on long-term anticoagulation, in the AQUATIC trial (Assessment of Quitting versus Using Aspirin Therapy in Patients with Stabilized Coronary Artery Disease after Stenting Who Require Long-Term Oral Anticoagulation. a bit of a mouthful....) in this French study: see   aspirin plus anticoag NEJM2025  in dropbox, or DOI: 10.1056/NEJMoa2507532     -- "chronic coronary syndrome" is the new name for "stable coronary artery disease" Details : -- 872 adults were eligible who had documented chronic coronary syndrome with previous coronary stent implantation more than 6 months before enrollment, had features of high residual atherothrombotic risk, and were receiving an oral anticoagulant (either a direct oral anticoagulant DOAC or a vitamin K antagonist VKA) for any reason.     --inclusion criteria: high-ri...

  A recent study found that the oral PCSK9 inhibitor Enlicitide decreased an array of adverse lipid markers including lipoprotein(a) (referred to as Lp(a)) in the phase-3 CORALreef HeFH study: see   lipid oral PCSK9 lipid effect JAMA2025  in dropbox, or doi:10.1001/jama.2025.20620   Details : -- 303 participants with genetically-confirmed heterozygous familial hypercholesterolemia (HeFH) who were at least 18 years old and were on statin therapy as well as many being on ezetimibe were randomized to the oral PCSK9 inhibitor enlicitide decanoate 20 mg once daily for 52 weeks versus placebo. Patients were instructed to take this medication on an empty stomach 30 minutes prior to eating     -- these patients had either an LDL level of 55 mg/dL or greater and a history of major atherosclerotic cardiovascular disease (ASCVD), or a level of 70 mg/dL or greater without a history of ASCVD -- this trial was conducted in 59 sites across 17 countries, screening pat...