geoffrey modest medical blogs

  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...

  A recent study found that moderate-intensity statins plus ezetimibe in the elderly was associated with similar LDL reduction to a high-intensity statin but decreased adverse effects (see   lipids elderly mod statin plus ezetimibe JIntMed2025  in dropbox, or doi: 10.1111/joim.20029)   Details : -- 561 patients who were at least 70yo with documented atherosclerotic cardiovascular disease (ASCVD) in South Korea were randomized to high-intensity statin therapy (rosuvastatin 20mg) vs moderate-intensity statin along with ezetimibe (rosuvastatin 5mg with ezetimibe 10mg) for 6 months in the SaveSAMS trial, a prospective, multicenter, open-label, randomized comparison at 11 sites -- mean age 77, 67% male, 62kg, BMI 24 -- hypertension in 74%, diabetes in 46%, chronic kidney disease in 21% (none of these were further defined: no info on actual BP, A1c, level of CKD) -- coronary artery disease in 92%, comprising  prior MI in 9%, percutaneous coron...