geoffrey modest medical blogs

  A very recent study, the VESALIUS-CV (Effect of Evolocumab in Patients at High Cardiovascular Risk without Prior Myocardial Infarction or Stroke) trial found that adding the PCSK9 inhibitor evolocumab to patients with diabetes with no prior history of ASCVD (atherosclerotic cardiovascular disease) prevented the first major cardiovascular event (see   diabetes primary ASCVD prevention with PCSK9 JAMA2026  in dropbox, or doi:10.1001/jama.2026.3277)   Details : -- VESALIUS-CV was a randomized, double-blind, placebo-controlled trial of evolocumab conducted across 774 sites in 33 countries, enrolling 12,257 patients with diabetes but no prior myocardial infarction or stroke, LDL-C level 90mg/dL or greater, and qualifying atherosclerosis or high-risk diabetes. This current study was a prespecified subgroup analysis to examine outcomes in patients without known significant atherosclerosis     --none of the patients had prior arterial revascularization, arte...

  A secondary analysis of the CONNECT trial, that stands for (a bit of a stretch...)  “A Randomized Comparison of Long-Term Vascular Healing Between Biodegradable Polymer vs Durable Polymer Everolimus Eluting Stents in Acute ST-Elevation Myocardial Infarction” found that a lower target LDL level was associated with decreased neoatherosclerosis, which is associated with subsequent stent failure (see   LDL goal after stent JAMAcardiol2025  in dropbox, or doi:10.1001/jamacardio.2025.4723)   Details : -- the CONNECT trial was a prospective, multicenter, open-label, assessor-blind, randomized clinical trial to investigate the association between achieving guideline-endorsed target LDL levels with long-term neoatherosclerosis formation after current-generation drug-eluting stent implantation. This trial was conducted in 7 centers in 2 countries (Switzerland and Japan)     -- patients at least 18 years old were eligible if they presented with a...