geoffrey modest medical blogs

  A new meta-analysis confirmed the rather common finding of significant discordance between estimated GFR (eGFR) by cystatin vs creatinine, finding that when eGFR was significantly lower by cystatin, there were significant increases in all-cause mortality, cardiovascular events, and kidney failure (see  ckd cystatin better than creat JAMA2025  in dropbox, or doi:10.1001/jama.2025.17578)   Details : -- the data source for this meta-analysis was the Participants in the Chronic Kidney Disease Prognosis Consortium (CKD-PC), focusing on participants with concurrent Cystatin-C (referred to as cystatin below) and creatinine measurements (eGFRcys and eGFRcr, respectively) and clinical outcomes, using an individual-level meta-analysis -- 23 outpatient cohorts: total of 821327 individuals     -- mean age 59, 48% female, 13.5% with diabetes, 40% with hypertension     -- mean eGFRcr 87, mean eGFRcys 81, median eGFRcys-eGFRcr difference of -5.4%, me...

  This is an addition to the last blog on PCSK9 inhibitors and lipoprotein (a): I should have included this impressive study on PCSK9 inhibitors and their clinical benefit in Lp(a) reduction, a benefit independent of LDL reduction, in the Fourier study mentioned in the last blog (see  Lp(a) Fourier study PCSK9 dec events Circ2019  in dropbox, or DOI: 10.1161/CIRCULATIONAHA.118.037184)   --Lp(a) was measured in 25,096 patients randomized to the injectable PCSK9 inhibitor evolocumab vs placebo with a prespecified endpoint analysis to assess the relationship between Lp(a) levels, PCSK9 inhibition with evolocumab, and cardiovascular risk reduction, finding:     -- patients with higher Lp(a) levels were at increased risk of a cardiovascular event independent of their LDL levels     -- evolocumab reduced Lp(a) levels by 26.9%     -- there was a moderately positive correlation between the percent change in Lp(a) and LDL leve...