Simplified landmark cardiology trials app 📱 by Justin Sharim MD. Mission: to spread evidence-based medicine worldwide 🌎
Joined March 2022
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Just a Sunday perusing the Cardiac Trials app📱😎 (sound on 🎶)
apps.apple.com/us/app/cardia…
Cardiac Trials retweeted
Why do we give statins to patients with coronary artery disease? Where does this data originate? This landmark historic trial — dubbed the king 👑 of statin trials — was the first to definitively show the profound life-prolonging effects of statins. 4S Trial, Lancet 1994 ♥️
Cardiac Trials retweeted
Five 🔑 2026 trials we’ve added to the @CardiacTrials app this year:
1. WITHDRAW-AF: withdrawing GDMT post afib rhythm control
2. Ez-PAVE: LDL-C targets
3. SINGLE-AF: anticoag in intermediate chadsvasc
4. TRIC-I-HF: Tricuspid valve TEER
5. CORALreef Lipids: oral PCSK9i
#2026 Withdrawing GDMT in patients with improved EF? Lifelong GDMT is standard, long after EF improvement. This trial however showed no outcomes difference with GDMT withdrawal in prior tachycardia mediated cardiomyopathy — once afib was controlled. WITHDRAW-AF Trial, EHJ 2026 ♥️
#2026 Withdrawing GDMT in patients with improved EF? Lifelong GDMT is standard, long after EF improvement. This trial however showed no outcomes difference with GDMT withdrawal in prior tachycardia mediated cardiomyopathy — once afib was controlled. WITHDRAW-AF Trial, EHJ 2026 ♥️
Cardiac Trials retweeted
Catheter ablation in end-stage heart failure? A population not previously studied in this context, having been excluded from prior large trials. This trial showed the importance of sinus rhythm maintenance in this vulnerable population. CASTLE-HTx Trial, NEJM 2023 ♥️
#echofirst tip:
Aortic stenosis leads to overestimation of mitral regurgitation severity
Mitral regurgitation leads to underestimation of aortic stenosis severity
Cardiac Trials retweeted
High intensity statin after ACS? A standard of care prior to hospital discharge REGARDLESS of cholesterol levels, due in large part to this trial.
High intensity statins:
1️⃣ Atorvastatin 40 or 80 mg daily
2️⃣ Rosuvastatin 20 or 40 mg daily
PROVE-IT TIMI 22 Trial, NEJM 2004 ♥️
Cardiac Trials retweeted
the 4 pillars
HFrEF Quadruple therapy - in☝️post #meded
1️⃣ Beta blockade (COPERNICUS, MERIT-HF, CIBIS II)
2️⃣ Renin-angiotensin inhibition (CONSENSUS, SOLVD, PARADIGM-HF)
3️⃣ Mineralocorticoid receptor antagonism (RALES, EPHESUS, EMPHASIS-HF)
4️⃣ SGLT-2 Inhibition (DAPA-HF, EMPEROR-Reduced)
CAC staging to guide interventions - a proposed algorithm, JACC Advances 2024 ♥️
📚 sciencedirect.com/science/ar…
A reminder to attendings, fellows, & residents:
Let your med students leave early if you can. Give them time to study, to exercise, to be with family, or to simply rest. They need that. ♥️
Cardiac Trials retweeted
HFrEF Quadruple therapy - in☝️post #meded
1️⃣ Beta blockade (COPERNICUS, MERIT-HF, CIBIS II)
2️⃣ Renin-angiotensin inhibition (CONSENSUS, SOLVD, PARADIGM-HF)
3️⃣ Mineralocorticoid receptor antagonism (RALES, EPHESUS, EMPHASIS-HF)
4️⃣ SGLT-2 Inhibition (DAPA-HF, EMPEROR-Reduced)
Cardiac Trials retweeted
Statins for for primary prevention? A well-established concept today with roots in this historic trial. This trial proved the beneficial effects of statins in those with hyperlipidemia alone, a year after the 4S Trial (1994) did so in CAD. WOSCOPS Trial, NEJM 1995 ♥️
Cardiac #pharma tip 🫀📚
Na channel blockers (class IC – flecainide, propafenone): slow phase 0 depolarization —> increase QRS duration
K channel blockers (class Ill – amiodarone, dofetilide): slow phase 3 repolarization, prolonging action potential —> increase QT interval
Catheter ablation in end-stage heart failure? A population not previously studied in this context, having been excluded from prior large trials. This trial showed the importance of sinus rhythm maintenance in this vulnerable population. CASTLE-HTx Trial, NEJM 2023 ♥️
High intensity statin after ACS? A standard of care prior to hospital discharge REGARDLESS of cholesterol levels, due in large part to this trial.
High intensity statins:
1️⃣ Atorvastatin 40 or 80 mg daily
2️⃣ Rosuvastatin 20 or 40 mg daily
PROVE-IT TIMI 22 Trial, NEJM 2004 ♥️
Cardiac Trials retweeted
Ezetimibe for patients with acute coronary syndrome? Ezetimibe – blocks the absorption of cholesterol across small intestinal mucosa – with reduced CV mortality in this trial. IMPROVE-IT Trial, NEJM 2015 ♥️
Statins for for primary prevention? A well-established concept today with roots in this historic trial. This trial proved the beneficial effects of statins in those with hyperlipidemia alone, a year after the 4S Trial (1994) did so in CAD. WOSCOPS Trial, NEJM 1995 ♥️
This, friends, is why randomized clinical trials are so important
Breaking and MASSIVE:
Lowering Lp(a) with #pelacarsen in patients with elevated Lp(a) and heart disease does NOT improve cardiovascular outcomes in Phase 3 trial globenewswire.com/news-relea…
Cardiac Trials retweeted
Clopidogrel as secondary prevention monoTx? This trial (published when clopidogrel was not yet generic) showed improved outcomes over aspirin. Today, many use clopidogrel in lieu of aspirin for comorbid GERD, though aspirin remains the traditional Tx. CAPRIE Trial, Lancet 1996 ♥️
Clinical trials #reminder
☝️Caution in interpreting secondary endpoints when a trial fails to achieve its primary endpoint.
Same principle applies to subgroup analyses (often underpowered, overestimated)
Notable, but hypothesis-generating 📚
HFrEF Quadruple therapy - in☝️post #meded
1️⃣ Beta blockade (COPERNICUS, MERIT-HF, CIBIS II)
2️⃣ Renin-angiotensin inhibition (CONSENSUS, SOLVD, PARADIGM-HF)
3️⃣ Mineralocorticoid receptor antagonism (RALES, EPHESUS, EMPHASIS-HF)
4️⃣ SGLT-2 Inhibition (DAPA-HF, EMPEROR-Reduced)