This Week in Cardiology: Diabetes Risk and Heart Failure Therapies

From the New England Journal of Medicine, a trial examined whether adding evolocumab to statin therapy benefits high-risk patients with type 2 diabetes who do not have known atherosclerosis. The analysis included 3655 participants in this prespecified subgroup evaluation ^[1].

While the authors describe potential reductions in major adverse cardiovascular events and mortality within this specific group, they note that limitations inherent to subgroup analyses must be considered when interpreting these findings.

Meanwhile, attention turned to treatment intensification strategies for severe heart failure. A systematic review published in the American journal of cardiovascular drugs evaluated adding SGLT2 inhibitors or angiotensin receptor-neprilysin inhibitors to standard neurohormonal blockade ^[2].

The researchers suggest that while there is some indication of risk reduction, evidence regarding additive benefits remains limited, prompting a call for cautious application of these agents in patients with severe HFrEF.

Elsewhere this week, research appeared in the American journal of kidney diseases focusing on hospitalized populations. An analysis of EVEREST trial data indicated that acute kidney function decline occurring at seven and fourteen days significantly increases mortality and composite cardiovascular risk ^[3].

In contrast to later changes, early alterations observed within three days did not show a similar predictive association with these adverse outcomes.

We also saw research in Critical pathways in cardiology regarding pacing strategies for cardiac resynchronization therapy. A meta-analysis involving 5605 patients compared left bundle branch area pacing against biventricular pacing ^[4].

The findings suggest that LBBAP significantly reduced all-cause mortality and heart failure hospitalizations, alongside demonstrating better preserved cardiac function and shorter procedural times.

Finally, a study in Herz addressed risk stratification for emergency department chest pain. This systematic review of 14862 patients compared the HEART and GRACE scores for predicting thirty-day major adverse cardiac events ^[5].

The authors report that the HEART score demonstrated higher sensitivity than the GRACE score (0.96 versus 0.88), suggesting it may be preferable for ruling out imminent risk in this setting.