Name: Feb 06 2026 This Week in Cardiology
Uploaded: 2026-02-19T21:17:36.000Z
Duration: 23 min 42 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

You're listening to this Week in Cardiology from theheart.org Medscape Cardiology.

Basic passive voice

This podcast is intended for healthcare professionals only.

Adverbs of manner

Any views expressed are the presenter's own and do not necessarily reflect the views of WebMD or Medscape.

Hi everyone, this is John Mandrola from the heart.org Medscape Cardiology.

And this is this Week in Cardiology for February 6, 2026.

This week, some more problems with the prevent risk equation.

A new breakthrough in lipid lowering therapy, an even more surprising benefit in stroke care, and

some more thoughts on statins and preventive care of heart disease.

So the first topic today is prevent score problems.

Now in the old days we used risk scores like Framingham and the pooled cohort equation or pce.

These weren't perfect, but they were decent.

Recently, key opinion leaders have come up with a new score called the prevent score which is supposed to be better because it includes 30 to 39 year olds and that expands the age range.

It removes race as a predictor, supposedly improving equity, and

it adds optimal social determinants index and also includes kidney function.

I think perhaps the most valuable or beneficial thing with the prevent score is it's derived from more recent data and therefore better reflects modern cardiovascular epidemiology.

Now finally, let's not forget the point of these risk scores.

The risk scores are used to guide treatment.

Now, instead of treat everyone with say a blood pressure of 135 over 90, the risk score suggests treatment if a global 10 year risk reaches some set out threshold.

Now I go on about this because of a very very provocative paper published in JAC from the Kaiser Permanente Group on using the prevent equations in young adults.

This group assessed performance and algorithmic fairness of base n social determinant index augmented prevent equations in young adults age 30 to 39 and defined fairness as similar performance across racial and ethnic groups.

They then did an exploratory analysis conducted among young adults aged 20 to 29 years.

Now this was a big data study including 160,000 plus young adults with varying races and ethnic groups.

The total incidence of cardiovascular disease was very low at 0.7%, which you'd expect because these are young people.

The main finding was that the mean calibration found severe under prediction in non Hispanic black individuals.

Well, the prevent score underestimated risk by 46% in this group.

And of course this is very important because it could lead to substantial undertreatment of black individuals with life saving cholesterol and blood pressure meds.

The authors assessed whether adding the Social Determinant index would improve calibration in black individuals, but

So my comments it's ironic that the tool meant to prevent undertreatment of young adults may actually cause undertreatment of young black adults, specifically the exact population with the highest premature cardiovascular disease burden.

I could use a simple example for instance of a non Hispanic Black individual age 35.

The blood pressure 135 over 85 on no meds prevent score predicts a 4% 10 year cardiovascular disease risk.

So the clinician sees 4%, says low risk, let's try lifestyle medications first, follow up in six months.

But it probably ought to be this is moderate risk indicating treatment is best to do now.

Meanwhile a Hispanic patient with identical values, the prevent score predicts 4%, the true risk is about 4% and that patient can get appropriate conservative management.

Now I've said this a blue million times on this podcast, but

prediction is hard, especially about the future.

Like Yogi Berra said recently, I got kind of smashed on social media for suggesting a young woman needn't take statins because her overall risk was so low.

Many suggested that we should treat regardless of overall risk, the thinking being that atherosclerosis is a slowly developing problem and the longer exposure to to lower LDL cholesterol or lower blood pressure is going to be beneficial.

But if you take that logic to its natural end, we may as well start in the teen years or even younger and then just treat everyone.

There must be some happy medium where we use risk to guide therapy.

Perhaps we don't have to hew so strongly to certain thresholds.

For instance, there's nothing magic about this 7.5% risk threshold.

The thing that strikes me about this paper is that epidemiology clearly tells us that non Hispanic black individuals have higher cardiovascular risk on average.

And at least in this population studied, the prevent score led to underestimation of risk and this could lead to or would lead to significant undertreatment if everybody just went by the risk scores.

Now the risk score that was designed to be race neutral performed worse on race and it's kind of a head shaker.

If I had a dollar for every instance in medicine where well intentioned policy led to harm.

Like things like the Healthcare Readmission Reductions Program which penalized hospitals for high rates of readmissions may have actually led to higher mortality and heart failure.

Many years ago I visited the EPI lab of Dr.

Dave Wilber in Chicago and I'll never forget it.

Over his stimulator he had a sign that read in big letters, resist the urge to help.

And perhaps we need more of that in policy.

All right, next topic is a new breakthrough in LDL cholesterol management with an oral PCSK9 inhibitor.

New England Journal published the results of the Coral Reef Lipids trial of the oral PCSK9 drug in licitide.

The study was presented at AHA, but it's published this week so we'll talk about it briefly.

And I relooked at the trial and it's impressive.

This was a BIG trial, about 3,000 patients who had an elevated LDL cholesterol, almost all of them on statins.

And it was just enlistatide versus placebo.

The primary endpoint of this trial was LDL cholesterol lowering, not cardiovascular outcomes.

Inlicitide worked, resulted in a about 55% reduction place placebo resistant reduction in LDL cholesterol over the 52 week trial.

There were no safety signals compared to placebo.

And so my comments, this may be my briefest commentary on a trial ever because this seems like a clear winner.

The drug shreds non HDL cholesterol and it's on top of statins.

The degree of reduction is similar to the injectable PCSK9 drugs.

And it's more than bempedoic acid, more than ezetimibe and more than inclisiran.

And a daily pill is always gonna be better than a weekly injection.

So I can't see how this drug doesn't help patients though.

We need to remember this wasn't an outcomes trial.

The LDL cholesterol is still a surrogate.

It happens to be a very reliable surrogate for ascvd, but it's still a surrogate.

The authors tell us in the paper that Merck is sponsoring a large outcome trial called Coral Reef Outcomes Trial with a projected completion date of December of 2029.

And of course another major headwind for this drug in the US will be cost because you can be sure that Merck will price the drug quite high.

All right, speaking of wins, the next topic is a win for Factor 11 inhibitor, Ascendexian.

Now, a couple of years ago, the promise of Factor 11 inhibition as a safer oral anticoagulant took a huge hit when the Oceanic Afib study of Ascendexian versus Apixaban in patients with AF had to be stopped early because of higher stroke rates in the Factor 11 arm.

The Factor 11 drug just didn't seem to have the anticoagulant efficacy that apixaban had at the time.

In November of 23 the decision was made to continue the Oceanic Stroke Study of a seduction 50mg daily versus placebo in patients with non cardioembolic stroke or high risk tia.

These are the type of stroke patients plan for antiplatelet therapy either with single or dual antiplatelet therapy.

Oceanic Stroke had a primary endpoint of ischemic stroke at a primary safety endpoint of bleeding oh, along with many secondary endpoints.

The trial results were just presented in New Orleans at the Stroke Congress.

I don't think there's a paper yet, but I did find the slide deck thanks to Dr.

Mike Gibson on X and I've attached that link in the show notes so you'll be able to see the slides.

The inclusion Criteria were adults within 72 hours of symptom onset.

This was felt to be non cardioembolic ischemic stroke with a NIH SS less than or equal to 15 or high risk TIA.

These patients had a history of atherosclerosis or evidence of plaque on imaging or non lacunar stroke on imaging.

They had a plan for antiplatelet therapy, single or dual.

Now of course if the patient had AFIB or another source of cardioemboli, they were not included in this study.

This was a huge trial of over 6,000 patients per arm.

Most of these patients had cardiovascular disease or substantial cardiovascular risk factors.

Just under a third had interventional therapy with either endovascular or thrombolytic therapy for their acute stroke event.

About 2/3 of the patients were on dual antiplatelet therapy.

The main Result was a 26% reduction in recurrent ischemic stroke over three years.

26% reduction hazard ratio 0.74 95% conference interval 0.65 to 0.84 absolute risk reduction numbers.