This Week in Cardiology Aug 08 2025 This Week in Cardiology
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Aug 8, 2025 Listener feedback on the Surpass Cardiovascular Outcomes Trial reveals key insights about diabetes medications and heart health. A deep dive into atrial fibrillation ablation techniques showcases the debate between catheter and surgical approaches. An FDA alert warns of air embolism risks associated with Watchman systems, sparking concerns among medical professionals. Lastly, managing anticoagulation in frail elderly patients presents unique challenges, spotlighting recent trials that guide treatment decisions.
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Regulatory Need For Active Comparator
- Regulatory agencies (FDA and EMA) require CVOTs with active comparators for new diabetes drugs.
- This makes placebo-controlled GLP‑1 trials unethical when cardioprotective agents are established.
Treat Mortality Signals With Caution
- John Mandrola warns the lower all‑cause mortality in SURPASS may be statistical noise without matching CV outcome reductions.
- He highlights dose differences and lack of convenience or cost benefit for terzepatide versus dulaglutide.
Meta‑Analysis Fails With Incompatible AF Trials
- John argues combining 63 AF ablation trials produced misleading results because the studies were heterogeneous in era, size, and endpoints.
- He emphasizes meta-analysis only helps when trials are similar and high quality.