This Week in Cardiology

Nov 14 2025 This Week in Cardiology

Nov 14, 2025
Dive into a critical discussion on the PISCES trial and its implications for fish oil's cardiovascular benefits in dialysis patients. Hear insights on the Vesalius trial, revealing the effectiveness of PCSK9 inhibitors. Explore the debate over beta-blockers after myocardial infarction, emphasizing recent findings that challenge routine use. Discover the outcomes of the Closure AF trial, which raises questions about left atrial appendage closure’s efficacy. Lastly, examine the OCEAN trial's low post-ablation stroke rates, reshaping anticoagulation strategies.
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INSIGHT

PISCES Results May Overstate Benefit

  • The PISCES fish-oil trial showed a large 43% MACE reduction but methodological flags weaken plausibility.
  • Event clustering and composite counting likely overstate benefit; first-event analysis gave a smaller 27% reduction.
INSIGHT

PCSK9 Lowers MI But Modest Absolute Gain

  • The VESALIUS-CV trial with avilocumab reduced three-point MACE (6.2% vs 8.0%) with an NNT ≈55.
  • Benefits were driven by fewer nonfatal MIs while coronary death did not significantly decline, highlighting LDL causality but modest absolute gain.
INSIGHT

LDL Is Causal But Not Sufficient

  • Intensive LDL lowering to ~40 mg/dL again supports LDL as causal in atherosclerosis.
  • LDL is one causal pathway among many, so targeting LDL alone has diminishing returns for eliminating coronary disease.
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