The Curbsiders Internal Medicine Podcast #477 Hotcakes: Suzetrigine for acute pain, SGLT2i and PAD, Safety of Lowering LDL, Restrictive vs Liberal Transfusion Strategy in MI revisited
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Mar 31, 2025 Molly Brett, a primary care physician and associate editor for NEJM Journal Watch, joins the hosts to discuss groundbreaking findings in medical practice. They dive into the cognitive safety of very low LDL levels, raising intriguing questions. The podcast also explores suzetrogine as a promising non-opioid option for acute pain. Additionally, they evaluate the safety of SGLT2 inhibitors, linking them to peripheral artery disease. Finally, a debate unfolds over restrictive versus liberal transfusion strategies in acute myocardial infarction, shedding light on their long-term implications.
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Low LDL and Cognition
- Very low LDL cholesterol levels, achieved with PCSK9 inhibitors like Evolocumab, have not been shown to cause cognitive decline in a 5-year study.
- This negative trial followed patients with pre-existing cardiovascular disease and high LDL cholesterol despite statin therapy.
Suzetrigine for Acute Pain
- Suzetrigine, a new non-opioid pain medication, has shown promise for acute pain management after soft tissue and bony surgeries in phase 2 trials.
- It works by selectively inhibiting a sodium channel subtype in peripheral sensory neurons, offering a potential alternative to opioids.
SGLT2 Inhibitors and PAD Risk
- A retrospective study on US veterans with diabetes found a small increased risk of peripheral artery disease events (PAD) with SGLT2 inhibitors versus DPP4 inhibitors.
- The absolute risk difference was about one additional PAD event per 1,000 patient-years of SGLT2 inhibitor use.