The latest trials are reshaping cardiovascular disease prevention. Join experts for a rapid review of the data behind GLP-1 RAs, PCSK9 inhibitors, obicetrapib & inflammation reduction — & what these emerging therapies could mean for clinical practice. ow.ly/gZU450ZGbn5

Tomorrow is @BCFootball’s Red Bandana Game on ESPN2. I don’t think there’s a better 14 minutes of TV that ESPN has ever done. I watch this once a year.

A SCREENING TEST AND DECISION AID ARE NOT THE SAME Much of the current arguments about CAC (fair amount of the academic argument) is lack of clarity on this issue and hence important to try settling this question first. Few thoughts on this 1st 1. Key to understand whether preventive therapy is already indicated? 2. If done primarily for younger adults or those below statin consideration thresholds (<3% PREVENT) CAC functions as screening, because a positive result identifies disease in someone who would otherwise have received nothing. 3. In those scenarios all the prerequisite for adoption on screening test need to be applied 2nd 1. In the current era and guidelines recs, if therapy is already indicated, then CAC functions as a decision aid, refining an allocation decision that was going to be made regardless. 2. The discriminator is here not whether the test can move someone from no treatment to treatment but will likely adjust a decision already in play. 3rd 1. In the screening mindset, the untested arm may remain entirely untreated, or not offered and then the only effect on treatment is if you detected the disease or not. 2. In the decision-aid framework, both arms arrive at a management decision, and the focus is the accuracy of the decision-making (which in both risk score and CAC is “actual risk”) with which therapy is allocated among individuals already under consideration 3. There is no screening test I know of, that actually lowers the likelihood of being offered a downstream treatment. 4. Substantial share of CAC's clinical value given that roughly half of statin-eligible individuals have a score of zero (As also seen in Corcal, 3X less statin use without the downstream penalty of increase events) 4th 1. I completely agree that screening requires randomized comparison against no screening with hard endpoints. 2. A decision aid is appraised on decisional quality, values concordance, adherence, and allocation of treatment recs, how information among patients already going to be treatment changes the paradigm, most importantly informed choices, downstream harm (excessive test, cost etc) 3. For a treatment decision carries methodological constraints the screening paradigm does not accommodate. 5th, so what is CAC? 1. The honest answer is that it depends entirely how you use it. 2. Applied in low risk and or indiscriminately it is a screening test. No value for it and should be held to the "screening" value proposition bar. 3. Applied to a statin-eligible patient in whom the treatment decision is genuinely uncertain, CAC is a decision aid, and the relevant questions change entirely. 4. This is where the guidelines are absolutely correct MY TAKE IS THAT WE CANNOT APPLY SCREENING STANDARDS TO A DECISION AID! MY HOPE IS WE ALL CAN HELP REDEFINE THE FRAMEWORK ON HOW THIS EVALUATED @rblument1 @MichaelJBlaha

This is how it all started! When we moved to Boston in 2020 for my cardiac imaging fellowship, money was tight living on just a fellow income. Rent for a small one bedroom apartment in Boston, near Brigham, was more than 50% of our income. There was no other choice.

Host @PraveenRangana9 is joined by co-authors of the recently published NATURE-CT study: Srikanth Krishnan, MD, MSc, FSCCT and @SuvasiniL. Tune in and enjoy! ow.ly/FIPh50ZHFP4