The anti-ANGPTL3 fully human monoclonal antibody SHR-1918 (ruisiruiximab) from Hengrui Medicine cut LDL-C by 64.2% relative to placebo in a nationwide multicenter phase 3 trial in patients with homozygous familial hypercholesterolemia. Led by Professor Daoquan Peng of the Second Xiangya Hospital of Central South University, the study was selected for the LBA session and presented orally at the ESC congress in Munich, held August 28 to 31, 2026.
Blocking fructose catabolism specifically in the murine small intestine mitigates fructose-induced obesity and insulin resistance, an unexpected finding since intestinal fructose clearance was thought to protect the liver. The effect traces to decreased dietary fat absorption caused by shortening of ileal lacteals. Fecal transplantation showed the altered microbiome reduces ileal macrophages required for lacteal growth.
Dapagliflozin started one day before elective cardiac surgery cut postoperative acute kidney injury nearly in half. Among 784 adults randomized at Dutch hospitals, AKI within 7 days occurred in 28% of the dapagliflozin group versus 52% on placebo (relative risk, 0.54; P < .001). Four perioperative doses of 10 mg offer a preventive strategy where none had been identified.
A pooled individual participant-level analysis of 38,753 patients across nine randomized trials quantifies the short-term (2-12 weeks) effects of heart failure drug combinations on blood pressure, eGFR and serum potassium, with a prediction model for individualized estimates. In HFrEF, ARNI + SGLT2i + sMRA lowered SBP by -9.2 mmHg, reduced eGFR by -6.8 ml min-1 m-2 and raised potassium by +0.30 mmol l-1; in HFmrEF/HFpEF, SGLT2i + nsMRA raised potassium by only +0.21 mmol l-1. The model gives clinicians expected treatment effects for any therapy combination, addressing concerns over hypotension, kidney dysfunction and hyperkalemia that limit comprehensive therapy.
Pooled analysis of the phase 3 trials HELIOS-B and CARDIO-TTRansform (2086 patients with ATTR-CM) found TTR gene-silencing therapy cut the composite of all-cause mortality and recurrent cardiovascular events by 20% (RR, 0.80; 95% CI, 0.69-0.94), reduced all-cause death (HR, 0.74; 95% CI, 0.61-0.91), and preserved 6-minute walk distance (+22.2 m vs placebo). Benefit was significant in patients not on baseline TTR stabilizers (RR, 0.69) but not in those already receiving stabilizer therapy (RR, 0.97). The findings support TTR gene silencing for ATTR-CM and clarify how background stabilizer use shapes the treatment effect.
Catheter-directed thrombolysis with alteplase plus anticoagulation reduced the composite of death, recurrent pulmonary embolism, or cardiorespiratory decompensation or collapse within 7 days in intermediate-high-risk acute pulmonary embolism: 0.7% vs 6.8% with anticoagulation alone (relative risk 0.10, P<0.001). In 558 randomized patients, clinically relevant bleeding occurred in 4.6% vs 5.0% and major bleeding in 1.4% vs 2.2%; intracranial hemorrhage occurred in 2 thrombolysis patients and none on standard care.
Why it matters: Randomized trial showing a large 7-day benefit of catheter-directed thrombolysis in intermediate-high-risk PE without excess clinically relevant bleeding.
In patients with severe aortic stenosis and coronary artery disease undergoing transcatheter aortic-valve implantation (TAVI), doing TAVI before PCI was noninferior to the conventional PCI-first approach. At 1 year, the composite endpoint of death, myocardial infarction, ischemia-driven revascularization, rehospitalization, or major bleeding occurred in 22.2% of the TAVI-first group versus 24.2% of the PCI-first group (risk difference -2.0 percentage points; 95% CI -7.4 to 3.4). This randomized trial of 986 patients at 48 European centers supports resequencing the two procedures.
Oral anticoagulation with a factor Xa inhibitor after transcatheter aortic valve implant reduced leaflet thrombosis compared with acetylsalicylic acid, in a randomized trial of 360 patients aged 65 to 80 with severe aortic valve stenosis. HALT on 12-month 4-dimensional CT occurred in 16.2% of the NOAC group vs 28.6% of the ASA group (risk ratio 0.55; 95% CI 0.37-0.82). The composite safety endpoint of VARC-3 bleeding, thromboembolic events, and all-cause death met noninferiority (7.5% vs 10.6%).
JAMA reports that the FDA has approved the first oral PCSK9 inhibitor for lowering LDL cholesterol. It is the first oral formulation for this target; only the headline is usable from the original.
Clopidogrel monotherapy was noninferior to extended dual antiplatelet therapy (DAPT) with clopidogrel plus aspirin for net adverse clinical events in high-ischemic-risk patients 12 months after drug-eluting stent implantation: 5.0% versus 5.1% at 24 months (risk difference, -0.1 percentage points; 90% CI, -1.3 to 1.2). The trade-off was clear, as the key secondary ischemic end point occurred in 3.7% with monotherapy versus 1.6% with DAPT (hazard ratio, 2.33), while BARC type 2, 3, or 5 bleeding occurred in 1.8% versus 4.1% (hazard ratio, 0.43).
A default prasugrel policy did not reduce ischemic events compared with a default ticagrelor policy after percutaneous coronary intervention for acute coronary syndrome. In 17,095 Swedish patients, the composite of death, myocardial infarction, or stroke at 1 year occurred in 11.1% under prasugrel versus 11.8% under ticagrelor (adjusted OR 0.90; 95% CI 0.77 to 1.06), with less major bleeding under prasugrel (4.2% vs 4.4%; OR 0.80).
Transcatheter tricuspid-valve repair plus medical therapy beat medical therapy alone in patients with symptomatic severe tricuspid regurgitation at high risk of heart-failure events. In 360 randomized patients, the win ratio for the hierarchical composite of death, heart-failure hospitalization, and quality-of-life improvement at 1 year was 2.42 (95% CI, 1.76 to 3.33). Freedom from death or heart-failure hospitalization through 3 years was 52.4% with repair versus 21.0% without (hazard ratio 0.40).
Adding individualized low-voltage zone ablation to pulmonary vein isolation substantially improved rhythm outcomes in persistent atrial fibrillation patients with low-voltage zones of 3.0 cm2 or greater. In the IDEAL-AF trial, 209 patients at 5 Swedish centers were randomized after pulmonary vein isolation to adjunctive low-voltage zone ablation or no further ablation. Arrhythmia-free survival off antiarrhythmic drugs at 12 months was 67.6% vs 37.4% (odds ratio 3.5; P < .001), with greater quality-of-life gains and no excess serious adverse events.
Pulmonary-artery denervation plus guideline-directed medical therapy cut clinical worsening in heart failure-related pulmonary hypertension associated with left heart disease. In 264 randomized patients, the 2-year Kaplan-Meier incidence of clinical worsening was 25.7% with denervation versus 51.5% with medical therapy alone (hazard ratio 0.49, P = 0.006). It offers a procedural option beyond drugs for this population.
Why it matters: First multicenter randomized trial to show pulmonary-artery denervation reduces clinical worsening in left heart disease-associated pulmonary hypertension.
A secondary analysis of the CARDIOTTRansform phase 3 randomized controlled trial found that eplontersen, a transthyretin-targeting antisense oligonucleotide, benefited patients with transthyretin amyloid cardiomyopathy who were not on transthyretin stabilizers at baseline, but showed no such effect in those already taking stabilizers. The result separates responders from non-responders by background therapy. Findings were presented at the 2026 ESC Congress.
Adding milvexian, an oral factor XIa inhibitor, to standard antiplatelet therapy within 7 days after an acute coronary syndrome did not reduce recurrent ischemic events. In 14,194 patients followed for a median of 12.2 months, the composite of cardiovascular death, myocardial infarction, or ischemic stroke occurred in 5.4% with milvexian versus 5.1% with placebo (hazard ratio, 1.05; 95% CI, 0.91 to 1.21). The trial was stopped for futility at a planned interim analysis; major bleeding rates were 0.3% in both groups.
Omitting aspirin during primary PCI for STEMI failed a noninferiority test against dual antiplatelet therapy. In 2216 patients randomized to low-dose prasugrel monotherapy or DAPT with aspirin and low-dose prasugrel, death, stroke, or myocardial infarction at 12 months occurred in 11.0% versus 8.5% (hazard ratio 1.34; 95% CI 1.02 to 1.75), while major bleeding was lower with monotherapy (5.6% vs. 8.4%). Up-front aspirin remains part of standard care at PCI.
Evolocumab started in the catheterization laboratory before PCI for high-risk acute MI did not change clinical outcomes at 1 year. All-cause death or unplanned cardiovascular hospitalization occurred in 14.6% of 1087 patients given evolocumab plus standard care vs 15.4% of 1074 given standard care alone (adjusted odds ratio 0.94; P = .59). It did, however, achieve the LDL-C target (<55 mg/dL and at least 50% reduction) in 82% vs 40% of patients at 12 months, with median LDL-C of 16 vs 56 mg/dL at 6 weeks.
Atorvastatin 40 mg daily lowered major cardiovascular events versus placebo in community-dwelling adults 70 and older without cardiovascular disease, diabetes, or dementia (hazard ratio 0.70, 95% CI 0.61 to 0.82) over a median 5.9 years in the STAREE trial of 9971 participants. It did not extend disability-free survival: death, dementia, or persistent physical disability occurred at similar rates (hazard ratio 0.94, P=0.25). Serious adverse events occurred in 2.7% of each group.
Dual antithrombotic therapy combining direct oral anticoagulants with potent P2Y12 inhibitors in patients with atrial fibrillation and acute coronary syndrome was associated with higher bleeding rates than direct oral anticoagulants with clopidogrel and aspirin, with no evidence of reduced ischemic events. The randomized controlled trial results were presented at the 2026 European Society of Cardiology Congress.
