30-Second Takeaway
- CRT-based ‘ablate and pace’ lowers mortality vs drugs in AF with HF, without LVEF improvement
- Finerenone reduces HF hospitalization in HFpEF/HFmrEF; all MRAs substantially increase hyperkalemia risk
- GLP-1 receptor agonism and SGLT2 inhibitors show emerging HF and cardiorenal benefits beyond glycemic effects
- Lp(a), CAC, PRS, and biomarker panels refine midlife ASCVD risk and treatment intensity
- AI diagnostics and hemodynamic markers (PVR) may sharpen HFpEF and Group 2 PH phenotyping and therapy
Week ending March 21, 2026
Targeted strategies in AF, HFpEF, and ASCVD risk
'Ablate and pace' with CRT reduces mortality in HF patients with AF
This meta-analysis pooled 24 studies (n=4,292) comparing ‘ablate and pace’ with pharmacologic therapy in AF, mostly with CRT pacing. In HF patients, ablate-and-CRT reduced all-cause mortality by 36% versus drugs alone (RR 0.64; 95% CI 0.49-0.85). Mortality benefit was consistent across RCTs and observational studies despite variable follow-up durations. LVEF change did not differ between strategies, suggesting benefit from rate regularization and resynchronization rather than EF improvement.
Finerenone reduces HF hospitalization in HFpEF/HFmrEF; MRAs double hyperkalemia risk
This Bayesian network meta-analysis included eight RCTs (10,644 HFpEF/HFmrEF patients, mean age 70 years, LVEF 55%). Finerenone significantly reduced HF hospitalization versus placebo (RR 0.84; 95% CrI 0.75-0.93); spironolactone and eplerenone did not reach significance. No MRA significantly reduced cardiovascular mortality in this population. All MRAs increased hyperkalemia risk versus placebo, with similar relative risks around twofold across agents.
GLP-1 receptor agonists lower MACE and ESKD risk in type 1 diabetes
This sequential target trial emulation used EHR data from 174,678 patients with type 1 diabetes from 2013 to 2024. GLP-1RA initiation lowered 5-year MACE risk versus noninitiation (4.3% vs 5.0%; HR 0.85; 95% CI 0.77-0.95). End-stage kidney disease risk was also reduced (1.6% vs 1.9%; HR 0.81; 95% CI 0.69-0.95). Importantly, GLP-1RA use was not associated with higher rates of DKA or severe hypoglycemia.
Elevated Lp(a) increases ASCVD risk across all CAC strata, including CAC=0
This pooled cohort analysis included 11,319 adults without ASCVD and 1,569 incident events over 14.8 years. Elevated Lp(a) >50 mg/dL (HR 1.24; 95% CI 1.09-1.41) and CAC>0 (HR 2.44; 95% CI 2.14-2.77) independently increased ASCVD risk. With CAC=0, absolute ASCVD rates were low but higher when Lp(a) was elevated (4.9 vs 3.8 per 1,000 person-years; HR 1.28). Risk was highest when both CAC ≥300 and Lp(a) >50 mg/dL were present (HR 6.12; 95% CI 4.80-7.81).
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.