This week’s cardiovascular update brings together the latest trial results, regulatory decisions and breakthroughs shaping the industry.
In Today’s Newsletter
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🏥 RSI trial: ketamine vs etomidate in emergency intubation [1] [US • 09 Dec 2025]
Context: Multicenter U.S. randomized RSI trial, 2,365 adults undergoing emergency intubation, NEJM publication cited.
Key point: Mortality similar for ketamine vs etomidate, but ketamine increased cardiovascular collapse, notably hypotension (endpoint details as reported).
Implication: May influence prescriber choice and payer reviews pending full data.
❤️ Fibroids tied to higher long-term CVD risk [2] [US • 10 Dec 2025]
https://newsroom.heart.org/news/uterine-fibroids-linked-to-elevated-heart-disease-risk
Context: JAHA study of 2.7 million U.S. women, 10-year follow-up using claims data.
Key point: Fibroids associated with ~81% higher ASCVD risk overall, especially marked under age 40; limitations include potential underdiagnosis in controls.
Implication: Could inform practice and payer discussions, interpretation depends on study design and confounding control.
🌬️ Cardamyst (etripamil) nasal for PSVT gets FDA nod [3] [US • 16 Dec 2025]
Context: Approval supported by Phase 3 RAPID trial and broader program, >1,800 participants and >2,000 episodes.
Key point: First self-administered, rapid-acting therapy to convert acute PSVT to sinus rhythm in adults, with common transient nasal AEs.
Implication: Could streamline initiation and adherence via remote prescribing and logistics.
🩺 ASCO 2017 anthracycline echo surveillance impact: flat uptake [4] [10 Dec 2025]
https://www.jacc.org/doi/10.1016/j.jacadv.2025.102430
Context: SEER-Medicare analysis, 2011–2020, older adults with lymphoma, HER2-negative breast cancer, or sarcoma receiving anthracyclines.
Key point: No significant change in outpatient TTE frequency after 2017 guidance, with about half receiving any TTE within 18 months.
Implication: Could inform practice and payer discussions, interpretation depends on study design and confounding control.
📱 eBRAVE-AF: digital AF screening misses highest-risk adults [5] [12 Dec 2025]
https://www.jacc.org/doi/10.1016/j.jacadv.2025.102416
Context: Substudy using German insurer claims from randomized smartphone-based screening trial.
Key point: Participants were younger and healthier than invitees; modeling suggests greater benefit if higher-risk nonparticipants engaged.
Implication: Access programs may expand screening, initiation, and follow-up at scale.
🧬 In vivo CRISPR ANGPTL3 editing cuts LDL/TG in Phase 1 [6] [15 Dec 2025]
https://cardiologynownews.org/?p=139062
Context: CRISP-ANGPTL3 Phase 1 open-label dose escalation across AU/NZ/UK; AHA 2025 presentation with NEJM publication noted.
Key point: Single IV CTX310 lowered ANGPTL3 up to ~80%, LDL-C ~49%, TG ~55% at 60 days, with no dose-limiting toxicities reported.
Implication: Signals pipeline investment and modality expansion.
💉 Lerodalcibep (Lerochol) FDA approval for hypercholesterolemia [7] [US • 15 Dec 2025]
https://www.tctmd.com/news/fda-approves-lerodalcibep-adults-hypercholesterolemia
Context: Third-generation PCSK9 inhibitor, monthly self-administration, room-temperature stability up to 3 months.
Key point: Phase 3 LIBerate program showed substantial LDL-C reductions vs placebo over one year, with supportive long-term extension data.
Implication: Introduces competition that may affect pricing and formulary access.
Why it matters
- Self-administered cardiology therapies are moving into acute arrhythmia care and chronic lipid lowering.
- RWE and claims-based analyses continue to surface care gaps in surveillance and digital screening reach.
- In vivo gene editing is edging toward cardiometabolic indications with early efficacy signals.
- Two FDA approvals in lipids and arrhythmias may shift outpatient management and ED utilization.
- Equity and implementation remain central, from fibroid-associated CVD risk to enrolling higher-risk patients in digital programs.
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FAQ
What did the RSI trial conclude about ketamine vs etomidate for emergency intubation?
Ketamine did not improve survival versus etomidate and was associated with more cardiovascular collapse, per a multicenter randomized U.S. trial reported via CU Anschutz with NEJM publication referenced [1].
How strong is the association between uterine fibroids and CVD risk?
In a JAHA analysis of 2.7 million women, fibroids were linked to about 81% higher 10-year ASCVD risk, with larger relative risk under age 40, acknowledging claims-data limits [2].
What is Cardamyst (etripamil) approved for and how is it used?
FDA approved Cardamyst nasal spray for adult PSVT episode conversion to sinus rhythm, enabling self-administration during symptomatic events, supported by the RAPID Phase 3 program [3].
Did the 2017 ASCO guidance increase echo surveillance after anthracyclines?
No measurable change was observed in older Medicare beneficiaries, with roughly half receiving any TTE within 18 months, per JACC: Advances analysis [4].
Does smartphone AF screening reach those most likely to benefit?
In eBRAVE-AF, higher-risk invitees were underrepresented among participants; modeling suggests greater yield if they engaged, highlighting an implementation gap [5].
How promising is CTX310 for lipid lowering, and is it safe so far?
A single infusion produced sizable short-term LDL-C and TG reductions without dose-limiting toxicities in Phase 1, though longer follow-up is needed for durability and off-target safety [6].
What differentiates lerodalcibep among PCSK9 inhibitors?
Monthly self-administration with room-temperature stability and robust LDL-C reductions in Phase 3 may improve usability and access pending pricing and coverage [7].
Entities / Keywords
Etiprimal, Cardamyst, etripamil nasal, PSVT; Ketamine, etomidate, RSI trial, emergency intubation; Uterine fibroids, JAHA, ASCVD risk; ASCO 2017, echocardiography, anthracycline cardiotoxicity; eBRAVE-AF, digital screening, oral anticoagulation; CTX310, ANGPTL3, in vivo CRISPR, LDL-C, triglycerides; Lerodalcibep, Lerochol, PCSK9 inhibitor, LIBerate program.