Jorge Acuña Valerio

Cardiólogo Intervencionista & Periférico | Internista • @cardiodata • #Cardiology #Cardiotwitter #PCI #Diabetes #PAD #CLI #PeripheralIntervention #DiabeticFoot

[FIFA World Cup @FIFAWorldCup]

Mexican golazos at the #FIFAWorldCup 🇲🇽🌟

[AHA Science @AHAScience]

Progression along the spectrum of cardiovascular-kidney-metabolic (CKM) syndrome stages is accompanied by increasing absolute risk of cardiovascular disease. This framework highlights the cumulative and progressive nature of CKM-related risk.

📷 Conceptual crosswalk between absolute risk of cardiovascular disease and cardiovascular-kidney-metabolic syndrome stages

✍🏼 @HeartDocSadiya @RangaswJ @pnatarajanmd @dramitkhera @NicoleBhaveMD @yuan_lu1 @rblument1 @JenHoCariology @virani_md @ChiadiNdumele

[Richard Hall @RichHall80]

It was 36 years ago, that the Italia 90 World Cup began at San Siro in Milano

The opening ceremony began with the song by Gianna Nannini and Edoardo Bennato "Un'estate italiana" which is still the greatest opening ever in my opinion #Italia90 🇮🇹

[Davide Capodanno @DFCapodanno]

We know that aspirin can often be safely discontinued after PCI, provided it is not stopped too early. But how early is too early?

In this meta-analysis of 11 RCTs including 37,443 PCI patients—now incorporating the recent NEOMINDSET and TARGET-FIRST trials—we found that aspirin discontinuation at either ≤3 months or ≤1 month, followed by P2Y12 inhibitor monotherapy, reduced bleeding without increasing MACE compared with 12-month DAPT.

The key finding is that while discontinuation within the first month may provide an additional bleeding benefit, it appears to come at the cost of increased stent thrombosis, particularly in patients at higher ischaemic risk.

https://t.co/83VoBaFuiS

[Jorge Acuña Valerio @jacuval]

PCI Prior to TAVI of Only Modest Benefit in Patients With CAD and Aortic Stenosis https://t.co/qRaa9rxRiC

[Jorge Acuña Valerio @jacuval]

Not All Antihypertensives Alike When It Comes to Tolerability https://t.co/mcqISPbPrK

[د. صادق العلي @Dr_ALALI1]

🚨 أرقام ApoB و Lp(a) أهم من الكوليسترول الكلي، والLDL لتقييم خطورة أمراض القلب

🔸 ApoB = عدد الجسيمات الضارة (كل جسيم LDL أو VLDL أو remnant فيه ApoB واحدة)
🔸 Lp(a) = جسيم وراثي مستقل يزيد الخطورة بشكل كبير

🔺 متى نقيسها؟

💡 حسب إرشادات ACC/AHA 2026
▫️ Lp(a): يُقاس مرة واحدة على الأقل لكل بالغ
▫️ ApoB: يُستخدم بعد تحقيق أهداف LDL-C، خاصة في مرضى السكري وارتفاع الثلاثيات

🔺 تفسير القياس:
▫️ Lp(a) ≥125 nmol/L (≈50 mg/dL) → خطر قلبي مضاعف (1.4 مرة)
▫️ Lp(a) ≥250 nmol/L (≈100 mg/dL) → خطر مضاعف أكثر (≥2 مرة)

🔺 بعد القياس نعمل تقييم للنتيجة:

▫️ لو ApoB مرتفع رغم LDL-C في الهدف → شدد العلاج (زيادة statin أو إضافة ezetimibe أو PCSK9i)
▫️ لو Lp(a) مرتفع → شدد السيطرة على باقي العوامل (LDL-C، ضغط، سكر، وزن) + cascade screening للعائلة

✅ تطبيق عملي في العيادة

🔹 الخطوة الأولى: Lp(a) ≥ 125 nmol/L (≈50 mg/dL) = خطر قلبي مضاعف

🔹 الخطوة الثانية: تحديد المستوى المناسب لApoB:
1️⃣ بشكل عام: <90 mg/dL
2️⃣ لمرضى السكري + عوامل خطر: <80 mg/dL
3️⃣ لمن تعرض لأي مشكلة قلبية أو جلطات ASCVD: <70 mg/dL

🔹 الخطوة الثالثة:
لو ApoB مرتفع رغم LDL-C في الهدف → شدد العلاج (statin + ezetimibe أو PCSK9i).
🔹 الخطوة الرابعة:
Lp(a) مرتفع → شدد السيطرة على كل العوامل الأخرى + فحص العائلة.

- Reference:
- 2026 ACC/AHA/ADA Guideline on the Management of Dyslipidemia

[Crémieux @cremieuxrecueil]

Eli Lilly has done it.

They've gone and made what seems to be a powerful, permanent gene therapy for LDL cholesterol.

That means they'll be able to effectively prevent most heart disease with a single infusion!

[Davide Capodanno @DFCapodanno]

In the GLUCO-TAVI trial, 100 patients undergoing TAVI were randomized (1:1) to peri-procedural glucocorticoids (IV methylprednisolone + 5-day oral prednisone) vs standard care to evaluate whether inflammation modulation could reduce post-TAVI conduction disturbances requiring pacemaker implantation.

At 1 month, permanent pacemaker implantation occurred in 8% of patients receiving glucocorticoids vs 16% in the control group (RR 0.50, 95% CI 0.16–1.55; p=0.23), showing a numerically lower event rate, although the study was not powered to demonstrate statistical significance.

At 1 year, no significant differences were observed in PPI (RR 0.67; p=0.41) or new LBBB (RR 1.12; p=0.66).

Peri-procedural glucocorticoid therapy was feasible and appeared safe, with no signal for excess complications, mortality, or adverse events.

These hypothesis-generating findings suggest that a short course of glucocorticoids represents a potential strategy to reduce post-TAVI conduction disturbances. Evaluation in larger, adequately powered randomized trials is warranted before any conclusions regarding clinical applicability can be drawn.

ARTICLE: https://t.co/ATRb0ICWWH
EDITORIAL: https://t.co/subFyAQN9z

[Jorge Acuña Valerio @jacuval]

@9ersmuse Garrison Hearst 96 yd TD run in OT vs jets, Bowman pick six at Candlestick farewell game, and Jerry Rice 127th TD record catch vs Raiders are over Steve Young run for me

[Juan Manuel Mejía @Meyaix]

With the results of BAXHTN study published in @NEJM (https://t.co/UWEcGjtRxv). Baxdrostat (aldosterone synthase inhibitor - ASI) is now FDA approved for the management of hypertension. https://t.co/lsXWZFtl4a Ongoing studies (BaxDuo Arctic and Pacific) for chronic kidney disease

[Paul Wischmeyer MD @Paul_Wischmeyer]

Walking ~7000 steps/day vs. ~2000 steps/day is associated with:
- 47% lower all-cause mortality
- 47% lower cardiovascular disease mortality
- 37% lower cancer mortality
- 38% lower dementia risk
- 22% lower depression

If you care about your health, start walking.

[Neil Stone @DrNeilStone]

Myocarditis after Covid vaccine

5 per million

Myocarditis after Covid infection

150 per million

[Dr. FEVI🫀🩺 @javier20ch]

Síndrome Coronario Agudo Prematuro. 🤔🫀💥
🔴El infarto ya no es cosa de “adultos mayores”. Hasta 1 de cada 4 pacientes con SICA tiene <55 años. Y lo más relevante: no es el mismo SICA que conocemos.
🔴3 grandes mecanismos en jóvenes: Enf. Coronaria obstructiva (80–90%), MINOCA (10–20%), SCAD (disección, + en ♀️).
🔴Perfil distinto: menor carga de placa, lesiones más cortas y frecuentemente un vaso, más erosión de placa que ruptura, menos diabetes/HTA, pero más factores emergentes.
🔴Los verdaderos culpables en la actualidad➡️ Tabaquismo (incluye vaping, hasta 95%), dislipidemia [incluye Lp(a)], cocaína, marihuana, anfetaminas, historia familiar y genética, inflamación sistémica.
⚠️♀️Particularidades en mujeres jóvenes: ↑ SCAD (hasta 35% en <50 años), ↑ MINOCA, mayor mortalidad a largo plazo vs hombres jóvenes.📈☠️

📜🆓️⤵️ State-Of-The-Art Review @ESC_Journals 👌🏻
https://t.co/Bhwo3lLq7k
https://t.co/mDsEZkn4yJ

[CardiovascularCorner @TrackYourHeart]

Anticoagulation Cheat Sheet

[Dirección de Enseñanza del INCMNSZ @INCMNSZ_Ensena]

¿Buscas hacer tu residencia médica e iniciar en marzo de 2027?

Ya está abierta la convocatoria del INCMNSZ para el registro y participación en el proceso de selección.

Consulta las bases aquí:
https://t.co/KOPb94Kmdp
¡Compártela con quien esté por dar este gran paso!

@CCINSHAE_mx @SSalud_DGCES @FacMedicinaUNAM @SSalud_mx @incmnszmx

#ResidenciasMédicas #INCMNSZ #ENARM #EducaciónMédica

[Ahmed Bennis MD 🫀 @drbennisahmed]

The most powerful table in heart failure medicine. 🧵
Without treatment, 2-year mortality in HFrEF: 35%
Add each pillar of GDMT and watch what happens:
💊 ARNI → 25.2% (↓28% RR)
💊 + Beta Blocker → 16.4% (↓35% RR)
💊 + Aldosterone Antagonist → 11.5% (↓30% RR)
💊 + SGLT2i → 9.5% (↓17% RR)
Cumulative result:
✅ 72.9% relative risk reduction
✅ 25.5% absolute risk reduction
✅ NNT = 4
Treat 4 patients with all 4 therapies. Save 1 life.
GDMT isn’t polypharmacy. It’s math.
(Fonarow GC et al. Am Heart J 2011; Lancet 2008)
#HeartFailure #HFrEF #GDMT #Cardiology #CardioTwitter #MedTwitter

[Latinometrics @LatamData]

🇲🇽 💰

Mexico City gets more federal money per person than any other state... and it's not even close ⤵︎

[Brad Wilcox @BradWilcoxIFS]

Just remember: Your coworkers will NOT be there for you in the last chapter of your life.