Jeff R Ma

Bmedsci/MD

[Jeff R Ma @jeffreyma22]

Overview of RCTs directly targeting inflammation in patients with cardiovascular diseases

Now Zeus (2026) failed… time to rethink the inflammatory hypothesis?

DOI: 10.1161/ATVBAHA.124.319980

#cardiology #zeus #inflammation

[Davide Capodanno @DFCapodanno]

Published in the NEJM, three letters raise important points about CHAMPION-AF:
1) The primary endpoint includes cardiovascular death (42% of events), which is a “dilutive” component that does not characterize either treatment arm and favors a finding of noninferiority.
2) Focusing on ischemic stroke reveals a hazard ratio of 1.61 (95% CI, 1.00–2.59), with no difference in hemorrhagic stroke. This is somewhat the opposite of what one would expect from percutaneous LAAC.
3) The number of events was so much lower than anticipated that, while maintaining the same noninferiority margin, the trial effectively allowed a doubling of events while still declaring noninferiority.
4) It is inappropriate to consider the risk of intracranial hemorrhage solely as a function of oral anticoagulant exposure, while ignoring predisposing structural conditions such as cerebral amyloid angiopathy.
https://t.co/ixPmWmo7J8

[Jeff R Ma @jeffreyma22]

“I am, Sir, a Brother of the Angle, and therefore an enemy of the Otter; for I hate them perfectly, because they love fish so well”.

- The Compleat Angler (1653)

[HeartRhythm @hrs_journal]

Very Late Recurrence After Atrial Fibrillation Ablation: Clinical Characteristics and Pulmonary Vein Reconnection Patterns

@jeffreyma22

https://t.co/0nCMCLFeb7

[Jeff R Ma @jeffreyma22]

“Church going” - Philip Larkin (1954)

[Jeff R Ma @jeffreyma22]

The Anxious Generation by Jonathan Haidt

[Jeff R Ma @jeffreyma22]

CS Lewis warned us about AI half a century ago

[Jeff R Ma @jeffreyma22]

"Conquest and Inquisition - parallel phenomena, products of Spain’s imposing vices."

- Emil Cioran, The Temptation to Exist

[Jeff R Ma @jeffreyma22]

A society that educates for work only ends up with a citizenry that does not know how to think, vote, argue, or - perhaps most importantly - imagine.

Curiosity and employability are equally important outputs of education

[Jeff R Ma @jeffreyma22]

“The true physician has a Shakespearean breadth of interest in the wise and foolish, the proud and humble, the stoic and the whining rogue. He cares for people.”

Tinsley Randolph Harrison of Harrison’s Principle of Internal Medicine

[Jeff R Ma @jeffreyma22]

“His craving for alcohol was the equivalent, on a low level, of the spiritual thirst of our being for wholeness, expressed in medieval language: the union with God.”

(C.G. Jung, Letter to Bill W. (Co-founder of AA), January 30, 1961)

[Jeff R Ma @jeffreyma22]

On Happiness

[Jeff R Ma @jeffreyma22]

NOAH-AFNET 6 trial (2023) further showed that treating subclinical AF episodes (>6min on recording device) with DOACs caused major bleeding without improvement in stroke risk.

[Jeff R Ma @jeffreyma22]

LOOP trial (2021):
Randomised well patients with AF risk factors to Implantable loop recorder (ILR) vs control. The ILR group received AF diagnosis and anticoagulation at 3x the rate over 3yrs. However - no difference in stroke or major bleeding outcomes.

?AF screening benefit

[Jeff R Ma @jeffreyma22]

Memes replicate successfully irrespective of its epistemological virtue. Ensuring free speech is therefore less about guaranteeing emergence of Truth, but giving Truth a fight chance amidst the messiness of the “marketplace of ideas”

[Jeff R Ma @jeffreyma22]

Medicine, law, business, engineering, these are noble pursuits necessary to sustain life. But poetry, beauty, romance, love, these are what we stay alive for.

Please, don’t worry so much. Because in the end, none of us have very long on this earth. We make things fleeting.

[Jeff R Ma @jeffreyma22]

“All I want for Christmas are ethical clinical trials”.

[BMJ Group @bmj_company]

A new @bmj_latest investigation raises new concerns over landmark trial (PLATO) for top selling anti-platelet drug, Ticagrelor. Peter Doshi reveals new details that show problems in data reporting in the PLATO trial records. https://t.co/7YfQOEAJr0

[Jeff R Ma @jeffreyma22]

PLATO trial:

A multicenter, double-blind RCT of 18,624 ACS patients, showed ticagrelor reduced the composite of CV death, MI, or stroke at 12 months (9.8% vs 11.7%, p<0.001) compared to clopidogrel, without a significant increase in major bleeding. NNT 50. Beware dyspnoea!

[Jeff R Ma @jeffreyma22]

“Denizens of prestigious institutions are even more interested than others in prestige and wealth. For many of them, that drive is how they reached their lofty positions in the first place”

Troubled
Rob Henderson