Clinician scientist. Voracious learner. Director of McGill Geriatric Cardiology Program. Creator of https://nitter.cf/t.co/PVflDwZCSD & https://nitter.cf/t.co/4IJWOncQte.
Joined January 2018
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Jonathan Afilalo retweeted
In our lecture series on aging, @FrailtyMD said something very instructive (paraphrasing here):
"We have to make an extra effort to distinguish between frailty and multi-morbidity, otherwise, we won't be able to intervene early!"
Majority of the deficit accumulation models, e-Frailty, ICD-based frailty indices, etc, measure cumulative comorbidity not frailty. Jon's imaging-based coreslicer (coreslicer.com) is very impressive!!
@MichaelGNanna @heartwiselab
#innovation
Multidimensional Aging Trajectories Preceding Cardiovascular Events: @JAMACardio
🥸 This from our field of CV aging - aging (functional decline) comes before CV events!!
😱 Aging and longevity research in CV disease is very important: @MichaelGNanna @Ajar_Kochar @DrAROrkaby @DEF_gericard @SimoneBiscaglia @GianlucaCampo78
👇👇👇👇
😅 I found a frailty shout-out at the end of the recently published PAD guidelines
“endovascular (revascularization) options often suffice for less complex disease and are an option for frail patients also with complex lesions when surgery is unsuitable”
Agree/Disagree? How often does frailty tip the scale when deciding on revascularization strategy? @AeroMD
A pragmatic trial is not a fig leaf for sloppy methods with stale EHR data. The #PRECIS2 framework reminds us that effectiveness studies need intentional design, not just convenient shortcuts.
💬 Editorial by @JAMAplusTrials Editor in Chief Alison J. Huang, MD, MAS, Thomas G. Travison, PhD, and JAMA Senior Editor Derek C. Angus, MD, MPH:
#PragmaticTrials are intended to support real-world clinical decision-making, but the term is used inconsistently across studies. A pragmatic orientation may improve the applicability of #ClinicalTrials to routine care, yet it does not justify weaker methods or reduced rigor.
📣 This September’s JAMA+ Trials Theme of the Month examines ongoing confusion and debate in pragmatic trial research, including how eligibility, intervention delivery, outcome assessment, and analysis align with pragmatic goals. Clearer design and reporting may help clinicians and health systems judge whether trial findings are usable in practice.
🔗 ja.ma/4gO0FCx
Epidemiological and Mendelian randomization studies consistently show an inverse relationship between adult height and cardiovascular disease — why?
1⃣ Genetics: height-associated SNPs overlap with pathways controlling lipids and BP
2⃣ Development: height is a marker of childhood stress (IUGR, nutrition, repeated infections, low SES) which alter organ development and endothelial function
3⃣ Artery size: smaller coronary and peripheral artery diameters so it takes less plaque to cause critical stenosis, and shorter arterial trees so it takes less time to reflect systolic waves causing increased afterload
4⃣ Lung size: smaller lungs leave less functional reserve against age-related decline or respiratory disease
📊 STAREE Trial (NEJM 2026)
• P: Adults age 70 without prior CVD, diabetes, or dementia (n=9,971)
• I: Atorvastatin 40 mg daily
• C: Placebo
• O: Reduced MACE (HR 0.70), but no difference in disability-free survival or dementia (HR 0.94)
Why test statins for dementia in the first place? A mechanistic roadmap:
🛡️ Protective
• Prevents cerebrovascular atherosclerosis & ischemic strokes
• Depletes isoprenoids in vascular & glial cells, boosting blood flow & calming oxidative stress
• Reduces amyloid-β and tau protein accumulation
⚠️ Potential Harm
• Depletes brain cholesterol needed for synaptic membranes & myelin
• Lowers CoQ10, compromising energy production in brain cells
• Depletes isoprenoids in hippocampal & cortical neurons, reversibly blunting memory consolidation & learning
💊 Molecule Matters
• Lipophilic (atorvastatin, simvastatin): Readily cross the blood-brain barrier -> greater potential for direct central effects (both benefits and side effects)
• Hydrophilic (rosuvastatin, pravastatin): Negligible CNS penetration -> act primarily on vascular endothelium and systemic lipids, potentially lower risk of "brain fog”
Jonathan Afilalo retweeted
Better communication isn't just "bedside manner" - it's a CLINICAL SKILL. 5 tangible ways to improve it in the latest #JACC article: jacc.org/doi/10.1016/j.jacc.… @hmkyale
How should you adjust your exercise prescription in frail cardiac patients? Read on... @CircAHA
pubmed.ncbi.nlm.nih.gov/4242…
Jonathan Afilalo retweeted
This week, a team of researchers quietly published in @JACCJournals one of the most profound studies of valvular heart disease in recent memory.
The PREVUE-VALVE study used a decentralized, in-home echocardiography model to estimate the prevalence of valvular heart disease among U.S. adults aged 65–85. Importantly, this was not a clinic-based echo cohort; participants were recruited nationally and underwent comprehensive transthoracic echo in their homes, with studies interpreted by a core lab. That intentional design choice is critical: PREVUE-VALVE is a true prevalence study, accurately representing the true burden of valve disease in the U.S. population.
The findings are striking: 8.2% of older Americans have moderate or greater valvular heart disease, and 18.4% have “clinically significant” disease when mild-to-moderate regurgitation is included. TR was the most common lesion, followed by AS, MR, AR, and MS. The burden rises sharply with age, reaching nearly 15% among adults aged 80–85.
Extrapolated nationally, this means approximately 4.7 million Americans aged 65–85 currently have moderate or greater VHD, projected to increase to 6.5 million by 2060. Using the broader clinically significant definition, the number is already over 10 million and projected to approach 15 million.
For structural heart programs, health systems, and policymakers, the message is clear: the valve disease burden is large, growing, and will require thoughtful planning around screening, access, and treatment capacity.
Congratulations to @djc795, Michael 'Mickey' Brener MD MS, and all co-authors for a stunning glimpse into the present and future of valve disease!
jacc.org/doi/epdf/10.1016/j.…
CHAMPION-AF trial: LAAC vs. DOAC for AF
Design: RCT multicentre international
Population: N=3,000 AFib patients eligible for DOAC
- 72y old
- 68% male
- 85% white
- 69% paroxysmal
- 48% ablated
- CHADS-VASc 3.5 ± 1.3
Intervention group: LAAC Watchman Flx device + DOAC/ASA or DAPT x 3m then ASA indefinitely
Control group: DOAC
Primary outcome: CV death, CVA, or systemic embolism at 3y -> noninferior *but trend towards 17 more CVAs in device group (NNH 91)
Safety outcome: Nonprocedural major bleeds at 3y -> superior
Secondary outcome: All major bleeds at 3y -> noninferior
Tertiary outcome: All major & clinically significant nonmajor bleeds at 3y (Fig S7)
Other: No between group difference in EQ-5D or SF-12
vs. CLOSURE-AF trial:
- Opposite conclusion i.e. LAAC inferior to DOAC
- CLOSURE-AF population was "higher risk"
- Multiple different LAAC devices vs. only 1
- DAPT post LAAC vs. mainly DOAC+ASA
- Investigator led vs. industry sponsored
nejm.org/doi/full/10.1056/NE…
Special issue 📢 "Advancing Cardiogeriatric Care and Frailty Science in Cardiovascular Disease"
heartlungcirc.org/current
@JuleeMcDonagh @DrPMDavidson @bnukoirala @rebeccahritchie @ErikFung @calebferg @quin_denfeld @HeartLungCirc 🇦🇺🇺🇸🇨🇦🇨🇳🇬🇧
Jonathan Afilalo retweeted
New data in @Annals_Oncology: A target trial emulation of >229K obese, nondiabetic adults shows GLP-1RA use is associated with a 41% reduction in obesity-associated cancers compared to lifestyle modifications alone (HR 0.59). - Congratulations to Aparna Kamat, Arthur Hsu, @pedroramirezMD & entire @MethodistHosp team
annalsofoncology.org/article…
@SGO_org
Apitegromab for lean mass preservation
during tirzepatide-induced weight loss
Big effect in all-comers, expect more benefit in older subgroup at risk for sarcopenia!
nature.com/articles/s41591-0…
“Systematic screening for preexisting conditions can identify frailty and inform personalized rehabilitation strategies, improving outcomes and adherence to secondary prevention after CABG.”
ahajournals.org/doi/pdf/10.1…
Jonathan Afilalo retweeted
🧠 About 1 in 4 older people in hospital have dementia.
⚠️ But a lot of this has never been diagnosed.
Older people with undiagnosed dementia are frequently admitted to hospital and discharged from hospital without any attempt to make the diagnosis or flag a potential diagnosis and arrange follow-up.
This is a major missed opportunity - to use hospital admission as an opportunity to diagnose dementia where possible, or to flag likely dementia and then arrange follow-up.
In this JAGS paper, Tan and colleagues describe a practical hospital-wide approach combining an electronic health record flag with nurse-administered 4AT and AD8 screening.
Among 11,180 hospital encounters, 83.3% were screened; 18.0% had known dementia, 4.3% screened positive for potential dementia, and 9.0% for cognitive impairment.
That matters because hospital admission is not just a point of acute care, but also an opportunity to identify major cognitive disorders that affect treatment, safety and discharge planning.
The 4AT is useful here. The 4AT is the most validated and used *delirium* tool globally.
But the 4AT also has built-in cognitive tests - so it provides a dual role as a delirium screener but also a tool to assist in detection of dementia.
☑️ This is relevant to the 4Ms - detecting both delirium and dementia/cognitive impairment is necessary - and the 4AT can help with both in the form of one 2-minute tool.
Agree
Jonathan Afilalo retweeted
Our new review out today on Testosterone, Creatine, HMB & other anabolic agents in ICU.
❓ Do you use creatine, testosterone, HMB or oxandrolone in your ICU or hospital patients?
🔖 journals.lww.com/co-critical…
#ICURehab #FOAMcc #CriticalCare #ICUNutrition
@ICUnutrition
