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In This Issue of JAMA Cardiology
November 2019


JAMA Cardiol. 2019;4(11):1059. doi:10.1001/jamacardio.2018.3225

Long-term efficacy of inclisiran, a small interfering RNA that reduces low-density lipoprotein cholesterol (LDL-C) levels with infrequent dosing, is unknown. In a prespecified analysis of a phase 2 randomized clinical trial, Ray and coauthors observed 501 patients with elevated LDL-C levels despite maximally tolerated statin therapy after 1 dose (200, 300, or 500 mg) or 2 doses (100, 200, or 300 mg on days 1 and 90) of inclisiran vs placebo. There was a significant reduction in LDL-C levels at 1 year of 29.5% to 38.7% after 1 dose and of 29.9% to 46.4% after 2 doses. In an Invited Commentary, Leening discusses the potential and challenges related to introduction of long-acting injectable LDL-C–lowering drugs.

Invited Commentary

Author Audio Interview

Whether publicly reported annual percutaneous coronary intervention (PCI)–related mortality predicts a hospital’s future performance is unclear. Using the New York Percutaneous Intervention Reporting System, Sandhu and coauthors analyzed the correlation between a hospital’s observed to expected (O/E) PCI-related mortality rates each year, and future O/E mortality ratios between 1998 and 2016 were assessed. Among 67 hospitals, low PCI-related mortality (O/E mortality ratio, ≤1) and high mortality (O/E mortality ratio, >1) had only moderate inverse associations between the O/E mortality ratio in the index year and subsequent change in O/E ratio, and little of the variation in risk-adjusted mortality was explained by prior performance. In an Editorial, Dehmer notes that hospitals with high or low PCI-related mortality rates largely regress to the mean in subsequent years.


The sensitivity, specificity, and estimated number needed to treat (NNT10) to prevent 1 atherosclerotic cardiovascular disease (ASCVD) event in 10 years have not been compared among the 5 major guidelines on statin use for primary prevention of ASCVD. Mortensen and Nordestgaard examined the guidelines applied to 45 750 individuals aged 40 to 75 years in the Copenhagen General Population Study, with a mean follow-up time of 10.9 years. The European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines were less sensitive and more specific than the other 4 guidelines. With similar NNT10 to prevent 1 event, the Canadian Cardiovascular Society, American College of Cardiology/American Heart Association, and National Institute for Health and Care Excellence guidelines assign statin therapy to many more individuals who later develop ASCVD compared with the US Preventive Services Task Force and ESC/EAS guidelines.

New-onset postoperative atrial fibrillation (POAF) is a common complication of cardiac valve surgery, but its long-term risk of thromboembolism is uncertain. Of 1587 patients who underwent left-sided valve surgery in Danish nationwide registries and the Eastern Danish Heart Surgery Database from 2000 to 2015, Butt and coauthors identified 741 patients (46.7%) with POAF, of whom 675 were matched with 2025 patients with nonvalvular AF (NVAF). In the adjusted analysis, the long-term risk of thromboembolism was similar in patients with POAF and NVAF. Oral anticoagulation therapy during follow-up was associated with a lower risk of thromboembolic events in patients with POAF and those with NVAF compared with no anticoagulation therapy. In an Invited Commentary, Piccini discusses the link between POAF after valve surgery and the long-term risks of recurrent AF and stroke.

Invited Commentary