Real-World Utilization and Persistence of Lipid-Lowering Therapies after Percutaneous Coronary Intervention

Presenter: Muhammad Raffey Shabbir, MD

This retrospective analysis of the TriNetX US Collaborative Network (2015–2025) evaluated real-world lipid-lowering therapy (LLT) use following percutaneous coronary intervention (PCI) in 40,798 adults. Despite guideline recommendations, only 65% initiated statins, while use of non-statin therapies remained low—3.3% for ezetimibe monotherapy, 3.5% for statin–ezetimibe combination, and 1.7% for PCSK9 inhibitors. Newer agents such as inclisiran and bempedoic acid were rarely prescribed (<0.5%). Notably, around 26% of patients had no documented LLT within 12 months post-PCI. Initiation of therapy was delayed (median 35–54 days), and persistence was suboptimal across all treatments, particularly for ezetimibe (113 days). Retention rates also varied, with statins and combination therapy showing relatively better continuity than non-statins.

Real-world post-PCI lipid management remains suboptimal, with delayed initiation, poor persistence, and underutilization of non-statin therapies. The substantial proportion of untreated patients highlighting a significant care gap and the need for improved strategies to support timely and sustained LLT.

Cardiovascular Benefits of Telmisartan in Metabolic Dysfunction Associated Steatotic Liver Disease

Presenter: Nithila Sivakumar, MD

This population-based retrospective cohort study using the TriNetX network evaluated cardiovascular outcomes in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) treated with telmisartan versus other angiotensin receptor blockers (ARBs). Propensity score matching was performed to balance demographics, comorbidities, and medications, and outcomes were assessed over 5 years.

Telmisartan use was associated with significantly lower risks of major adverse cardiovascular outcomes (HR 0.55; 95% CI: 0.40–0.76), ischemic heart disease (HR 0.64; 95% CI: 0.47–0.87), arrhythmia (HR 0.56; 95% CI: 0.42–0.77), stroke (HR 0.57; 95% CI: 0.36–0.90), and heart failure (HR 0.59; 95% CI: 0.38–0.92).

Overall, telmisartan was associated with reduced cardiovascular risk across multiple outcomes in patients with MASLD over a 5-year follow-up.

SGLT2 Inhibitors, but not DPP4 Inhibitors, Lower LDL-C and Improve Outcomes in Patients with Diabetes and Coronary Artery Disease

Presenter: Anish Theertham

This retrospective cohort study evaluated the impact of SGLT2 inhibitors (SGLT2i) and DPP4 inhibitors (DPP4i) on lipid profiles and clinical outcomes in 423 inpatients with type 2 diabetes mellitus and angiographically confirmed coronary artery disease. Patients were grouped based on use of SGLT2i (n=68), DPP4i (n=76), combination therapy (n=31), or neither (n=248). After adjustment for statin intensity and comorbidities, SGLT2i use was associated with a significant reduction in LDL-C (β = -0.38 mmol/L; 95% CI: -0.65 to -0.11), as was combination therapy (β = -0.39 mmol/L; 95% CI: -0.73 to -0.03), while DPP4i alone showed no effect. Other lipid fractions were unchanged. Over a median follow-up of 2.8 years, SGLT2i monotherapy was associated with a reduced risk of the composite outcome of all-cause mortality and major adverse cardiovascular events (HR 0.55; 95% CI: 0.31–0.97; p=0.039). No significant outcome benefit was observed with DPP4i or combination therapy.

SGLT2i therapy was associated with modest LDL-C lowering and reduced all-cause mortality or major adverse adverse cardiovascular events. These findings support further investigation into the potential role of SGLT2i in secondary prevention for high‑risk patients with T2DM and CAD.

Incremental Cardiovascular Benefits of GLP1 Receptor Agonists in Patients with Type 2 Diabetes and Heart Failure on SGLT2 Inhibitors Undergoing Transcatheter Aortic Valve Implantation: A Real-World Cohort Study

Presenter: Shawn Wang

This retrospective cohort study using the TriNetX database evaluated the incremental benefit of GLP-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2D) and heart failure (HF) undergoing transcatheter aortic valve implantation (TAVI) who were already receiving SGLT2 inhibitors (SGLT2i). Adults treated between 2015 and 2023 were included, comparing those initiating GLP1-RA within 14 days post-TAVI with SGLT2i-only users after 1:1 propensity matching. Among 3,634 patients, 468 received GLP1-RA; after matching, 465 patients were included in each group (mean age 73 years, 33% female). At 1 year, GLP1-RA use was associated with improved survival (93.9% vs 89.2%; HR 0.56; p=0.017), reduced hospitalization (HR 0.79; p=0.029), and fewer HF exacerbations (HR 0.57; p<0.001). Other cardiovascular outcomes were not significantly different between groups.

Overall, addition of GLP1-RA to SGLT2i therapy was associated with improved survival and reduced heart failure-related events in this high-risk population. These findings suggest a potential incremental benefit of GLP1‑RA in this population and support the need for prospective validation.

Beta-Blockers in Patients with Myocardial Infarction and without Heart Failure: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

Presenter: Hassan Kawtharany

This meta-analysis evaluated the effect of beta-blocker (BB) therapy in patients with myocardial infarction (MI) and left ventricular ejection fraction (LVEF) >40%. Five randomized controlled trials (n=19,826) published after 2000 were included, with 9,892 patients receiving BB and 9,934 receiving no BB. Risk of bias was low across studies. BB therapy was not associated with a significant reduction in all-cause mortality (HR 0.98; 95% CI: 0.85–1.13) or cardiac mortality (HR 1.16; 95% CI: 0.89–1.51). There were also no significant differences in MI (HR 0.88; 95% CI: 0.77–1.00), heart failure (HR 0.82; 95% CI: 0.63–1.07), unplanned coronary revascularization (HR 1.01; 95% CI: 0.87–1.17), or ventricular arrhythmia (RR 0.87; 95% CI: 0.51–1.48). Additionally, BB use was not associated with increased risk of symptomatic atrioventricular block (HR 1.06; 95% CI: 0.83–1.34) or stroke (RR 1.16; 95% CI: 0.9–1.48).

BB therapy showed no significant benefit across outcomes in patients with MI and LVEF >40%, although non-significant trends toward reduced MI and heart failure were observed.

Effect of Baseline Lipid Levels or Statin Use on Finerenone Treatment Outcomes in Patients with Chronic Kidney Disease and Type 2 Diabetes: A Fidelity Post Hoc Analysis

Presenter: Ashish Verma

This analysis of the FIDELITY dataset evaluated whether baseline LDL levels or statin use modified the effects of finerenone in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). The pooled dataset included 12,778 patients from the FIDELIO-DKD and FIGARO-DKD trials receiving optimal renin–angiotensin system inhibition. At baseline, 58.1% had LDL ≥70 mg/dL and 72.3% were on statins. Lower LDL (<70 mg/dL) was associated with reduced risk of cardiovascular (CV) events (HR 0.80; 95% CI: 0.72–0.88; p<0.0001) and kidney outcomes (HR 0.83; 95% CI: 0.72–0.96; p=0.0116). Statin use was also associated with lower CV (HR 0.81; p=0.0001) and kidney risk (HR 0.76; p=0.0006). Finerenone reduced the risk of composite CV outcomes (HR 0.86; 95% CI: 0.79–0.95) and kidney outcomes (HR 0.84; 95% CI: 0.77–0.92) compared with placebo. These benefits were consistent across LDL and statin subgroups (p-interaction ≥0.10). Adverse event rates were similar between groups. Hyperkalemia was more frequent with finerenone, but events leading to hospitalization or discontinuation were low.

Finerenone reduced CV and kidney risk irrespective of baseline LDL levels or statin use.

Patients Impacted by Eligibility of Statin Initiation During the Transition from Pooled Cohort Equation to the New Predicting Risk of Cardiovascular Disease Events Equations

Presenter: Xiaowei Yan

This retrospective cross-sectional study evaluated changes in statin eligibility when transitioning from the pooled cohort equation (PCE) to the newer PREVENT-ASCVD risk estimator in adults aged 40–75 years eligible for primary prevention. Data included 229,839 patients from a healthcare system and 3,266 from NHANES. Using PCE, 22% of patients met the ≥7.5% risk threshold for statin eligibility, while 18% had ≥5% risk using PREVENT-ASCVD. Among patients with PREVENT risk ≥5%, 94.7% remained statin-eligible based on PCE, with minimal variation across racial and ethnic groups. However, among patients with PREVENT risk <5% (not recommended for statins), 6.3% would still be eligible based on PCE. This discrepancy varied by race, highest in non-Hispanic Black patients (18.7%) and lowest in non-Hispanic Asian patients (3.3%). Similar patterns were observed in NHANES data.

While PREVENT-ASCVD shows improved calibration and equity for most racial and ethnic groups, some mismatch persists, particularly for non-Hispanic Black patients.

Incremental Prognostic Value of Left Atrial Reservoir Strain for AF/Stroke Prediction in Non-Ischemic Cardiomyopathy

Presenter: Maria-Luiza Luchian

This retrospective study evaluated the prognostic value of left atrial reservoir strain (LASR) for predicting new-onset atrial fibrillation (AF) or ischemic stroke in patients with non-ischemic cardiomyopathy (NICM) and low late gadolinium enhancement (LGE). A total of 368 patients without prior AF who underwent cardiac MRI between 2008 and 2020 were included. Over follow-up, 103 patients experienced the composite endpoint. Median values included LVEF 34%, LASR 24.15%, LAVi 35.89 mL/m², and LGE 0.10. The CHA₂DS₂-VASc score alone showed poor predictive ability (C-index 0.53), while adding left atrial parameters improved discrimination up to 0.63. A LASR cutoff <13.9% identified higher risk (HR 0.40; 95% CI: 0.23–0.69; p<0.001). Increased LAVi (>33 mL/m²) was also associated with higher risk (HR 1.62; p=0.033).

Overall, left atrial function measures, particularly LASR, improved risk prediction for AF and stroke beyond clinical scores and standard imaging parameters.

ACC 2026, March 28 – 30, New Orleans, LA