Dr Abdulbasit Sadiq

It's Movember, so a plain question for the men. When did you last have your blood pressure checked? A) This month B) This year C) I honestly can't remember In Nigeria about 1 in 3 adults has high blood pressure, and fewer than 1 in 3 of them know it.

At 15:00 Nigerian time today, CRISPR Therapeutics presents CTX310 at AHA. It's a one-time infusion that edits the ANGPTL3 gene in the liver, so the liver stops making ANGPTL3, a protein that slows the clearance of fat from the blood. Today's data are in people with very high triglycerides. The target came from genetics. In a US study of 58,335 people, about 1 in 240 carried a broken copy of ANGPTL3, and carriers had 27% lower triglycerides, 9% lower LDL and 41% lower odds of coronary artery disease. CTX310 breaks the gene in liver cells on purpose. Last year's first trial in people, published in NEJM, gave one infusion to 15 adults. At the highest dose, triglycerides fell by about 55% and LDL by about 49% at 60 days. Two people had serious adverse events, one of them a sudden death about six months later that the investigators judged unrelated to the treatment. This afternoon I'll be looking at how long the effect lasts, what happens to the liver, and how many people have now been treated. Unlike a tablet, an edit can't be stopped if a problem shows up years later, so it needs far more safety data before it is offered to anyone outside severe disease. The genetic study behind the target was done in people of European ancestry. I'd like to see that analysis repeated in African genomes.

A trial presented in Chicago tonight tested whether a whole county can raise cardiac arrest survival. In 62 North Carolina counties it combined phone coaching of bystander CPR, community CPR training and getting defibrillators used before the ambulance arrives. If a Nigerian city could fund only one, which would save more lives? A) CPR training in every secondary school B) Defibrillators in markets and motor parks

Yesterday I asked whether you'd stop an 82-year-old's statin. STREAM, published in NEJM last night, tested exactly that. 1,880 people aged 70 and over with at least two long-term conditions, all taking statins for primary prevention, were randomised to stop or continue. Stopping met its noninferiority margin, but heart attack, stroke and death were all more common in the group that stopped. The authors put it at about 1 extra event for every 40 people over 2 years, and the trial's safety board has since advised the stop group to discuss restarting. The usual reason to deprescribe is to spare people side effects, and quality of life, muscle pain and falls were no different between the groups. I would still stop a statin for real muscle symptoms or a short life expectancy. For an older patient who is taking it without trouble, I would now keep it going.

Since Thursday, Claude can read some Americans' bank balances and up to two years of transactions, through Plaid. It can't move money or see passwords. ChatGPT added a similar feature in May. What would you check first, forgotten subscriptions or where last month's money went?

OptimPacing is presented at AHA tonight, at about 22:30 Nigerian time. It compares two ways of placing a pacemaker lead in people with heart block, and the answer could change what a standard pacemaker implant looks like 🧵

Tomorrow's AI session at AHA has four studies, and the one I'm watching most closely is PROVAR+. It tests AI reading ECGs sent in remotely, to pick out structural heart disease in underserved populations. It's the one closest to how things are in Nigeria. An ECG machine is cheap and almost every hospital has one, while echocardiography may not be readily available in rural areas. If AI can read a small-town clinic's ECGs and say which patients to send for an echo, the scans go to the people most likely to need them. The other three: - WATCH-LV, smartwatch ECGs checked for a weak left ventricle, including repeat readings at home - AI ECHO INSIGHT, AI-assisted reading of echocardiograms - LIFE-AI, AI analysis of plaque on CT coronary scans The session starts at 16:45 Nigerian time on Monday.