Population Health Research Institute

Spironolactone may reduce heart failure risk post-heart attack but doesn't significantly impact death or severe heart events, according to the CLEAR SYNERGY trial. High potassium levels were more common in spironolactone users, leading to more discontinuations.

New data from CLEAR SYNERGY (OASIS 9) trial shows no reduction in cardiovascular outcomes with colchicine, and a side effect of diarrhea. Interventional cardiologists, including Sanjit S. Jolly and Ajay Kirtane, are reconsidering its use in AMI patients.

Experts recommend steps to remove barriers in cardiovascular clinical trials, aiming for representative research results. Despite efforts, trials underrepresent children, older adults, females, and ethnic minorities. The paper, published in Nature Medicine, suggests changes across trial management, including recruitment, eligibility criteria, informed consent, and trial design. Inclusion must start at the top with diverse trial leadership, and education is needed to improve research readiness and trust in science.

The Stop-or-Not Trial found no significant difference in death and major complications at 28 days after noncardiac surgery between continuing and discontinuing renin-angiotensin system (RAS) inhibitor therapy, suggesting both strategies are acceptable. Clinicians should manage RAS inhibitor therapy based on individual patient factors and surgery specifics.