Clinical Cardiology Alert – January 1, 2026

CREST-2 Boosts Modern Medical Therapy for the Initial Treatment of Asymptomatic Carotid Stenosis

CREST-2 consisted of two parallel randomized trials in patients with ≥ 70% asymptomatic carotid stenosis, showing that intensive medical therapy alone produced very low stroke rates, with no significant additional benefit from carotid endarterectomy and a modest absolute risk reduction with carefully performed transfemoral carotid stenting over four years. These findings support intensive risk factor control as the default strategy and suggest reserving revascularization for highly selected patients at experienced centers.

Who Needs Antithrombotic Therapy After Atrial Fibrillation Ablation?

An international trial of rivaroxaban vs. low-dose aspirin started one year or more after successful atrial fibrillation catheter ablation has shown no significant differences in a composite outcome of stroke, systemic embolism, or covert cerebral emboli by head magnetic resonance imaging and no differences in major bleeding but shows an increase in clinically relevant minor bleeding with rivaroxaban.

Value of Natriuretic Peptide Measurements in HFpEF

A pooled analysis of four trials of drug therapy for heart failure with preserved ejection fraction (HFpEF) patients has shown that, although the risk of adverse outcomes is higher with increasing baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, the effect is attenuated at higher body mass index levels, such that lower NT-proBNP cutoffs for risk-stratifying obese patients need to be developed.

Total Steps vs. How You Get Them and the Risk of Cardiovascular Events

In a large U.K. Biobank study of subjects who performed a one-week determination of steps/day, those who achieved < 8,000 steps/day were categorized by the duration of their step acquisition periods and were followed for a mean of eight years. All-cause mortality and the development of cardiovascular disease (CVD) were greater in those with short step acquisition periods (< 5 minutes) as compared to those with longer periods (> 15 minutes). Thus, longer step acquisition bouts are more effective in reducing mortality and CVD in those with less-than-ideal total daily step counts.

Defining Normal Ascending Aorta Size by Imaging

Two large biobank studies of the relationship between various imaging measurements of ascending aorta size normalized to several body size metrics have shown that ascending aorta area/height performs best for predicting adverse aortic events.