My thoughts on REDUCE AMI #ACC2024 John Mandrola, MD

@drjohnm This is brilliant. There are so many dogmas to challenge. “Randomization should be the rule, not the exception” - love that @YndigegnY @cpgale3 @DavidErlinge @MGtberg

@drjohnm The whole 15 min went like 5 seconds! Astonishing breakdown of the study. Thank you!

@drjohnm Thank you for your thoughtful review. Q of titration off BB presents very interesting issue. Thank you for touching on it. Not simple ethical issue to test whether less is more when the "more" has become SoC. Ongoing randomization 👍, but can med suppress ego to do?

@drjohnm They prescribed the beta blockers but did not really achieve the beta blockade. Each patient is different and requires a different dose. Same flaw with perioperative beta blocker studies.

@drjohnm Well done (and timely!)

@drjohnm Curious in your opinion is reduction in LDL-C sufficient in ASCVD trials today for reimbursement decisions? Or is the bar reductions in CV events?

@drjohnm sapere aude 🙏🏻

@drjohnm Docs put migraine sufferers on this drug. Had me on it a year and I said no, I don't want to be on any meds not proven to do anything for me. Of course we're told they're "safe." not sure what it means in this context.