My top ten tips for graduating fellows and faculty entering and continuing “early career” as I am transitioning into “mid-career”. A thread:

The reason anyone gets insanely rich is almost always because of the stock market. It certainly how @elonmusk did. And the reason they get rich from the stock market, is because 150m Americans decided they wanted to own shares of stocks directly, or through their retirement plans, or through other approaches as a way of building their net worth and trying to create a better life for themselves. One Hundred Fifty Million Americans. About 60% of adults. Effectively believing that @elonmusk and many billionaires could make them wealthier and help them achieve a better life. If you want @elonmusk , and most billionaires to no longer be that rich, convince those 150m to sell their stocks, funds, ETFs whatever. Of course you would wipe out the net-worth of most of those people, and everyone else’s savings, as the markets crashed and brought down the economy and created the worst depression we have ever seen. Alternatively There are ways to improve healthcare access and eventually make it available to all. To start - If you want @elonmusk and all billionaires to improve healthcare for everyone , ask them to stop doing business with the enormous healthcare conglomerates and to work directly with transparently priced care providers. It’s the behemoth HC conglomerates that make HC so bad for so many. (Check my timeline for more detail) Removing them would push the cost of healthcare down for everyone. Their corporate decisions impact our healthcare cost and availability. Of course if they do that, not only would our HC costs go down , and the quality of care for their employees and the entire country go up But They would see their corporate cash flow increase dramatically and we would have more millionaires, billionaires and maybe even another trillionaire when that cash flow moved from the big health care conglomerates to their bottom line, so would the net worth of the 150 million American adults that own public stocks Capitalism is better than socialism because 150m Americans can influence exactly what happens in this country.

😱 US #HeartFailure mortality is still going ⤴️⤴️⤴️ 💔 425,147 HF related ☠️ (45% of all CV ☠️) in 2023 🆘 Yet, massive gaps in GDMT use and HF prevention efforts Fight back: 🎯 Prevention 🎯Treatment 🎯 Implementation NOW #Cardiology #GDMT @ACCinTouch @American_Heart @HFSA

Results of a study where clinicians blindly assess output from AI models shows better outcomes for Gemini and ChatGPT than UpToDate AI nature.com/articles/s41591-0…

Cost Offset With Quadruple Therapy for Heart Failure jamanetwork.com/journals/jam…… @MKeykhaeiMD @NMHheartdoc @SJGreene_md @ATSandhu @MKIttlesonMD @JAMACardio @JAMA_current

Our new paper is out in the European Journal of Preventive Cardiology #EJPC looking at body composition changes in patients taking GLP-1 receptor agonists while going through our Pritikin intensive cardiac rehabilitation program at @UCSDCardiology academic.oup.com/eurjpc/adva… Congratulations to my mentees who led this study: UC San Diego medical students Ian Jennings and Kristine Ly, UCSD undergraduate Mariam Marooki, and research coordinators Gavin McLLaren and @marissadzotsi . Not all weight loss is equal and quality of weight loss matters. When patients lose weight on GLP-1 RAs, the muscle they keep matters just as much as the fat they lose. Across 468 patients, those on GLP-1 RAs improved their fitness and lost fat while holding their skeletal muscle mass steady. In a structured cardiac rehab setting built around supervised resistance training, aerobic exercise, we did not see the muscle loss that has been a concern with this class of medications. Just as important, everyone in cardiac rehab improved their fitness by roughly 3 METs, whether or not they were on a GLP-1. That is a meaningful number. Each 1-MET improvement is associated with a 10 to 25% reduction in mortality, so a gain of this size translates into a substantial improvement in cardiovascular outcomes. It is a powerful reminder of what structured cardiac rehab delivers. The takeaway for preventive cardiology: GLP-1 therapy works best as part of a comprehensive program. Combined with structured exercise and nutrition, patients gain multiple cardiometabolic benefits and preserve the muscle that keeps them strong and functional. We need to utilize cardiac rehab more! @MWilkinsonMD @hsbhatia @dranulala @purviparwani @DrMarthaGulati @VietHeartPA @EJPCEiC @SamiaMoraMD @EugeniaGianos @JamalRanaMD @Bweber04 @MonSangh @ditchhaporia @khurramn1 @MichaelJBlaha @Jcontreras75 @emilyswlau @EmilyManoogian @SatchinPanda

Big data needs organized curation for clinically meaningful relevance. Read our pre-proof @TheJHLT on the structural methods of an automated transplant database jhltonline.org/article/S1053…

Published today, the first-ever clinical practice guideline on cardiovascular-kidney-metabolic syndrome from the American Heart Association and @ACCinTouch. Cardiovascular-kidney-metabolic (CKM) syndrome staging is recommended for youths and adults to prevent CKM syndrome stage progression, to tailor therapy to absolute risk, to reduce cardiovascular events and loss of kidney function across the life course, and to promote CKM syndrome stage regression through lifestyle changes and weight loss. The diagnosis of CKM syndrome stage requires assessment of metabolic health, kidney function, and cardiovascular risk factors, which enhances the identification of frequently unrecognized or asymptomatic CKM conditions. ✍🏼 @ChiadiNdumele @HeartDocSadiya @kardiologykazi @noshreza @virani_md @biykemb @NutritionHF @mandeepbajaj65 @KatherineTuttl8 @RangaswJ @lisaVWMD @KBreathettMD @EmoryFamMed @ShoaClarke @mad_sters @jmortonmd @sripalbangalore @AnumSaeedMD

New in @CircHF GUIDE-HF insights from #HFC members show ARNi and MRAs reduce filling pressures early, highlighting the value of remote hemodynamic monitoring to guide GDMT optimization. @mrchrtfaildoc @LindenfeldJoann @akshaydesaimd ahajournals.org/doi/10.1161/…

Here’s a MASSIVE summary of Retatrutide - the upcoming triple agonist from Eli Lilly and how it compares to Tirzepatide and Semaglutide. What about side-by-side side effect comparison by dose? What do the trials show? Full detailed article in attached tweet below.

#Obesity is increasingly managed with medications as disease-modifying therapies, reflecting its role as a gateway disease driving #metabolic, #cardiovascular, #reproductive, #neuropsychiatric, & #mechanical conditions thelancet.com/journals/landi… #GLP-1 receptor agonists #ADA2026

And today @JAMA_current Mazdutide, also a GLP-1 and glucagon dual receptor agonist with similar body weight loss as Survodutide jamanetwork.com/journals/jam…

Presented at #ADASciSessions: In a phase 3 trial involving adults with obesity but without diabetes, the glucagon receptor–GLP-1 receptor dual agonist survodutide led to significantly greater reductions in body weight than placebo. Full SYNCHRONIZE-1 trial results: nej.md/4x7Tafs @ADA_DiabetesPro

🔥 🔥 🔥 hot take 🔥 🔥 🔥 My academic friends, stop sharing your content with @VuMedi for free. This is all predatory and exploiting us for their profits. What do you really get out of this? Publicity? You are already more famous than you know. You don’t need @VuMedi

Proud to help promote our @MidAmericaHeart / UMKC T32 Postdoctoral Fellowship Training Program in Cardiovascular Outcomes Research. This NHLBI-funded program has been a major engine for developing the next generation of cardiovascular outcomes researchers. Fellows receive deep mentorship, hands-on analytic and clinical research experience, access to major registries and trial datasets, and opportunities to develop expertise in quality of care, implementation science, health status measurement, health economics, and cardiovascular clinical research. The program is a 2-year postdoctoral fellowship, with an option for a combined pathway with clinical cardiovascular fellowship training. Fellows may also pursue an MS in Bioinformatics with emphasis in Clinical Research and a Certificate in Biomedical Technology Entrepreneurship. Our trainees have built an exceptional record of national presentations, peer-reviewed publications, and early-career awards. Please share with outstanding applicants interested in using research to improve the quality, value, and outcomes of cardiovascular care. Contact Danielle Olds, PhD, MPH, RN at dolds@saint-lukes.org for more information.

Preclinical and prior clinical studies demonstrated GLP-1 agonism 💊 and amylin agonism cause delayed gastric emptying 🐌🍽️ Zenagamtide (amycretin) a dual GLP-1/amylin agonist does not delay gastric emptying, according to a new presentation at ECO 2026 📊🔬 These results that the increased satiety and impressive weight loss with this dual agonist is centrally mediated, by way of the brain's appetite centers 🧠, and not gut driven. The concern that delayed gastric emptying could increase peri-operative of endoscopy adverse events would also not apply to this molecule ✅🩺 Oral presentation ppt: sciencehub.novonordisk.com/c…

Episode 3: Dr. James Januzzi Jr, MD Moving the Needle in Medicine Did you know that Dr. Januzzi almost passed on the chance to study NT-proBNP in the early 2000s? What followed helped establish the diagnostic cutoffs that are now used worldwide and fundamentally changed how we think about heart failure. Really enjoyed hearing the story behind one of cardiology’s biggest names, and learned a lot that I did not know before (he wasn't always the best student...) hcplive.com/view/moving-the-…

New study of 111,646 women: GLP-1 use was linked to about 30% lower breast cancer incidence. For scale, tamoxifen (the drug we prescribe to prevent it) runs about 38%, minus the endometrial cancer and clot risk. Not proof yet, but looks very promising.

Tedford got hacked folks, he only buys crypto from me and he knows better than to spend on a car like this lol

In HELIOS-B, vutrisiran slowed renal decline in ATTR-CM: fewer ≥40% eGFR drops vs placebo (12.7% vs 21.2%). Benefits on CV outcomes were consistent across kidney function, even in advanced CKD. Improves not just CV outcomes but has renal benefits🫀🧪 bit.ly/3Q2hhf1