Chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) are driven by the BCR:ABL1 fusion and remain highly responsive to tyrosine kinase inhibitors (TKIs). Ponatinib, a third-generation TKI, uniquely retains activity against the T315I 'gatekeeper' mutation and most other BCR:ABL1 variants, producing deep cytogenetic and molecular responses in resistant CML and improving survival in Ph+ ALL. Across the PACE and OPTIC programs, frontline Ph+ ALL combinations (hyper-CVAD- and blinatumomab-based), and real-world cohorts, ponatinib demonstrates robust antileukemic efficacy in diverse settings and after multiple prior TKIs. However, its multikinase profile confers a clinically meaningful risk of arterial occlusive events (AOEs)-including coronary, cerebrovascular, and peripheral arterial complications-whose incidence is shaped by baseline cardiovascular risk and overall drug exposure. Mechanistic studies suggest that endothelial dysfunction, pro-inflammatory signaling, impaired nitric oxide bioavailability, and microvascular rarefaction contribute to ponatinib-associated vascular toxicity. Clinically, response-based dosing-such as step-down from 45→30→15 mg in CML or 30→15 mg in Ph+ ALL upon molecular milestones-preserves efficacy while reducing exposure-related AOE risk, though events are not eliminated. Emerging cardio-oncology strategies can further mitigate harm: baseline risk stratification (e.g. SCORE2/SCORE2-OP, HFA-ICOS), aggressive management of blood pressure and lipids, selective antiplatelet prophylaxis in high-risk profiles, and close longitudinal surveillance. Overall, contemporary evidence supports ponatinib as a high-potency option for T315I disease and multi-tyrosine kinase inhibitor (TKI) resistance, and as a practical component of modern Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) therapy, provided that dosing is individualized and cardiovascular risk is proactively managed. Future priorities include refining patient selection, validating preventive cardio-oncology bundles, and defining minimal-effective exposure thresholds that sustain durable disease control with the lowest feasible vascular liability.

Cardiovascular-kidney-metabolic (CKM) syndrome is a systemic disorder characterized by an overall reduction in cardiovascular health that occurs as a result of the development of ≥2 cardiovascular, kidney, or metabolic risk factors. Prevalence of CKM syndrome and its contributing conditions is rising, carrying an associated increase in excess morbidity, premature mortality, and direct and indirect health-related expenditures for patients, particularly for individuals with adverse social determinants of health. The growing body of evidence supporting CKM syndrome as a single, multifactorial disease underscores the importance of implementing an overarching, interdisciplinary therapeutic approach for the prevention and management of each facet of the disease. The recent development of several therapies with multiple benefits for cardiovascular, kidney, and metabolic health provides an important opportunity to facilitate the development of treatment plans that address the root cause of CKM syndrome for patients in early stages and to alleviate symptoms, delay progression, and improve quality of life in later stages of the syndrome. These developments provide a challenge for primary care physicians (PCPs) to ensure they are managing patients at their current disease stage, with the most appropriate combination of therapies available. This review aims to provide PCPs with a guideline-driven, practical guide to facilitate these decisions on the most appropriate management path for different scenarios for patients with CKM syndrome.

Chronic kidney disease (CKD) remains a hidden epidemic, under-recognized and under-diagnosed, despite widespread recognition of the benefits of systematic screening of at-risk individuals and early diagnosis. CKD is an important driver of cardiovascular risk, even in the early stages before a diagnosis has been made. An elevated albumin-to-creatinine ratio is an independent cardiovascular (CV) risk factor, and importantly, it is modifiable. Inclusion of urinary albumin-to-creatine ratio testing enables detection of CV risk and CKD before estimated glomerular filtration rate declines and allows for implementation of guideline‑directed therapy at the earliest point where it is clinically indicated. Inclusion of urinary albumin-to-creatinine ratio as part of routine testing of at-risk individuals in standard practice would enable early intervention with guideline-directed medical therapies to optimize outcomes and alter disease progression. Individuals at risk of CKD include, but are not limited to, those with type 2 diabetes, CV disease, or hypertension, all conditions that can cause early, often silent, kidney damage. In these populations, measuring the urine albumin-to-creatinine ratio enables early detection of CKD and CV risk, allowing timely initiation of guideline-directed therapies to prevent disease progression. Although this podcast presents expert opinion, rather than original research, all recommendations are guideline-driven and evidence-based, rather than opinion-based.

Calcium channel blockers (CCBs) and statins are commonly combined to prevent cardiovascular diseases (CVDs). However, their concomitant use may lead to drug-drug interactions (DDIs) and increased adverse effects (AEs). This systematic review and meta-analysis aimed to evaluate the evidence of adverse effects (AEs) associated with the calcium channel blockers (CCBs) and statins concomitant use. We searched MEDLINE, Embase, Web of Science, and CENTRAL from database inception to 4 April 2025. Eligible studies included randomized controlled trials (RCTs) and observational studies reporting AEs of CCB-statin combinations compared with CCB or statin treatment in adults. Outcomes assessed included CCBs- and statins-associated AEs, treatment discontinuation, hospitalization, and all-cause mortality. Meta-analyses of similar outcomes were performed to estimate pooled Odds Ratios (OR) with 95% confidence intervals (CI). Of 9,737 articles screened, 20 studies (n = 1,053,198) were included. Peripheral edema, myalgia, and discontinuation were most reported in 11, 7, and 9 studies, respectively. Meta-analyses demonstrated no significant differences in the risk of peripheral edema (OR 1.03, 95% CI 0.14-1.48), myalgia (OR 1.33, 95% CI 0.63-2.79), or discontinuation (OR 0.78, 95% CI 0.50-1.23 for CCB-statin vs. CCB; OR 0.97, 95% CI 0.68-1.38 for CCB-statin vs. statin). However, evidence of other AEs was inconsistent and limited. CCB-statin combination appears generally safe in a short-term use (3 to 6 months). Further research is warranted to clarify the long-term risk of AEs.

Hyperglycemic chorea (HC), also known as diabetic striatopathy, is a rare, potentially reversible complication of poorly controlled diabetes mellitus. It manifests as involuntary, often unilateral, choreiform or ballistic movements. Despite its clinical significance, HC remains underrecognized, and its pathophysiology is not fully understood. We present a case of HC and a narrative review of the published case reports to characterize its epidemiology, clinical features, imaging findings, treatment, and outcomes. We conducted a narrative review of case reports and case series on HC using PubMed/MEDLINE from inception to 1 September 2024, following PRISMA guidelines. Inclusion criteria were English-language reports of adult patients (≥18 years) with chorea attributed to hyperglycemia. A total of 80 publications encompassing 100 patients were included. The mean age was 66.6 years, with a female predominance (67%). Hemichorea was more common (71%), with left-sided preponderance. Most patients (75%) had a prior diagnosis of diabetes, and the mean presenting blood glucose and HbA1c were 468 mg/dL and 13.7%, respectively. Imaging revealed basal ganglia hyperintensity on MRI in 80% of cases. Treatment primarily involved insulin therapy, with 69% receiving adjunctive anti-chorea medications. Symptom resolution occurred in 73.9% of patients, with a mean recovery time of 36.7 days. HC is an important differential diagnosis for acute-onset chorea in elderly patients with uncontrolled diabetes. Prompt recognition and glycemic control are key to symptom resolution. Neuroimaging, particularly MRI, plays a crucial role in diagnosis, and adjunctive pharmacotherapy may aid in symptom management.