This special educational symposium explored controversies in cardiovascular risk management and compared and contrasted best common practices and guidelines on both sides of the Atlantic.

Eugene Braunwald set out to illustrate the necessity and possible achievements of good collaboration between academia and industry, by taking the physiologic and clinical advances that led to the development of the first ARNi as an example.

In a dialogue, Jorge Plutzky and Erik Stroes explored to what extend we are at the edge of an era, considering the advent of PCSK9 inhibiting therapy. They discuss how this can impact clinical practice.

Dr. Marc Pfeffer discusses how insights on the effect of antidiabetic drugs on CV outcomes has evolved over time, culminating in the benefit seen with empagliflozin on mortality and on heart failure. The latter benefit deserves more attention.

Raffaele De Caterina considers various forms of valvular disease that have been seen as a criterium not to use NOAC therapy for stroke prevention. Mitral stenosis may be an example that merits further study, as treatment may be indicated and safe.

Samuel Z Goldhaber considered the balance between the effect of NOACs on efficacy in preventing stroke and the risk of bleeding. How can NOACs best be dosed for an optimal balance?