Schwartz GG, Nicholls SJ, Toth PP, et al. - Using data from the BETonMACE phase 3 trial, researchers sought to determine the correlation of insulin use with the risk of major adverse cardiovascular events (MACE) after acute coronary syndrome (ACS) in a contemporary cohort of patients receiving evidence-based background cardiovascular treatments, as well as to assess the interaction of insulin use and apabetalone, a bromodomain and extra-terminal protein inhibitor, on that risk. Eight hundred twenty-nine (34.2%) of the 2,418 patients who were followed for a median of 26.5 months were given insulin. Despite the use of evidence-based, contemporary therapies, insulin-treated patients with type 2 diabetes, low high-density lipoprotein cholesterol, and ACS are at high risk for recurrent MACE. After controlling for other risk factors for MACE, there is still a strong association between insulin treatment and the risk of MACE. There is an unmet need for more treatments to reduce this risk.