In August 2025, the American Heart Association and American College of Cardiology released updated hypertension guidelines. Under the new guidelines, therapy is advised at blood pressure ≥130/80 mm Hg in adults with diabetes, chronic kidney disease, or a Predicting Risk of Cardiovascular Disease Events-estimated 10-year cardiovascular disease risk ≥7.5%. The long-term population-level changes following these guidelines remains uncertain. We analyzed NHANES (National Health and Nutrition Examination Survey) 2009 to 2018 data linked to mortality through 2019. Hypertensive adults without baseline cardiovascular disease were included. Treatment eligibility was defined using guideline criteria. Cox models estimated associations between antihypertensive therapy and all-cause and cardiovascular mortality. Simulation analyses projected lives saved under full and partial treatment uptake. The weighted cohort represented 81.0 million US adults with hypertension. Of these, 22.8 million (28%) were guideline eligible for therapy; 13.1 million (57%) were treated, and 9.7 million (43%) remained untreated. Antihypertensive therapy was associated with a 23% reduction in all-cause mortality (hazard ratio [HR], 0.77 [95% CI, 0.63-0.94]) and 50% reduction in cardiovascular mortality (HR, 0.50 [95% CI, 0.36-0.68]). At 10 years, universal treatment of eligible but untreated adults was projected to prevent ~200 900 all-cause and ~ 162 600 cardiovascular deaths. Benefits were greatest in adults with diabetes. In this nationally representative cohort, nearly 1 in 3 US adults with hypertension were newly eligible for therapy under the guideline, yet >2 in 5 remained untreated. Extending treatment to all eligible adults could prevent >200 000 all-cause and 160 000 cardiovascular deaths over the next decade.
Kidney disease disproportionately affects American Indian (AI) individuals. Identifying potential areas for intervention is critical to optimize kidney health in this population. This study examined associations of achievement of the American Heart Association's Life's Essential 8 (LE8) with albuminuria (marker of kidney injury and cardiovascular disease) among AI individuals in the SHFS (Strong Heart Family Study). The study included participants from the SHFS, a longitudinal study of cardiovascular disease among AI individuals from 12 tribes (analytic cohort: n=1642; age, 39±16 years; 62% women). Participants completed baseline (2001-2003) and follow-up (2007-2009) examinations. The primary exposure was a modified LE8 score, excluding sleep. The primary outcome was incident albuminuria (albumin-to-creatinine ratio ≥30 mg/g). Descriptive statistics and generalized estimating equations were used to examine associations of modified LE8 with incident albuminuria. In this young cohort of AI individuals, kidney disease risk factors were common. Based on modified LE8 scores, 26%, 65%, and 9% had low, moderate, or high cardiovascular health, respectively. Compared with participants with low cardiovascular health scores, participants with moderate and high cardiovascular health scores had decreased odds of incident albuminuria. Corresponding odds ratios were 0.58 (95% CI, 0.41-0.82) and 0.17 (95% CI, 0.05-0.57), for moderate and high LE8 scores, respectively. LE8 components for nicotine exposure, physical activity, blood glucose, and body mass index contribute to this association, with only blood glucose and body mass index remaining significant after adjustment. Preventive interventions that promote optimal health factors and behaviors, like LE8, may improve cardiovascular and kidney disease risk among AI individuals.
Variability in vascular risk factors (VRFs) has been associated with dementia risk. Whether aggregate VRF variability from childhood influences midlife cognitive function (CF) is unclear. Participants of the Bogalusa Heart Study with ≥3 measurements of VRFs (systolic blood pressure, fasting glucose, non-HDL cholesterol, and BMI) from childhood to midlife and one midlife CF assessment were included. Long-term VRF variability was measured using coefficient of variation. A weighted composite score (WCS) was constructed by regressing the global cognitive score (GCS) on VRF variability tertiles and using the coefficients as weights. The GCS, defined as the average of 8 age-, race-, and sex-standardized neuropsychological test scores, represents overall CF. Each VRF variability tertile indicator was multiplied by its coefficient, and the products were summed to generate the WCS. Neuropsychological test scores were also classified into 3 neuropsychological profiles by test performance using cluster analysis as an alternative measure of midlife CF. Associations between WCS and neuropsychological profiles were evaluated using multinomial logistic regression. Among 1009 participants (mean age 48 years, 34% Black; 61% women), those in the highest WCS tertile had 134% higher odds of memory/executive function deficit neuropsychological profile versus the lowest tertile. When WCS was disaggregated, those in the highest glucose variability tertile had 79% and 72% greater odds of the attention/processing speed and memory/executive function deficit neuropsychological profiles, respectively, versus the lowest tertile. Higher aggregate VRF variability from childhood may adversely influence midlife CF. Monitoring VRF variability earlier may help preserve brain health.
The benefit of continuing oral anticoagulation (OAC) after catheter ablation (CA) for atrial fibrillation (AF) in patients with a high risk of stroke remains unclear. The Safeness or Threat Of Pausing-Oral anticoagulant therapy After Catheter ablation for atrial fibrillation study (STOP-OAC study) aimed to investigate the safety and efficacy of OAC discontinuation after CA for AF in patients with CHADS2 score ≥2. We enrolled 1655 consecutive patients with AF with CHADS2 score ≥2 (mean CHADS2 of 2.4 and CHA2DS2-VASc of 3.8) who underwent first-time CA at 8 institutions in Japan from April 2021 to March 2024. The main analysis was the landmark analysis at 240 days after CA compared between the 2 groups either on or off OAC at 240 days. There were 327 patients who had stopped OAC at 240 days (off-OAC group), and 1241 patients who continued OAC at 240 days (on-OAC group). Patients in the off-OAC group compared with those in the on-OAC group less often had nonparoxysmal AF (43.1% and 54.3%), and history of ischemic stroke (7.7% and 23.4%) with lower CHADS2 score (2.2±0.5 and 2.4±0.6). The incidence of ischemic stroke beyond 240 days was not different between the 2 groups (0.4% and 0.5% per patient-year, P=0.21), whereas the incidence of major or clinically relevant nonmajor bleeding beyond 240 days was significantly lower in the off-OAC group than in the on-OAC group (0.4% and 1.7% per patient-year, P<0.001). The STOP-OAC study provides real-world evidence supporting the safety and efficacy of early OAC discontinuation after CA of AF in selected patients with CHADS2 score ≥2.
Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD); however, effective risk stratification tools remain limited. The Endothelial Activation and Stress Index (EASIX) is a composite biomarker reflecting endothelial injury and cellular stress, but its association with CVD in populations with RA remains unexplored. This study aimed to investigate the association between EASIX and both CVD prevalence and CVD mortality in individuals with RA using a nationally representative sample. Data were obtained from the National Health and Nutrition Examination Survey 2001 to 2018. Adults with RA and complete information on EASIX components and cardiovascular outcomes were included. EASIX was calculated as (lactate dehydrogenase×creatinine)/platelet count. Logistic regression and Cox proportional hazards models were used to evaluate the associations between EASIX, CVD prevalence, and CVD mortality, adjusting for potential confounders. A total of 1857 participants with RA were included. Higher EASIX scores were significantly associated with increased odds of CVD prevalence and an elevated risk of CVD mortality. Notably, a nonlinear association was observed between EASIX and CVD mortality, indicating a threshold effect. These associations remained robust after controlling for systemic inflammation and other potential confounders. The robustness of our results was further supported by subgroup and sensitivity analyses. This is the first study to demonstrate a significant association between EASIX and both CVD prevalence and mortality in individuals with RA. The findings highlight EASIX as a promising, easily accessible biomarker for cardiovascular risk stratification in this high-risk population.
Heart failure with preserved ejection fraction (HFpEF) exhibits an inflammatory-metabolic phenotype in association with multiple factors. Among them, epicardial adipose tissue (EAT), a type of visceral adipose tissue surrounding the heart, has been gaining attention. EAT expansion is associated with the development of HFpEF, the increased risk for heart failure-related mortality in patients with HFpEF, independent of age, body mass index, diabetes, and sex. Thus, reducing EAT expansion has been proposed as a promising therapeutic strategy for treating HFpEF. Although specific treatment for EAT expansion is unavailable, modulating the inflammatory response and systemic energy metabolism are beneficial in improving clinical symptoms or prognosis in patients with HFpEF. To further enhance our capacity in effectively treating HFpEF, this review discusses the knowledge gaps between EAT expansion and the lack of a platform to reduce EAT expansion in HFpEF, including the choices of appropriate animal models, the conceptual mechanisms of glucose and lipid metabolism in EAT expansion toward potential strategies for selective EAT-targeted therapeutic avenues.
Informal caregivers play an important role in heart failure care. Health coaching can effectively help informal caregivers adopt healthy lifestyles to prevent and control diseases. However, the cost-effectiveness of interventions that support them remains unclear. We compare the cost-effectiveness of a virtual health coaching intervention (Virtual Caregiver Coach for You) designed to support caregivers in managing their stress by promoting self-care practices versus health information alone for informal caregivers of patients with heart failure. In this randomized controlled trial, 250 informal caregivers were randomized (1:1) to receive Virtual Caregiver Coach for You plus health information, or health information alone, for 6 months. The incremental cost-effectiveness ratio was calculated as costs per quality-adjusted life-year gained over 12 months. A 2-part model was used to estimate health care costs, and nonparametric bootstrapping with 1000 resamples was used to represent incremental cost-effectiveness ratio uncertainty. Among the 165 caregivers in the primary analysis, the Virtual Caregiver Coach for You intervention improved quality-adjusted life-years by 0.035 (95% CI, 0.003-0.068). From a health care sector perspective, the intervention was dominant: lower hospitalization rates (5% versus 8%) fully offset the program's costs, yielding average savings of $77.45 (95% CI, $20.74-$134.17) per caregiver. At a $50 000 per quality-adjusted life-year threshold, the intervention was cost-effective in 99.7% of simulated scenarios. From a societal perspective, the overall cost was $29.71 per caregiver (95% CI, -$37.01 to $96.44). The incremental cost-effectiveness ratio was $838 per quality-adjusted life-year gained. Virtual Caregiver Coach for You can be a cost-effective intervention that improves the self-care and quality of life of informal caregivers of patients with heart failure. URL: https://www.clinicaltrials.gov; Unique identifier: NCT03988621.
Stent thrombosis is a serious complication of angioplasty with stenting, as evidenced by the associated morbidity and mortality events. Its incidence is particularly elevated after emergent carotid stenting in patients with acute ischemic stroke, reaching 20%. A better understanding of the mechanisms driving stent thrombosis will open up new avenues to limit this alarming complication. Its 2 main determinants are the ruptured atherosclerotic plaque and the stent itself, whose particular role in the process remains unknown. Using a new macrofluidic model mimicking the geometry of the human carotid artery, the intrinsic thrombogenicity of carotid stents was evaluated. Real-time video microscopy combined with scanning electron microscopy revealed that the Casper and the Wallstent, 2 widely used commercial stents, are thrombogenic and promote the formation of a massive thrombus in the carotid bifurcation (Casper: median, 9 [interquartile range, 6.4-24.4]×105 μm2; Wallstent: median, 9.5 [interquartile range, 1.5-20.8]×105 μm2). This result was consistent with a retrospective clinical study in stented patients with tandem lesions, in which 21.1% presented stent thrombosis, and 38.7% of these cases occurred at the bifurcation. Moreover, a stent lying in the carotid bifurcation of the macrofluidic model generated a prothrombotic high-shear environment, triggering thrombosis, which was prevented in the presence of aspirin or abciximab. Finally, stents with a new design could avoid the formation of large thrombi in the carotid bifurcation (full stent: median, 8.9 [interquartile range, 7.8-17.2]×105 μm2; stent with an opening at the bifurcation: median, 2.1 [interquartile range, 1.1-3]×105 μm2), opening up the perspective of new ways to prevent carotid stent thrombosis. Stents placed inside the carotid bifurcation are responsible for a massive thrombus formation that could lead to stent thrombosis. The absence of mesh prevents its formation.
Heart failure associated with cardiac sarcoidosis (CS) is typically managed using conventional heart failure medications (HFMs). However, their effectiveness in this specific population remains unclear. We aimed to evaluate the association between HFMs and clinical outcomes in patients with CS and left ventricular systolic dysfunction. This post hoc observational analysis used data from the ILLUMINATE-CS (Illustration of the Management and Prognosis of Japanese Patients With Cardiac Sarcoidosis), a retrospective registry of patients diagnosed with CS between 2001 and 2017. Patients with left ventricular ejection fraction <50% were included. Characteristics and outcomes of patients treated with HFMs (β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and mineralocorticoid receptor antagonists) at diagnosis were assessed. The primary end point was a composite of all-cause death, hospitalization for heart failure, and documented fatal ventricular arrhythmia events. Propensity score-based overlap weighting analysis was used to balance covariates across the study groups. Of 242 eligible patients with CS, 199 (82%) received at least 1 HFM. The HFM group had significantly lower left ventricular ejection fraction (36% versus 40%) and higher brain natriuretic peptide levels (215 versus 152 pg/mL) than the non-HFM group. In the unadjusted analysis, the incidence of the primary end point did not differ significantly between the groups (38% versus 37%; hazard ratio [HR]=1.12 [95% CI=0.65-1.92]). Overlap weighting analysis showed no significant association between HFM use and the primary end point (HR=0.63 [95% CI=0.32-1.23]). Although HFM was commonly used in patients with CS and impaired left ventricular ejection fraction, HFM use at diagnosis was not significantly associated with improved clinical outcomes.
SGLT2 (sodium-glucose cotransporter-2) inhibitors (SGLT2is) improve outcomes in heart failure (HF), but evidence in patients with frailty and acute HF (AHF) is limited. This study investigated the association between SGLT2i use at discharge and outcomes in patients with AHF, with a focus on frailty. We analyzed 5579 patients hospitalized for AHF enrolled between 2018 and 2024 in the prospective WET-HF2 (West Tokyo Heart Failure 2) registry in Japan (age 79 years, 43% women, body mass index 23.1, 23% ischemic cause, left ventricular ejection fraction 45%, 24% SGLT2is at discharge). Frailty was assessed using the Clinical Frailty Scale (≥4; 63%), and complementary analyses were performed using frailty-related factors (low body mass index, reduced activities of daily living, malnutrition, and dementia). The primary outcome was a composite of cardiac death or HF rehospitalization within 1 year, which occurred in 766 patients (18%). A propensity score was calculated using variables associated with SGLT2i prescription. After propensity score-based inverse probability of treatment weighting adjustment, SGLT2i use was associated with a lower risk of the primary outcome (hazard ratio [HR], 0.76, P=0.045). This association was more pronounced in patients with frailty (HR, 0.59, P=0.005), but not in patients without frailty (HR, 1.18; Pinteraction=0.010). Analyses using frailty-related factors yielded similar patterns. At 1 year, SGLT2i use at discharge was not associated with deterioration in body mass index or nutritional status. In this observational registry, SGLT2i use at discharge was associated with improved outcomes in patients with AHF, particularly those with frailty, without evidence of nutritional harm. These findings support the potential safety of SGLT2is in patients with frailty and AHF.
Obesity and systemic inflammation have each been independently associated with an increased risk of heart failure (HF). However, whether inflammatory pathways mediate the association between obesity and the development of heart failure remains unclear. We analyzed data from a community-based cohort of 1998 participants to evaluate multiple adiposity indicators in relation to incident HF. hs-CRP (high-sensitivity C-reactive protein) was examined as a mediator using causal mediation analysis to quantify the contribution of systemic inflammation. Kaplan-Meier analyses and multivariable Weibull accelerated failure time models were applied to estimate hazard ratios (HRs) for HF occurrence. Over a median follow-up of 6.9 years, individuals with elevated hs-CRP levels showed significantly lower HF-free survival (log-rank P=0.010). In multivariable accelerated failure time models, indicators of central obesity and hs-CRP-but not BMI-were significantly associated with higher HF risk (eg, waist circumference: HR=1.30 [95% CI: 1.05-1.61], P=0.017; hs-CRP: HR=1.25 [1.05-1.51], P=0.013). Mediation analysis revealed that hs-CRP accounted for 26.5% of the effect of waist circumference and 32.4% of the effect of waist-to-height ratio on HF risk, with statistically significant indirect effects for both. Our findings build upon recent conceptual advances by demonstrating that central obesity contributes to HF largely through inflammation. By quantifying the proportion of HF risk attributable to systemic inflammation, this study reinforces the rationale for prioritizing both anti-obesity and anti-inflammatory strategies in HF prevention.
Macrophages are central regulators of atherosclerosis, governing lipid accumulation, inflammatory signaling, and plaque stability. Lipin-1 is a multifunctional lipid-metabolic regulator that integrates cellular metabolism with inflammatory responses through its dual roles as a phosphatidic acid phosphatase enzyme and a transcriptional coregulator. However, its role in macrophage-driven atherosclerosis remains controversial. This review critically evaluates the domain-specific functions of lipin-1 and their impact on disease progression. Accumulating evidence indicates that lipin-1 exerts divergent, domain-dependent effects. The transcriptional coregulatory activity of lipin-1 promotes peroxisome proliferator-activated receptor/peroxisome proliferator-activated receptor γ coactivator 1-α signaling, enhances fatty acid β-oxidation and oxidative phosphorylation, and supports interleukin-4-driven proresolving macrophage polarization. It also enhances efferocytosis, suppresses sterol regulatory element-binding protein-mediated lipogenesis, and reduces oxidized low-density lipoprotein-induced foam-cell formation. These effects are associated with reduced necrotic core formation, lower interleukin-23 signaling, diminished macrophage necroptosis, and improved plaque stability in experimental models. In contrast, the phosphatidic acid phosphatase enzymatic activity of lipin-1 activates diacylglycerol-dependent protein kinase C-extracellular signal-regulated kinase- activator protein-1 and toll-like receptor 4 signaling, promotes inflammatory eicosanoid production, enhances oxidized low-density lipoprotein uptake, impairs cholesterol efflux, and accelerates foam-cell formation and vascular inflammation. Myeloid-specific loss of phosphatidic acid phosphatase activity reduces lesion size and inflammatory burden while improving macrophage lipid handling. Collectively, current evidence supports a domain- and context-dependent role for lipin-1 in atherosclerosis. The transcriptional coregulatory function appears predominantly atheroprotective, whereas phosphatidic acid phosphatase enzymatic activity is proinflammatory and atherogenic. Selective modulation of lipin-1 activity in macrophages may therefore represent a promising therapeutic strategy to limit atherosclerosis progression while preserving inflammation-resolving pathways.
Systemic inflammation is increasingly recognized as an important contributor to cardiovascular outcomes. High-sensitivity CRP (C-reactive protein) is an established biomarker, but its prognostic value after mitral transcatheter edge-to-edge repair remains unclear. Clinical parameters such as body temperature may also reflect systemic inflammation; however, their prognostic role in this setting is uncertain. We sought to investigate the association between baseline inflammation makers and long-term outcomes in patients undergoing mitral transcatheter edge-to-edge repair. We analyzed 3511 patients from the OCEAN (Optimized Catheter Valvular Intervention)-Mitral registry with available CRP, categorized by Centers for Disease Control and Prevention/American Heart Association cutoffs: <1.0 mg/L (n=1216), 1.0-3.0 mg/L (n=988), and >3.0 mg/L (n=1307). Body temperature was also assessed as an exploratory inflammatory marker. During a median follow-up of 13 (interquartile range, 10-26) months, 826 deaths and 911 composite event of cardiovascular death or hospitalization for heart failure were observed. In multivariable models, both CRP and body temperature were associated with higher risk of death (CRP: hazard ratio [HR], 1.98 [95% CI, 1.63-2.40]; and body temperature: HR, 1.49 [95% CI, 1.25-1.78]). Patients with both elevated CRP (>3.0 mg/L) and high temperature (≥37.0 °C) had the highest risk. Sequential Cox analyses showed an incremental value of CRP beyond clinical, laboratory, and echocardiographic variables. The prognostic effect was most pronounced in patients without preprocedural inotrope use. Elevated CRP is an independent and incremental predictor of death and heart failure outcomes after mitral transcatheter edge-to-edge repair, with its prognostic impact amplified by higher body temperature. These findings highlight the importance of incorporating systemic inflammation into risk stratification for structural heart interventions. URL: https://www.umin.ac.jp/ctr/; Unique identifier: UMIN-ID: UMIN000023653.
Cuffless blood pressure (BP) monitoring remains challenging for clinical hypertension management. Although photoplethysmography offers promising solutions for cuffless BP measurement, its clinical validation is limited. This study evaluated the accuracy and clinical utility of photoplethysmography-based finger cuffless BP monitoring following European Society of Hypertension recommendations. The 2-phase study enrolled 1173 participants. In phase 1 (n=768), a novel photoplethysmography-based finger cuffless BP monitor was validated against invasive BP, office BP, and 24-hour ambulatory BP monitoring across 7 European Society of Hypertension-recommended scenarios. In phase 2 (n=405 hypertensive patients), the clinical utility of photoplethysmography- versus ambulatory BP monitoring-derived mean systolic BP (SBP), SBP time-in-target range, and variability was assessed by examining their associations with hypertension-mediated organ damage and cardiovascular complications, including arterial stiffness, endothelial dysfunction, coronary heart disease, and stroke. The photoplethysmography-based finger cuffless BP monitor fulfilled all validation criteria, with mean differences ≤5 mm Hg and standard deviations ≤8 mm Hg of both systolic and diastolic BP across 7 scenarios, including invasive, static, awake/asleep, device position, treatment, exercise, and recalibration test. Both ambulatory BP monitoring-derived time-in-target range and photoplethysmography-derived mean SBP and time-in-target range were significantly associated with endothelial injury and arterial stiffness. Notably, photoplethysmography-derived mean SBP and time-in-target range, but not ambulatory BP monitoring-derived metrics, showed a significant association with coronary artery disease. Furthermore, photoplethysmography-derived SBP variability was significantly and positively associated with endothelial injury. Our data demonstrated that the novel photoplethysmography-based finger cuffless BP monitor reached the criteria of clinical application following European Society of Hypertension recommendations and provided additional clinical implications for the evaluation of hypertension-mediated organ damage and cardiovascular complications.
Childhood adversity (CA) is associated with cardiovascular disease (CVD). Proteomic profiling may help elucidate underlying mechanisms. This study aimed to explore how CA and genetic risk jointly impact CVD and the potential role of proteomic biomarkers. A total of 14 508 participants without baseline CVD and with available proteomics data from the UK Biobank were included. CA was assessed using the Childhood Trauma Screener questionnaire. Proteomic signatures were derived using least absolute shrinkage and selection operator regression. Cox proportional hazard models were used to examine the associations of CA with CVD, and mediation analyses were conducted to assess the extent to which proteomic biomarkers explained these associations. Over a median follow-up of 13.5 years, 2286 incident CVD events were identified. The per-score increase in CA score was associated with all-cause and cause-specific CVD, with hazard ratios (HRs) for all-cause CVD, coronary heart disease, arrhythmia/conduction disorder, and heart failure being 1.049 (95% CI, 1.031-1.068), 1.039 (95% CI, 1.009-1.070), 1.041 (95% CI, 1.015-1.067), and 1.066 (95% CI, 1.012-1.122), respectively. No significant interaction between CA and genetic risk was observed. Participants with both high CA and high genetic risk had the highest all-cause CVD risk (HR, 1.847 [95% CI, 1.380-2.472]). Several proteins (pro-adrenomedullin, agrin, AHNAK, CD302, CD83, and yes-associated protein 1) explained 1.58% to 9.98% of the associations between CA and all-cause and cause-specific CVD. Proteomic signatures statistically mediated 3.68% to 10.80% of these associations. CA and genetic susceptibility jointly contributed to increased CVD risk. Proteomic biomarkers partially mediate the CA-CVD associations, providing insight into biological pathways linking early-life adversity and CVD.
Women have been underrepresented in peripheral artery disease revascularization trials. We aimed to analyze sex-specific outcomes after endovascular therapy (EVT) with stent implantation versus bypass surgery (BSx) in patients with symptomatic femoropopliteal peripheral artery disease, leveraging data from the REVIVE (Revascularization Strategies in Patients With Peripheral Arterial Disease Involving the Femoropopliteal Arteries) study. The REVIVE study pooled individual patient data from 5 randomized controlled trials comparing EVT with stent implantation versus BSx. The primary end point was major adverse limb events, a composite of all-cause death, major amputation, or reintervention. Secondary end points included amputation-free survival, the individual components of major adverse limb events, and primary patency at 2 years. Early complications were defined as a composite of any bleeding, infection, or all-cause death within 30 days. Of 639 patients, 185 (29.0%) were women. At 2 years, there were no significant differences in major adverse limb events between EVT and BSx in women (40.6% versus 42.1%; adjusted hazard ratio [aHR], 0.93 [95% CI, 0.57-1.52]) and men (39.7% versus 34.4%; aHR, 0.98 [95% CI, 0.69-1.39]; P-interaction=0.963). Similarly, there were no differences in secondary end points between EVT and BSx, regardless of sex. EVT, compared with BSx, was associated with lower rates of early complications (8.7% versus 25.9%, P=0.002 in women and 5.9% versus 21.5%, P<0.001 in men; P-interaction =0.77) and shorter hospital stay (3.7±5.7 versus 7.2±4.3 days, P<0.001 in women and 2.8±3.2 versus 7.4±5.1, P<0.001 in men). Our analysis supports the efficacy and safety of EVT with stent implantation as an alternative to BSx in patients with symptomatic peripheral artery disease involving the femoropopliteal segment, regardless of sex.
Cardio-kidney-metabolic diseases including obesity, metabolic dysfunction-associated liver disease, and type 2 diabetes have reached pandemic prevalence, fueling the search for new treatments for these conditions, given their associated complications, notably cardiovascular disease. Dual agonists of the glucagon and glucagon-like peptide (GLP-1) receptors are promising. Certain GLP-1 receptor monoagonists are indicated for treatment of type 2 diabetes, obesity, and metabolic dysfunction-associated steatotic liver disease; and for reducing cardiovascular events in type 2 diabetes or obesity and cardiorenal events in people with type 2 diabetes and chronic kidney disease. GCGR (glucagon receptor)/GLP-1 receptor dual agonists may have additional efficacy, given emerging evidence that glucagon regulates energy balance and lipid metabolism as well as glucose homeostasis. However, putative cardiac effects of glucagon highlight cardiovascular safety considerations for dual agonists. Although unequivocal evidence that the GCGR is expressed in the human heart is lacking, high-dose exogenous glucagon has acute chronotropic, inotropic, and hypertensive effects. Clinical studies of GCGR/GLP-1 receptor dual agonists (eg, mazdutide, survodutide) have generally found that they increased heart rate to a similar extent as GLP-1 receptor monoagonists (which are cardioprotective despite such chronotropic effects). Mazdutide and survodutide also reduced blood pressure and hyperglycemia. However, at least 1 other dual agonist was discontinued, partly due to unacceptably large increases in heart rate and prolongation of the corrected QT interval. These between-compound differences may reflect different potencies for activating the GCGR and GLP-1 receptors. Cardiovascular effects of GCGR signaling by dual agonists should be clarified per compound by ongoing clinical trials, notably the cardiovascular outcomes trial SYNCHRONIZE-CVOT (A Study to Test the Effect of Survodutide [BI 456906] on Cardiovascular Safety in People With Overweight or Obesity) and thorough corrected QT study of survodutide.
Systemic vasculitides are complex multisystem immune-mediated inflammatory diseases, classified by the affected vessel size, which are associated with a wide range of clinical manifestations and complications. The most common forms of large vessel vasculitis (LVV) are giant cell arteritis and Takayasu arteritis, although other more rare causes exist. Cranial giant cell arteritis is the most commonly diagnosed form of LVV, affects older adults and can result in sudden visual loss and stroke. Up to 80% of individuals with giant cell arteritis have LV involvement, which can exist with or without cranial involvement. Takayasu arteritis usually occurs in those under the age of 60 years, resulting in progressive injury of the aorta and its main branches. LVV may also affect the coronary and pulmonary circulations, as well as the pericardium and myocardium resulting in a range of cardiovascular pathologies. Diagnosing LVV can be challenging in the absence of a disease-specific laboratory biomarker, and relies on a combination of inflammatory markers, imaging, and temporal artery biopsy when required. Noninvasive multimodality imaging techniques are advancing and provide new avenues for diagnosis and disease monitoring. High-resolution ultrasound, magnetic resonance imaging, and computed tomography can survey the pattern and extent of arterial involvement and reveal signs of active inflammation. Positron emission tomography imaging with 18F-fluorodeoxyglucose and novel radiotracers provide more sensitive measures of vascular inflammation of the large vessels. Ultimately, these imaging tests can be used to guide therapeutic interventions and inform the clinical use of new targeted disease modifying therapies for LVV.
Recurrent pericarditis is an interleukin-1-mediated chronic autoinflammatory disease. The phase 3 study RHAPSODY (Rilonacept Inhibition of IL-1 Alpha and IL-1 Beta for Recurrent Pericarditis: a Pivotal Symptomatology and Outcomes Study; NCT03737110) and long-term extension demonstrated that rilonacept reduced the risk of recurrence. After 3 years of rilonacept treatment in RHAPSODY, Italian patients returned to standard management, as rilonacept was not commercially available. Clinical records from Italian RHAPSODY patients were retrospectively reviewed for the 18-month period post-long-term extension completion to assess recurrent pericarditis disease persistence and time to recurrence after rilonacept cessation/washout. The primary outcome was pericarditis recurrence (ie, pericarditis pain plus C-reactive protein elevation). Safety was also assessed. Seventeen patients were included in this analysis. The median disease duration (from incident episode to long-term extension completion) was 48 (interquartile range, 41-56) months; the median duration of continuous rilonacept treatment was 28 (interquartile range, 27-30) months. Fourteen (82%) of 17 patients experienced a post-trial off-treatment recurrence; the remaining patients (n=3) had no pericarditis recurrences and remained offtreatment. The median time to recurrence (n=14) was 8.0 (interquartile range, 6.0-9.0 weeks). Most patients' (n=8) post-trial off-treatment recurrences were managed with interleukin-1 pathway inhibition. Some (n=4) were managed with glucocorticoids, and few (n=2) were managed with NSAIDs/colchicine. No serious adverse events were experienced. The vast majority (86%) of the patients who experienced an off-treatment recurrence after 28 months of rilonacept restarted interleukin-1 pathway inhibition or corticosteroids, suggesting that NSAIDs/colchicine are insufficient in the management of patients with prolonged advanced disease. Rilonacept cessation and subsequent passive gradual washout is an evidence-based pragmatic approach to determine if continued therapy is warranted to prevent subsequent recurrences.
Home blood pressure monitoring is essential for hypertension management, but incorrect measurement practices remain common. Short-form videos are increasingly used for health education, although their accuracy is uncertain. This cross-sectional study evaluated 154 home blood pressure monitoring-related videos from TikTok, REDnote, and Bilibili using 17 criteria derived from the 2025 American Heart Association/American College of Cardiology and 2024 European Society of Cardiology guidelines. Total accuracy was calculated as the percentage of correctly demonstrated or described criteria. Associations between video characteristics and accuracy were explored. Videos were created by cardiovascular health care professionals (41.6%), non-cardiovascular health care professionals (38.3%), and non-health care individuals (20.1%). Health care professionals more frequently demonstrated resting for ≥5 minutes, positioning the arm at heart level, and appropriate cuff tightness (all P<0.001). However, validated monitor use, correct posture, bare-arm measurement, and recording of readings were accurate in <40% of videos; correct cuff sizing and multiday measurement were addressed in <20%. Visually demonstrative videos more often showed correct cuff placement than verbal-only videos (67.7% versus 34.4%, P<0.001), whereas verbal-only videos more often described measurement timing (50.8% versus 24.7%, P=0.001). Longer duration was associated with higher accuracy (β per 10 seconds=0.62 [95% CI, 0.33-0.90]; ρ=0.222, P=0.006;), whereas videos by non-health care individuals had lower scores than those by cardiovascular professionals (β=-22.84 [95% CI, -31.48 to -14.20]). Home blood pressure monitoring videos on Chinese short-form platforms frequently deviate from guideline recommendations. Greater professional involvement and evidence-based content review are needed.