Clinical Cardiology最新文献

{"title":"Lipid-Lowering Effect and Safety of Ezetimibe and Atorvastatin 5 mg in Patients With Primary Hypercholesterolemia or Mixed Dyslipidemia: A Randomized, Double-Blind, Parallel, Multicenter, Phase 3 Clinical Trial","authors":"You-Jeong Ki,&nbsp;Weon Kim,&nbsp;Ki Hong Lee,&nbsp;Sang-Jin Han,&nbsp;Yong-Hyun Kim,&nbsp;Joon-Hyung Doh,&nbsp;Tae Nyun Kim,&nbsp;Choon Hee Chung,&nbsp;Do Young Kim,&nbsp;Jin-Man Cho,&nbsp;Hyuck-Jun Yoon,&nbsp;In-Kyung Jeong,&nbsp;Sungha Park,&nbsp;Kee-Ho Song,&nbsp;Cheol Woong Yu,&nbsp;Deok-Kyu Cho,&nbsp;Sung Hee Choi,&nbsp;Seung-Jin Oh,&nbsp;Sanghoon Shin,&nbsp;Hyeonju Jeong,&nbsp;Yongwhi Park,&nbsp;Hyo-Soo Kim","doi":"10.1002/clc.70138","DOIUrl":"https://doi.org/10.1002/clc.70138","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to compare the lipid-lowering effect and safety of low-intensity atorvastatin (5 mg) plus ezetimibe (10 mg) combination therapy (A5E10) with monotherapy regimens–atorvastatin 5 mg [A5], ezetimibe 10 mg [E10], and atorvastatin 10 mg [A10])–in dyslipidemia patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A randomized, double-blind, placebo-controlled trial involving 252 dyslipidemia patients was conducted at 25 centers in South Korea (NCT05970679). Participants aged ≥ 19 years were randomized into four groups: A5E10, A5, E10, and A10. The primary endpoint was the percentage change in low-density lipoprotein cholesterol (LDL-C) levels from baseline to 8 weeks. Secondary endpoints included changes in other lipid parameters, lipid ratios, LDL-C goal achievement rates and safety assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean age of the patients was 63 years, and 51.2% were male. The A5E10 group showed significantly greater LDL-C reduction (47.6%) compared with A5 (33.4%), E10 (19.4%), and A10 (40.1%) at 8 weeks (<i>p</i> &lt; 0.0001). A5E10 also significantly reduced triglyceride, non-high-density lipoprotein cholesterol, and apolipoprotein B levels. In addition, a significant reduction in LDL-C levels was observed over the 4 weeks, with a 46.7% reduction in LDL-C levels after 4 weeks of A5E10 administration. No severe adverse events were observed in the A5E10 group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The combination of low-intensity atorvastatin and ezetimibe was more effective than moderate-intensity atorvastatin monotherapy in lowering LDL-C levels and improving other lipid parameters. It was well-tolerated and demonstrated rapid benefits within a month, offering a promising alternative for patients with low to moderate cardiovascular risk who do not achieve adequate control with statin monotherapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70138","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143939286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) Concentration and Cardiovascular Disease in a Group of Patients With Familial Hypercholesterolemia—A Lipid Clinic Experience","authors":"J. Kurdziel,&nbsp;A. Fedak,&nbsp;E. Kawalec,&nbsp;P. Miarka,&nbsp;A. Micek,&nbsp;M. Małecki,&nbsp;M. Walus-Miarka","doi":"10.1002/clc.70125","DOIUrl":"https://doi.org/10.1002/clc.70125","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>High Lp(a) concentrations are linked to an increased risk of cardiovascular disease (CVD). However, more evidence is needed to assess the association of Lp(a) with CVD in different vascular beds.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Hypothesis</h3>\u0000 \u0000 <p>The aim was to assess the prevalence of increased Lp(a) levels and the association between Lp(a) levels and CVD in hypercholesterolemic patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We examined 220 patients (110 women) with suspicion of FH. The mean (SD) age was 49.1 (15.02) years, LDL-C 3.49 (1.75) mmol/L, and the median (IR) Lp(a) concentration 0.15 (0.53) g/L.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>CVD was present in 24.5%, coronary artery disease (CAD) in 21.4% of the examined individuals. Patients with CVD and patients with CAD had higher Lp(a) levels than patients without these diseases (<i>p</i> = 0.0403 and <i>p</i> = 0.0063, respectively); however, after adjustment for age and sex, only the difference in Lp(a) concentrations between persons with and without CAD remained significant. In total, 42.3% of patients who underwent carotid ultrasound examination had carotid plaques. We did not observe differences in Lp(a) levels between patients with or without plaques or correlations between Lp(a) and carotid IMT. In total, 28.3% of patients had Lp(a) concentrations in the high (&gt; 0.5 g/dL), and 9.9% in the moderate-risk category (0.3–0.5 g/L). We observed an association between Lp(a) risk categories and the presence of CVD (<i>p</i> = 0.003) and CAD (<i>p</i> = 0.0004) but not with the presence of carotid plaques.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We found a high prevalence of increased Lp(a) levels in a group of hyperlipidemic persons and strong associations of Lp(a) risk categories with CAD but not with carotid atherosclerosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipid Control and Social Determinants: Their Association With LDL and Non-HDL Cholesterol Goals in Older Adults—A Population-Based Study","authors":"Cristian Orlando Porras Bueno,&nbsp;Jesús Andrés Beltrán España,&nbsp;Carolina Murgueitio Guzmán,&nbsp;Cándida Diaz-Brochero,&nbsp;Ángel Alberto García Peña","doi":"10.1002/clc.70146","DOIUrl":"https://doi.org/10.1002/clc.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Social determinants of health (SDH) significantly influence cardiovascular outcomes; however, their role in achieving lipid profile goals in older adults remains underexplored. This study aimed to evaluate the association between SDH and nonachievement of LDL cholesterol (LDL-C) and non-HDL cholesterol (non-HDL-C) targets in Colombian adults aged ≥ 60 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional analysis was conducted using data from 1270 participants in the SABE Colombia 2015 study. Logistic regression was applied to estimate odds ratios (ORs) for not achieving LDL-C and non-HDL-C goals on the basis of the Framingham, ASCVD 2013, and SCORE2 models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Non achieving LDL-C goals were associated with female sex, lack of affiliation with the health system and physical inactivity. Physical inactivity was associated with noncompliance on non-HDL-C goals, among others.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SDH are strongly associated with poor lipid control. Addressing modifiable SDHs could enhance cardiovascular risk management in older adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143919808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes, Healthcare Utilization, and Cost Following Implementation of a High-Sensitivity Cardiac Troponin Assay","authors":"Indu Poornima,&nbsp;Teigan Dwyer,&nbsp;Tyson Barrett,&nbsp;Tyler Moore,&nbsp;Corey Clarke,&nbsp;Brent A. Williams","doi":"10.1002/clc.70133","DOIUrl":"https://doi.org/10.1002/clc.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>High-sensitivity troponin (Hs-trop) protocols have been developed for the cardiac evaluation of chest pain patients presenting to emergency departments (ED), but uptake has been suboptimal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study sought to evaluate the effects of an Hs-trop protocol (Roche Gen-5 troponin assay) implementation on patient outcomes, healthcare utilization, and costs. Patients presenting to EDs with chest pain following implementation of an Hs-trop protocol (POST) were compared to control patients presenting in the year prior (PRE). Study endpoints included troponin elevations, cardiac diagnostic testing, and ED disposition. Among patients discharged directly from the ED, 30- and 90-day death, new myocardial infarction (MI), ED returns, and hospital admissions were compared. In a subset with insurance data, post-discharge healthcare costs and utilization were compared.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 15 015 patients meeting study criteria, there were no differences in MI diagnoses POST versus PRE, but myocardial injury without MI was more frequent POST (aOR = 9.03; 95% CI: 7.44, 10.96). Noninvasive cardiac testing at the index ED encounter was less frequent POST (aOR = 0.72; 0.67, 0.78), with no difference for invasive angiography. Among patients directly discharged from the ED, no differences were observed for death, but POST patients had fewer ED returns (aOR = 0.70; 0.59, 0.83) and hospital admissions (aOR = 0.62; 0.45, 0.85) within 30 days. Overall healthcare utilization was 8.4% lower in the POST group (<i>p</i> &lt; 0.001) but costs were not different.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Following implementation of an Hs-trop protocol, decreases were observed in noninvasive cardiac testing, and ED returns and hospital admissions within 90 days of discharge, without compromising outcomes. Overall healthcare utilization declined.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70133","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143909197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Impact of Implementation of Heart Team Approach on Cardiovascular Outcomes in Patients With Complex Coronary Artery Disease","authors":"Po-Hsueh Su,&nbsp;Ya-Lin Huang,&nbsp;Po-Wei Chen,&nbsp;Hsien-Yuan Chang,&nbsp;Jun-Neng Roan,&nbsp;Ting-Hsing Chao","doi":"10.1002/clc.70141","DOIUrl":"https://doi.org/10.1002/clc.70141","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with stable coronary artery disease (CAD), treatment options include medical therapy, percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). The decision between PCI and CABG depends on disease severity and revascularization risk. Guidelines promote a heart team approach (HTA) with shared decision-making, yet PCI remains prevalent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of 753 patients with complex CAD (left main or multivessel disease and SYNTAX score ≥ 33) between January 2019 and April 2022. We evaluated a quality improvement program featuring a clinical decision flow map, a support system for risk score calculations, and a standard operating procedure for HTA. We compared HTA activation, revascularization strategy choices, and long-term cardiovascular outcomes (composite endpoint: death, myocardial infarction, or unplanned revascularization) between patients treated with HTA (HTA group, <i>n</i> = 448) and without HTA (non-HTA group, <i>n</i> = 304). The program significantly increased HTA activation (from 26.4% to 61.7%) and CABG selection (from 11.1% to 20.4%). The HTA group had better CABG recommendations and choices (75.5% vs. 37.2%, and 26.8% vs. 7.2%, respectively), with a lower incidence of the primary composite endpoint (18.1% vs. 42.4%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A quality improvement program enhances HTA activation and revascularization strategies, leading to improved cardiovascular outcomes in complex CAD patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Assess the Functional Impact of Atrial Fibrillation in Patients With Heart Failure","authors":"Naoya Kataoka,&nbsp;Teruhiko Imamura","doi":"10.1002/clc.70140","DOIUrl":"https://doi.org/10.1002/clc.70140","url":null,"abstract":"<p>A well-established interplay exists between atrial fibrillation (AF) and heart failure (HF). However, the specific adverse impact of AF on quality of life among HF patients remains incompletely elucidated. The authors demonstrated that the presence of AF and reduced ejection fraction was associated with a lesser degree of improvement in functional class and the physical dimension of a quality-of-life questionnaire [<span>1</span>]. Several concerns merit consideration.</p><p>In the present study, patients with HF were included regardless of their left ventricular ejection fraction (LVEF) [<span>1</span>]. Prior studies focusing on HF populations over 60 years of age have shown that quality-of-life profiles and depressive symptoms differ significantly between cohorts with preserved versus reduced LVEF [<span>2</span>]. To better delineate the target population, it may be more appropriate to restrict the LVEF range.</p><p>The study did not differentiate between paroxysmal and persistent forms of AF [<span>1</span>]. Patients with paroxysmal AF may experience a more favorable quality of life, particularly when sinus rhythm is intermittently or spontaneously restored [<span>3</span>]. Stratification by AF subtype and burden may provide deeper insight into the differential impact on patient-reported outcomes.</p><p>The definition of arrhythmia-induced cardiomyopathy warrants clarification. This condition is typically diagnosed by the observation of reverse remodeling following the resolution of the causative arrhythmia [<span>4</span>]. It may be reasonable to consider arrhythmia-induced cardiomyopathy within the broader category of idiopathic cardiomyopathies, given its distinct pathophysiological trajectory.</p><p>In the current era, catheter ablation has emerged as a standard therapeutic option for AF in patients with HF [<span>5</span>]. Notably, in the present study, great improvement in New York Heart Association functional class was achieved with pharmacological therapy alone. A discussion regarding the therapeutic approach—namely, rhythm control versus rate control—would enhance the clinical relevance of the study's findings in the context of contemporary HF management.</p><p>The authors have nothing to report.</p><p>The authors have nothing to report.</p><p>The authors declare no conflicts of interest.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Assess Risk Factors for Lead Dislodgement in Patients Receiving Cardiac Implantable Electronic Devices-Reply-","authors":"Yasuhiro Matsuda,&nbsp;Masaharu Masuda,&nbsp;Hiroyuki Uematsu,&nbsp;Toshiaki Mano","doi":"10.1002/clc.70139","DOIUrl":"https://doi.org/10.1002/clc.70139","url":null,"abstract":"<p>The Authors' Reply:</p><p>We appreciate the comments and opinions of Dr. Kataoka and Dr. Imamura. We would like to respond to their letter.</p><p>Immunosuppressive therapy may affect lead dislodgement by suppressing adhesion between the patient's body and not only the cardiac implantable electronic device (CIED) lead tips but also the CIED lead body. As you say, focal inflammation near the site of the CIED lead tip is suppressed regardless of immunosuppressive therapy because we used steroid-eluting leads in all patients [<span>1</span>]. However, CIED lead adhesions due to inflammation occur not only between the tips and the myocardium, but also between the lead body and the tricuspid valve or vessel wall [<span>1, 2</span>].</p><p>Regarding the incidence of lead dislodgement in patients with cardiac sarcoidosis, a previous study showed that more than half of the adverse events in implantable cardiac defibrillator implantation for cardiac sarcoidosis were lead dislodgement due to fracture [<span>3</span>]. In our study, two patients received immunosuppressive therapy for sarcoidosis, and 1 (50%) patient experienced lead dislodgement [<span>1</span>]. Additionally, cardiac sarcoidosis itself induces cardiac injury through inflammation, therefore myocardial vulnerability may also be the cause of lead dislodgement by lead tension [<span>1, 4</span>].</p><p>With respect to frailty, unfortunately, we did not have sufficient data on frailty in all patients. However, among the 323 (50%) patients for whom a clinical frailty score was retrospectively obtained [<span>5</span>], there was no significant difference in clinical frailty scores between patients with and without lead dislodgement (6 [3−7] vs. 4 [3−5] points, respectively, <i>p</i> = 0.22). In addition, there was no significant difference in clinical frailty scores between patients on regular steroids and those not taking steroids (4 [3−6] vs. 4 [3−5] points, respectively, <i>p</i> = 0.99).</p><p>As discussed in the limitations section of the manuscript, procedural strategies and implantation skills may have varied between operators in this study [<span>1</span>]. However, in terms of operator learning curves, years of operator experience were similar in patients with and without lead dislodgement (9 [6−11] vs. 9 [7−12] years, respectively, <i>p</i> = 0.66), as we have previously shown in the manuscript [<span>1</span>].</p><p>Yasuhiro Matsuda has received a scholarship from the Japanese Heart Rhythm Society, Abbott and Nihon Kohden outside the submitted work.</p><p>The protocol of this study was approved by the Kansai Rosai Hospital Institutional Review Board (Reference number: 22D104g).</p><p>Yasuhiro Matsuda has received a scholarship from the Japanese Heart Rhythm Society, Abbott and Nihon Kohden outside the submitted work.</p>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 5","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143888927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Esaxerenone in the Continuum of Heart Failure With Preserved Ejection Fraction: Insights From a Prospective Observational Study","authors":"Takashi Naruke,&nbsp;Miho Hashimura-Kakogawa,&nbsp;Yoichi Suzuki,&nbsp;Yuki Ikeda,&nbsp;Lisa Kitasato,&nbsp;Takeru Nabeta,&nbsp;Yuki Usami-Naruke,&nbsp;Shunsuke Ishii,&nbsp;Jun Oikawa,&nbsp;Ryo Kameda,&nbsp;Yoshiyasu Minami,&nbsp;Hidehira Fukaya,&nbsp;Masaru Yuge,&nbsp;Takeo Kawaguchi,&nbsp;Junya Ako","doi":"10.1002/clc.70137","DOIUrl":"https://doi.org/10.1002/clc.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Heart failure with preserved ejection fraction (HFpEF) presents significant therapeutic challenges, particularly exacerbated by comorbidities such as hypertension and diabetes. The modulation of the Renin–Angiotensin–Aldosterone System is critical in managing HFpEF progression. Esaxerenone (ESAX), a selective mineralocorticoid receptor antagonist, may offer benefits in managing HFpEF continuum due to its unique mechanism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Conducted at Odawara Municipal Hospital, this single-center, prospective, observational study involved hypertensive adult outpatients diagnosed with either type 2 diabetes mellitus or chronic kidney disease. Patients were categorized into HFpEF and pre-HFpEF groups based on established criteria. The study primarily assessed changes in blood pressure and cardiac function (through NT-proBNP levels and echocardiography), along with secondary outcomes including aortic stiffness and oxidative stress over a 24-week period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Both HFpEF and pre-HFpEF patients exhibited significant reductions in blood pressure, with no significant differences between the patients. HFpEF patients experienced decreases in NT-proBNP levels and oxidative stress similar to those in pre-HFpEF patients. Notably, pre-HFpEF patients demonstrated more pronounced improvements in cardiac function, particularly in the E/e' ratio and global longitudinal strain, compared to HFpEF patients. Additionally, 30% of pre-HFpEF patients had improved to stage A, suggesting potential for early intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ESAX appears to be effective in managing the heart failure continuum, particularly benefiting pre-HFpEF patients. Its impacts suggest the potential benefits of early intervention in decelerating disease progression and potentially preventing the new onset of HFpEF, highlighting the importance of targeted therapies at early stages of heart failure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Socioeconomic Disparities on Care and Outcomes of Cancer Patients Presenting With STEMI Between 2005 and 2019; a Nationwide British Study","authors":"Mohamed Dafaalla,&nbsp;Nicholas Weight,&nbsp;Muhammad Rashid,&nbsp;James Nolan,&nbsp;Mamas A. Mamas","doi":"10.1002/clc.70135","DOIUrl":"https://doi.org/10.1002/clc.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>While current evidence suggests that the clinical outcomes of STEMI are worse among patients with cancer, it is unknown what role the patient's socioeconomic status plays.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationally linked cohort of STEMI patients (January 2005 to March 2019) was obtained from the MINAP and UK national Hospital Episode Statistics (HES APC) registries. Socioeconomic status was measured using Index of Multiple Deprivation (IMD) score divided into 5 quintiles (quintile 1: most affluent, quintile 5: most deprived). The impact of socioeconomic status on clinical outcomes was assessed using Cox-proportional-hazard and competing risk models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 8459 STEMI admissions with cancer were identified between 01/01/2005 and 30/03/2019 with 1577 patients (18%) from the most deprived quintile. Patients from the most deprived quintile were more frequently female (quintile 5; 29% vs. quintile 1; 24%) and from ethnic minorities (quintile 5; 8% vs. quintile 1; 2%). They were less likely to receive PCI between 2005 and 2009. By 2018 PCI use was higher in quintile 5 (quintile 5; 84% vs. quintile 1;81%). The odds of death at1year was not higher in the most deprived patients. The risk of death was significantly higher at 5 years post-discharge (HR 1.27, 95% CI 1.10−1.47).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The socioeconomic status impact on outcomes of STEMI patients with cancer can be minimized by delivering equitable inpatient care, particularly PCI. While patients from the most deprived areas have similar odds of survival in the short-term, they have lower probability of survival in the long-term.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143865794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Disparities in Acute Myocardial Infarction-Related Mortality Among U.S. Adults With Hypertension, 2000–2023","authors":"Maryam Sajid,&nbsp;Dua Ali,&nbsp;Shaheer Qureshi,&nbsp;Reja Ahmad,&nbsp;Asim Sajjad,&nbsp;Saad Ahmed Waqas,&nbsp;Raheel Ahmed,&nbsp;Peter Collins","doi":"10.1002/clc.70129","DOIUrl":"https://doi.org/10.1002/clc.70129","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Hypertension is a major public health concern and a key risk factor for acute myocardial infarction (AMI), significantly contributing to cardiovascular mortality. Despite advancements in management and treatment, trends in associated mortality remain underexplored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study examines U.S. national trends in hypertension- and AMI-associated mortality from 2000 to 2023, focusing on demographics and regions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Age-adjusted mortality rates (AAMRs) per 100,000 for adults aged ≥ 25 with hypertension and AMI were extracted from the CDC WONDER database. Annual percent changes (APCs) and average APCs (AAPCs) with 95% confidence intervals (CIs) were calculated, stratified by year, sex, race/ethnicity, age, urbanization, and Census region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 2000 to 2023, 933,024 hypertension- and AMI-related deaths were recorded. Overall, AAMR declined from 19.84 per 100,000 in 2000 to 16.26 in 2023 (AAPC: −0.93%, 95% CI: −1.18% to −0.76%). However, a sharp rise in mortality occurred between 2018 and 2021, coinciding with the COVID-19 pandemic. Stratified analyses revealed persistently higher mortality rates among menmen, non-Hispanic BlackBlack individuals, and residents of the Southern and rural U.S. regions. Younger adults showed an increasing AAMR trend, indicating a growing burden of hypertension and AMI-associated disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While long-term mortality trends show a decline, recent years have seen a rise, particularly among high-risk groups. Targeted public health interventions addressing hypertension management, cardiovascular risk reduction, and healthcare disparities are essential to mitigate the ongoing burden of hypertension and AMI mortality in the U.S.</p>\u0000 </section>\u0000 </div>","PeriodicalId":10201,"journal":{"name":"Clinical Cardiology","volume":"48 4","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/clc.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143856725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}