Circulation最新文献

{"title":"Effects of Evolocumab on Mortality Outcomes in Patients Without Previous Myocardial Infarction or Stroke: A Prespecified Analysis of the VESALIUS-CV Randomized Clinical Trial.","authors":"Robert P Giugliano, Erin A Bohula, Andrea Bellavia, Gaetano M De Ferrari, Lawrence A Leiter, Jose C Nicolau, Ajay K Bhatia, Sabina A Murphy, Lyrica Liu, Huei Wang, Vladimir Blaha, Andrejs Erglis, Jorge Ferreira, Assen Goudev, Henrik K Jensen, Robert Gabor Kiss, Gilles Montalescot, Alexandr Parkhomenko, Naveed Sattar, Peter Sinnaeve, Rimvydas Slapikas, Gabriel Paiva da Silva Lima, Marc S Sabatine","doi":"10.1161/CIRCULATIONAHA.126.082436","DOIUrl":"10.1161/CIRCULATIONAHA.126.082436","url":null,"abstract":"<p><strong>Background: </strong>Evolocumab, a PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitor, significantly reduced the risk of cardiovascular events in patients without previous myocardial infarction or stroke in the VESALIUS-CV trial (Effect of Evolocumab in Patients at High Cardiovascular Risk without Prior Myocardial Infarction or Stroke). However, mortality results have yet to be fully characterized.</p><p><strong>Methods: </strong>VESALIUS-CV was a double-blind study of 12 257 patients (median age, 66 years [interquartile range, 60-71]; 43% women) with qualifying atherosclerosis or high-risk diabetes without previous myocardial infarction or stroke, and low-density lipoprotein-cholesterol ≥90 mg/dL (or non-high-density lipoprotein-C ≥120 mg/dL or apolipoprotein B ≥80 mg/dL) who were randomized to evolocumab or placebo. Prespecified mortality outcomes of interest included all-cause mortality, subtypes of death (including cardiovascular [CV] and non-CV), and timing of events. Non-CV mortality was further investigated using multistate modeling to assess the contribution of prevention of nonfatal CV events (myocardial infarction, ischemic stroke, and ischemia-driven arterial revascularization) to non-CV mortality.</p><p><strong>Results: </strong>Over a median of 4.6 years (interquartile range, 4.0-5.2), 973 (7.9%) patients died: 351 (36%) of CV causes, 497 (51%) of non-CV causes, and 125 (13%) of undetermined cause. All-cause mortality rates were 20% lower with evolocumab compared with placebo: 434 deaths (5-year Kaplan-Meier rate of 7.9%) with evolocumab versus 539 deaths (9.7%) with placebo (hazard ratio, 0.80, 95% CI, 0.70-0.91; <i>P</i>=0.0005). There was consistency of benefit for CV death (156 deaths [2.8%] versus 195 [3.6%]; hazard ratio, 0.79; 95% CI, 0.64-0.98), non-CV death (229 [4.2%] versus 268 [5.0%]; hazard ratio, 0.85; 95% CI, 0.71-1.01), and deaths of undetermined cause (49 [1.1%] versus 76 [1.4%]; hazard ratio, 0.64; 95% CI, 0.45-0.92). Results were consistent regardless of age, sex, region, race, qualifying atherosclerosis or high-risk diabetes, baseline low-density lipoprotein-cholesterol, or background lipid therapy. Postrandomization nonfatal myocardial infarction, ischemic stroke, and ischemia-driven arterial revascularization were associated with increased risk of subsequent non-CV death within the next 4 years, with the majority occurring during the first year after the event. Multistate modeling suggested the observations regarding non-CV death with evolocumab was largely (78%; bootstrap interquartile range, 71-92%) driven by the prevention of antecedent nonfatal CV events.</p><p><strong>Conclusions: </strong>These results support using evolocumab to improve survival in high-risk patients who have not experienced a previous myocardial infarction or stroke, including those with high-risk diabetes without qualifying atherosclerosis with low-density lipoprotein-cholesterol ≥ 90 mg/dl (or non-high-density l","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preventing the First Event … and the Last? Lessons From VESALIUS-CV.","authors":"Fatima Rodriguez, Michael D Shapiro","doi":"10.1161/CIRCULATIONAHA.126.082769","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082769","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Last Mile of Cardiovascular Prevention: Evidence, Access, and Policy.","authors":"Andrew S Oseran, Rishi K Wadhera","doi":"10.1161/CIRCULATIONAHA.126.082918","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082918","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Relaxin Receptor Agonist AZD5462 in Participants With Chronic Heart Failure: Primary Results From the LUMINARA Trial.","authors":"James L Januzzi, Jaya B Rosenmeier, Patricia Ely Pizzato, Macarena P Quintana-Hayashi, Lai-Shan Melanie Chan, Petra Johannesson, Chandrali S Bhattacharya, Daniel Aradi, Jeroen Schaap, Jiri Vesely, Grzegorz Piotrowski, Koichiro Kinugawa, Daniel Pettersen, Joao Lima, Martin Fredriksson","doi":"10.1161/CIRCULATIONAHA.126.082763","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082763","url":null,"abstract":"<p><strong>Background: </strong>Stimulation of the relaxin family peptide receptor 1 experimentally reduces systemic vascular resistance and afterload, improves organ perfusion, and fosters reverse cardiac remodeling. We hypothesized that AZD5462, an oral once-daily relaxin family peptide receptor 1 agonist, may benefit individuals with chronic heart failure (HF).</p><p><strong>Methods: </strong>In this international, multicenter, double-blind, placebo-controlled, dose-ranging trial, adults with chronic HF and left ventricular ejection fraction ≤35% (cohort A) or 41% to 55% (cohort B) were randomized 1:1:1:1 to 3 (20, 80, or 360 mg) once-daily oral doses of AZD5462 or placebo. Primary end points were changes in end-systolic volume index (cohort A) and systemic vascular resistance index (cohort B) after 24 weeks.</p><p><strong>Results: </strong>A total of 235 (cohort A) and 140 (cohort B) participants were randomized across 57 sites in 10 countries. The mean age was 65 and 70 years, and 88% and 69% were male; baseline concomitant guideline-directed medical therapy for HF was excellent. Treatment with AZD5462 was well tolerated compared with placebo. In cohort A, at week 25, treatment with AZD5462 20 mg showed a placebo-adjusted end-systolic volume index change from baseline of -5.4 mL/m² (95% CI, -10.9 to 0.1; <i>P</i>=0.054). In cohort B, AZD5462 treatment resulted in significant placebo-adjusted reductions in systemic vascular resistance index at week 25 across all dose groups (all <i>P</i> <0.05).</p><p><strong>Conclusions: </strong>Among individuals with well-treated chronic HF, the addition of oral AZD5462 was well tolerated and demonstrated encouraging effects on cardiovascular hemodynamic measures across a wide range of left ventricular ejection fraction. Larger and longer duration trials are warranted to assess the impact of AZD5462 on clinical outcomes in HF.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT06299826.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing the Science of Nurse-Led Collaborative Care in Heart Failure.","authors":"Lisa A Kitko","doi":"10.1161/CIRCULATIONAHA.126.082775","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082775","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) and Atherosclerotic Cardiovascular Disease Among Adults Aged 20 to 100 Years.","authors":"Janeni Jeevanathan, Peter E Thomas, Pia R Kamstrup, Børge G Nordestgaard","doi":"10.1161/CIRCULATIONAHA.126.079412","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.079412","url":null,"abstract":"<p><strong>Background: </strong>High lipoprotein(a) is considered a causal risk factor for atherosclerotic cardiovascular diseases (ASCVD); however, whether the association between lipoprotein(a) and ASCVD is different among older individuals (defined as 70-100 years of age) compared with younger individuals is unclear. We evaluated differences in risk of ASCVD associated with high lipoprotein(a) stratified by age and sex.</p><p><strong>Methods: </strong>We included 57 899 women and 45 442 men aged 20 to 100 years from the Copenhagen General Population Study, of which 18 322 (18%) were aged 70 to 100 years. Age-stratified incidence rates and hazard ratios for ASCVD were estimated. Secondary analyses were additionally stratified by sex.</p><p><strong>Results: </strong>During a median follow-up of 12.5 years (maximum, 19.1), 9091 individuals were diagnosed with ASCVD. ASCVD incidence increase per 50 mg/dL (105 nmol/L) higher lipoprotein(a) were 0.3 per 1000 person-years (95% CI, 0.2-0.4) for age 20 to 49 years, 0.8 (0.6-0.9) for age 50 to 59 years, 1.5 (1.2-1.7) for age 60 to 69 years, 2.7 (2.2-3.2) for age 70 to 79 years, and 4.5 per 1000 person-years (3.7-5.4) for age 80 to 100 years. For lipoprotein(a) of 70 to 89 mg/dL (148-190 nmol/L), such incidence increases were 2.7 for age 20 to 49 years, 7.1 for age 50 to 59 years, 13.3 for age 60 to 69 years, 24.4 for age 70 to 79 years, and 40.9 for age 80 to 100 years. Corresponding values for lipoprotein(a) of 90 to 426 mg/dL (191-924 nmol/L) were 3.2, 8.3, 15.6, 28.7, and 48, respectively. The above results were similar in women and men, but with the highest incidence increases in men. Hazard ratios per 50 mg/dL higher lipoprotein(a) were similar across all age groups and sexes, ranging from 1.12 to 1.18 (<i>P</i>_interaction: by age=0.48; by sex=0.74).</p><p><strong>Conclusions: </strong>In a contemporary primary prevention cohort, the relative risk increase of ASCVD with higher lipoprotein(a) levels was similar for individuals aged older (aged 70-100 years) and younger individuals, with the highest absolute risk in this older age group.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimodal Collaborative Care for Heart Failure in Resource-Limited Settings.","authors":"Rajeev Gupta","doi":"10.1161/CIRCULATIONAHA.126.082774","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082774","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Nurse-Coordinated, Digital-Supported Collaborative Care Model in Reducing Hospital Stay and Mortality Among Patients With Heart Failure: TIME-HF Cluster RCT India.","authors":"Panniyammakal Jeemon, Sanjay Ganapathi, Navya Anikkady, Sunaib Ismail, Govindan Unni, Charantharayil Gopalan Bahuleyan, Renukadevi Meera, Rachel Daniel, Stigi Joseph, Justin Paul Gnanaraj, Sunil Pisharody, Rajeev Edakutty, Johny Joseph, Jabir Abdullakutty, Tiny Nair, Thottathan Athira, Mariyam Alex, Alan Jojo, Gopalan Rajendiran, Jayakumar Balakrishnan, Joyal J Kandathil, Madhu Sreedharan, Nalin Kumar Mahesh, Paul Thomas, Vijayan Ganesan, Placid Sebastian, Sajan Ahmad, Salman Salahuddin, Shafeeq Mattummal, Veena Nanjappa, Vijo George, Eapen Punnoose, N Syam, Sivadasanpillai Harikrishnan","doi":"10.1161/CIRCULATIONAHA.126.082490","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082490","url":null,"abstract":"<p><strong>Background: </strong>Heart failure with reduced ejection fraction causes high mortality and recurrent hospitalizations in India. We evaluated the effectiveness of the collaborative care model in improving days alive and out of the hospital and overall survival.</p><p><strong>Methods: </strong>We conducted a parallel-group, cluster-randomized controlled trial involving 1507 adults with heart failure with reduced ejection fraction across 22 centers in India (CTRI/2021/11/037797). Centers were randomized 1:1 to the intervention or usual care. Participants were followed up for 2 years. The intervention included risk stratification, lifestyle and pharmacological optimization, and a nurse-coordinated, mobile health-supported disease management program with self-care education, active follow-up, and continuous outpatient monitoring throughout the study period. The primary outcome was days alive and out of the hospital, and all-cause mortality was assessed as a secondary outcome. Days alive and out of the hospital was analyzed with a one-inflated β model. All-cause mortality was analyzed with Cox proportional hazards models adjusted for the clustered study design.</p><p><strong>Results: </strong>Among 1507 participants (752 usual care; 755 intervention), the mean age was 61.9 years, and 77.6% were men. All participants except one completed 24 months of follow-up. Most participants (70%) had low educational attainment; 57.3% lived in rural areas; and ischemic heart disease was the predominant cause (77.4%). Baseline characteristics were comparable between the intervention and usual care groups. In the one-inflated β model, the probability of surviving up to 730 days without hospitalization was 79.4% (95% CI, 77.7%-81.2%) in the usual care group and 84.0% (95% CI, 82.2%-85.8%) in the intervention group. Participants in the intervention group had 78% higher odds of achieving a percent days alive and out of the hospital of exactly 1 (730/730 days) compared with those in the usual care group (odds ratio, 1.78 [95% CI, 1.42-2.23]). There were 201 deaths (26.73%) in the usual care group compared with 163 deaths (21.59%) in the intervention group (risk ratio, 0.80 [95% CI, 0.67-0.97]). In the multivariable Cox proportional hazards model, the intervention group had a 22% lower mortality risk than the usual care group (hazard ratio, 0.78 [95% CI, 0.63-0.95]; <i>P</i>=0.028).</p><p><strong>Conclusions: </strong>A nurse-coordinated, mobile health-supported collaborative care model for heart failure with reduced ejection fraction in India increased the number of days alive and out of hospital, raised the absolute probability of remaining out of hospital by 4.5 percentage points, and reduced all-cause mortality by 22%.</p><p><strong>Registration: </strong>URL: www.ctri.nic.in; Unique identifier: CTRI/2021/11/037797.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Anselamimab on Cardiac Structure and Function in Patients With Light Chain Amyloidosis: Insights From the CARES Clinical Trials.","authors":"Xiaowen Wang, Marianna Fontana, Brian Claggett, Karola S Jering, Hicham Skali, Mathew S Maurer, Piero Ricchiuto, Chen Yao, Hrishikesh Kulkarni, Haihong Li, Michele F Mercuri, Candida Cristina Quarta, Scott D Solomon","doi":"10.1161/CIRCULATIONAHA.126.082847","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082847","url":null,"abstract":"<p><p></p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148857109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lipoprotein(a) and Atherosclerotic Cardiovascular Disease Risk: From Young to Older Adulthood.","authors":"Sadiya S Khan, Wendy S Post","doi":"10.1161/CIRCULATIONAHA.126.082984","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.126.082984","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":" ","pages":""},"PeriodicalIF":41.3,"publicationDate":"2026-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}