CirculationPub Date : 2024-10-29Epub Date: 2024-10-28DOI: 10.1161/CIRCULATIONAHA.124.068018
Christine M Albert
{"title":"Oral Anticoagulation in Device Patients With Atrial High-Rate Episodes: Shared Decision-Making After ARTESIA and NOAH-AFNET-6.","authors":"Christine M Albert","doi":"10.1161/CIRCULATIONAHA.124.068018","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.068018","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":null,"pages":null},"PeriodicalIF":35.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521184","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}
CirculationPub Date : 2024-10-29Epub Date: 2024-08-21DOI: 10.1161/CIRCULATIONAHA.123.068564
Bethany Barone Gibbs, Subashan Perera, Kimberly A Huber, Joshua L Paley, Molly B Conroy, John M Jakicic, Matthew F Muldoon
{"title":"Effects of Sedentary Behavior Reduction on Blood Pressure in Desk Workers: Results From the RESET-BP Randomized Clinical Trial.","authors":"Bethany Barone Gibbs, Subashan Perera, Kimberly A Huber, Joshua L Paley, Molly B Conroy, John M Jakicic, Matthew F Muldoon","doi":"10.1161/CIRCULATIONAHA.123.068564","DOIUrl":"10.1161/CIRCULATIONAHA.123.068564","url":null,"abstract":"<p><strong>Background: </strong>Sedentary behavior (SB) is observationally associated with cardiovascular disease risk. However, randomized clinical trials testing causation are limited. We hypothesized that reducing SB would decrease blood pressure (BP) and pulse wave velocity (PWV) in sedentary adults.</p><p><strong>Methods: </strong>This parallel-arm, 3-month randomized clinical trial recruited desk workers, age 18 to 65 years, with systolic BP 120 to 159 or diastolic BP (DBP) 80 to 99 mm Hg, off antihypertensive medications, and reporting <150 min/wk of moderate to vigorous intensity physical activity. Participants were randomized to a SB reduction intervention or a no-contact control group. The intervention sought to replace 2 to 4 h/d of SB with standing and stepping through coaching, a wrist-worn activity prompter, and a sit-stand desk. SB and physical activity were measured with a thigh-worn accelerometer and quantified during all waking hours and separately during work and nonwork times. Clinic-based resting systolic BP (primary outcome) and DBP, 24-hour ambulatory BP, and PWV were assessed by blinded technicians at baseline and 3 months.</p><p><strong>Results: </strong>Participants (n=271) had a mean age of 45 years and systolic BP/DBP 129/83 mm Hg. Compared with controls, intervention participants reduced SB (-1.15±0.17 h/d), increased standing (0.94±0.14 h/d), and increased stepping (5.4±2.4 min/d; all <i>P</i><0.05). SB and activity changes mainly occurred during work time and were below the goal. The intervention did not reduce BP or PWV in the intervention group compared with controls. Between-group differences in resting systolic BP and DBP changes were -0.22±0.90 (<i>P</i>=0.808) and 0.13±0.61 mm Hg (<i>P</i>=0.827), respectively. The findings were similarly null for ambulatory BP and PWV. Decreases in work-time SB were associated with favorable reductions in resting DBP (r=0.15, <i>P</i>=0.017). Contrary to our hypotheses, reductions in work-time SB (r=-0.19, <i>P</i>=0.006) and increases in work-time standing (r=0.17, <i>P</i>=0.011) were associated with unfavorable increases in carotid-femoral PWV. As expected, increases in nonwork-time standing were favorably associated with carotid-femoral PWV (r=-0.14, <i>P</i>=0.038).</p><p><strong>Conclusions: </strong>A 3-month intervention that decreased SB and increased standing by ≈1 hour during the work day was not effective for reducing BP. Future directions include examining effects of interventions reducing SB through activity other than work-time standing and clarifying association between standing and PWV in opposite directions for work and nonwork time.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT03307343.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":null,"pages":null},"PeriodicalIF":35.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11512617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142008392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
CirculationPub Date : 2024-10-29Epub Date: 2024-08-29DOI: 10.1161/CIRCULATIONAHA.124.068613
Kasper Bonnesen, Uffe Heide-Jørgensen, Diana H Christensen, Timothy L Lash, Sean Hennessy, Anthony Matthews, Lars Pedersen, Reimar W Thomsen, Morten Schmidt
{"title":"Comparative Cardiovascular Effectiveness of Empagliflozin Versus Dapagliflozin in Adults With Treated Type 2 Diabetes: A Target Trial Emulation.","authors":"Kasper Bonnesen, Uffe Heide-Jørgensen, Diana H Christensen, Timothy L Lash, Sean Hennessy, Anthony Matthews, Lars Pedersen, Reimar W Thomsen, Morten Schmidt","doi":"10.1161/CIRCULATIONAHA.124.068613","DOIUrl":"10.1161/CIRCULATIONAHA.124.068613","url":null,"abstract":"<p><strong>Background: </strong>Empagliflozin and dapagliflozin have proven cardiovascular benefits in people with type 2 diabetes at high cardiovascular risk, but their comparative effectiveness is unknown.</p><p><strong>Methods: </strong>This study used nationwide, population-based Danish health registries to emulate a hypothetical target trial comparing empagliflozin versus dapagliflozin initiation, in addition to standard care, among people with treated type 2 diabetes from 2014 through 2020. The outcome was a composite of myocardial infarction, ischemic stroke, heart failure (HF), or cardiovascular death (major adverse cardiovascular event). Participants were followed until an outcome, emigration, or death occurred; 6 years after initiation; or December 31, 2021, whichever occurred first. Logistic regression was used to compute inverse probability of treatment and censoring weights, controlling for 57 potential confounders. In intention-to-treat analyses, 6-year adjusted risks, risk differences, and risk ratios, considering noncardiovascular death competing events, were estimated. Analyses were stratified by coexisting atherosclerotic cardiovascular disease and HF. A per-protocol design was performed as a secondary analysis.</p><p><strong>Results: </strong>There were 36 670 eligible empagliflozin and 20 606 eligible dapagliflozin initiators. In the intention-to-treat analysis, the adjusted 6-year absolute risk of major adverse cardiovascular event was not different between empagliflozin and dapagliflozin initiators (10.0% versus 10.0%; risk difference, 0.0% [95% CI, -0.9% to 1.0%]; risk ratio, 1.00 [95% CI, 0.91 to 1.11]). The findings were consistent in people with atherosclerotic cardiovascular disease (risk difference, -2.3% [95% CI, -8.2% to 3.5%]; risk ratio, 0.92 [95% CI, 0.74 to 1.14]) and without atherosclerotic cardiovascular disease (risk difference, 0.3% [95% CI, -0.6% to 1.2%]; risk ratio, 1.04 [95% CI, 0.93 to 1.16]) and in people with HF (risk difference, 1.1% [95% CI, -6.5% to 8.6%]; risk ratio, 1.04 [95% CI, 0.79 to 1.37]) and without HF (risk difference, -0.1% [95% CI, -1.0% to 0.8%]; risk ratio, 0.99 [95% CI, 0.90 to 1.09]). The 6-year risks of major adverse cardiovascular event were also not different in the per-protocol analysis (9.1% versus 8.8%; risk difference, 0.2% [95% CI, -2.1% to 2.5%]; risk ratio, 1.03 [95% CI, 0.80 to 1.32]).</p><p><strong>Conclusions: </strong>Empagliflozin and dapagliflozin initiators had no differences in 6-year cardiovascular outcomes in adults with treated type 2 diabetes with or without coexisting atherosclerotic cardiovascular disease or HF.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":null,"pages":null},"PeriodicalIF":35.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142104923","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}
CirculationPub Date : 2024-10-29Epub Date: 2024-10-28DOI: 10.1161/CIRCULATIONAHA.124.069484
Efstathios Papatheodorou, Vincent L Aengevaeren, Thijs M H Eijsvogels, Khaled AlFakih, Rebecca Kathryn Hughes, Ahmed Merghani, Christine K Kissel, Saad Fyyaz, Athanasios Bakalakos, Mathew G Wilson, Damini Dey, Gherardo Finocchiaro, Gemma Parry-Williams, Camilla Torlasco, Michael Papadakis, James C Moon, Sanjay Sharma
{"title":"Prevalence of Coronary Atherosclerosis in Female Masters Endurance Athletes.","authors":"Efstathios Papatheodorou, Vincent L Aengevaeren, Thijs M H Eijsvogels, Khaled AlFakih, Rebecca Kathryn Hughes, Ahmed Merghani, Christine K Kissel, Saad Fyyaz, Athanasios Bakalakos, Mathew G Wilson, Damini Dey, Gherardo Finocchiaro, Gemma Parry-Williams, Camilla Torlasco, Michael Papadakis, James C Moon, Sanjay Sharma","doi":"10.1161/CIRCULATIONAHA.124.069484","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.069484","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":null,"pages":null},"PeriodicalIF":35.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521185","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}
CirculationPub Date : 2024-10-29Epub Date: 2024-10-28DOI: 10.1161/CIRCULATIONAHA.124.072348
{"title":"Highlights From the Circulation Family of Journals.","authors":"","doi":"10.1161/CIRCULATIONAHA.124.072348","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.072348","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":null,"pages":null},"PeriodicalIF":35.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521182","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}
CirculationPub Date : 2024-10-29Epub Date: 2024-10-28DOI: 10.1161/CIRCULATIONAHA.124.069508
Sean van Diepen, Janine Pöss, Janek M Senaratne, Ann Gage, David A Morrow
{"title":"Mixed Cardiogenic Shock: A Proposal for Standardized Classification, a Hemodynamic Definition, and Framework for Management.","authors":"Sean van Diepen, Janine Pöss, Janek M Senaratne, Ann Gage, David A Morrow","doi":"10.1161/CIRCULATIONAHA.124.069508","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.069508","url":null,"abstract":"<p><p>The classification of cardiogenic shock (CS) has evolved from a singular cold-and wet-hemodynamic profile. Data from registries and clinical trials have contributed to a broader recognition that although all patients with CS have insufficient cardiac output leading to end organ hypoperfusion, there is considerable variability in CS acuity, underlying etiologies, volume status, and systemic vascular resistance. Mixed CS can be broadly categorized as <i>CS with at least 1 additional shock state</i>. Mixed CS states are now the second leading cause of shock in contemporary coronary intensive care units, but there is little high-quality evidence to guide routine care, and there are no standardized classification frameworks or well-established hemodynamic definitions. This primer summarizes the current epidemiology and proposes a classification framework and invasive hemodynamic parameters to guide categorization that could be applied to help better phenotype patients captured in registries and trials, as well as guide management of mixed CS states.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":null,"pages":null},"PeriodicalIF":35.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142521183","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}
CirculationPub Date : 2024-10-27DOI: 10.1161/CIRCULATIONAHA.124.072009
Felice Gragnano, David van Klaveren, Dik Heg, Lorenz Räber, Mitchell W Krucoff, Sergio Raposeiras-Roubän, Jurriën M Ten Berg, Sergio Leonardi, Takeshi Kimura, Noé Corpataux, Alessandro Spirito, James B Hermiller, Emad Abu-Assi, Dean Chan Pin Yin, Jaouad Azzahhafi, Claudio Montalto, Marco Galazzi, Sarah Bär, Raminta Kavaliauskaite, Fabrizio D'Ascenzo, Gaetano M De Ferrari, Hirotoshi Watanabe, Philippe Gabriel Steg, Deepak L Bhatt, Paolo Calabrò, Roxana Mehran, Philip Urban, Stuart Pocock, Stephan Windecker, Marco Valgimigli
{"title":"Derivation and Validation of the PRECISE-HBR Score to Predict Bleeding After Percutaneous Coronary Intervention.","authors":"Felice Gragnano, David van Klaveren, Dik Heg, Lorenz Räber, Mitchell W Krucoff, Sergio Raposeiras-Roubän, Jurriën M Ten Berg, Sergio Leonardi, Takeshi Kimura, Noé Corpataux, Alessandro Spirito, James B Hermiller, Emad Abu-Assi, Dean Chan Pin Yin, Jaouad Azzahhafi, Claudio Montalto, Marco Galazzi, Sarah Bär, Raminta Kavaliauskaite, Fabrizio D'Ascenzo, Gaetano M De Ferrari, Hirotoshi Watanabe, Philippe Gabriel Steg, Deepak L Bhatt, Paolo Calabrò, Roxana Mehran, Philip Urban, Stuart Pocock, Stephan Windecker, Marco Valgimigli","doi":"10.1161/CIRCULATIONAHA.124.072009","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.072009","url":null,"abstract":"<p><strong>Background: </strong>Accurate bleeding risk stratification after percutaneous coronary intervention (PCI) is important for treatment individualization. However, there is still an unmet need for a more precise and standardized identification of high bleeding risk patients. We derived and validated a novel bleeding risk score by augmenting the PRECISE-DAPT score with the Academic Research Consortium for High Bleeding Risk (ARC-HBR) criteria.</p><p><strong>Methods: </strong>The derivation cohort comprised 29,188 patients undergoing PCI, of whom 1136 (3.9%) had a Bleeding Academic Research Consortium (BARC) 3 or 5 bleeding at 1 year, from four contemporary real-world registries and the XIENCE V USA trial. The PRECISE-DAPT score was refitted with a Fine-Gray model in the derivation cohort and extended with the ARC-HBR criteria. The primary outcome was BARC 3 or 5 bleeding within 1 year. Independent predictors of BARC 3 or 5 bleeding were selected at multivariable analysis (p<0.01). The discrimination of the score was internally assessed with apparent validation and cross-validation. The score was externally validated in 4578 patients from the MASTER DAPT trial and 5970 patients from the STOPDAPT-2 total cohort.</p><p><strong>Results: </strong>The PRECISE-HBR score (age, estimated glomerular filtration rate, hemoglobin, white-blood-cell count, previous bleeding, oral anticoagulation, and ARC-HBR criteria) showed an area under the curve (AUC) for 1-year BARC 3 or 5 bleeding of 0.73 (95% CI, 0.71-0.74) at apparent validation, 0.72 (95% CI, 0.70-0.73) at cross-validation, 0.74 (95% CI, 0.68-0.80) in the MASTER DAPT, and 0.73 (95% CI, 0.66-0.79) in the STOPDAPT-2, with superior discrimination than the PRECISE-DAPT (cross-validation: Δ AUC, 0.01; p=0.02; MASTER DAPT: Δ AUC, 0.05; p=0.004; STOPDAPT-2: Δ AUC, 0.02; p=0.20) and other risk scores. In the derivation cohort, a cut-off of 23 points identified 11,414 patients (39.1%) with a 1-year BARC 3 or 5 bleeding risk ≥4%. An alternative version of the score, including acute myocardial infarction on admission instead of white-blood-cell count, showed similar predictive ability.</p><p><strong>Conclusions: </strong>The PRECISE-HBR score is a contemporary, simple 7-item risk score to predict bleeding after PCI, offering a moderate improvement in discrimination over multiple existing scores. Further evaluation is required to assess its impact on clinical practice.</p>","PeriodicalId":10331,"journal":{"name":"Circulation","volume":null,"pages":null},"PeriodicalIF":35.5,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496238","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}
CirculationPub Date : 2024-10-27DOI: 10.1161/CIRCULATIONAHA.124.072466
William F Fearon
{"title":"In Which Patients Will PCI Relieve Angina?","authors":"William F Fearon","doi":"10.1161/CIRCULATIONAHA.124.072466","DOIUrl":"https://doi.org/10.1161/CIRCULATIONAHA.124.072466","url":null,"abstract":"","PeriodicalId":10331,"journal":{"name":"Circulation","volume":null,"pages":null},"PeriodicalIF":35.5,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496241","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}