Clinical Research in Cardiology最新文献

{"title":"Specific treatment of ATTR-CM in Germany-expert consensus of the German Society of Amyloid Diseases (DGAK) and German Cardiac Society (DGK).","authors":"Fabian Aus dem Siepen, Teresa Trenkwalder, Birgit Aßmus, Ingrid Kindermann, Daniel Lavall, Sebastian Spethmann, Lars Michel, Timon Hansen, Sebastian Kruck, Christoph Rischpler, Fabian Knebel, Stéphanie K Schwarting, Udo Bavendiek, Maria Papathanasiou, Ute Hegenbart, Ali Yilmaz, Katrin Hahn, Alexander Carpinteiro, Roman Pfister, Caroline Morbach","doi":"10.1007/s00392-026-03006-1","DOIUrl":"https://doi.org/10.1007/s00392-026-03006-1","url":null,"abstract":"<p><strong>Background: </strong>Transthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized cause of heart failure. Three disease-modifying agents are now approved for treatment in Germany: the transthyretin (TTR) stabilizers tafamidis and acoramidis, and the TTR gene silencer vutrisiran. In the absence of head-to-head trials, practical guidance for individual treatment decisions is lacking.</p><p><strong>Methods: </strong>A multidisciplinary expert panel appointed by the German Society of Amyloid Diseases (DGAK) and the German Cardiac Society (DGK) performed a comprehensive review of pivotal randomized controlled trials, open-label extension studies, real-world data, and the approved German summaries of product characteristics to develop evidence-based consensus recommendations.</p><p><strong>Results: </strong>All three agents have demonstrated significant reductions in all-cause mortality and cardiovascular hospitalizations in phase 3 trials with comparable efficacy and tolerability profiles. Due to the absence of direct comparative studies, the panel concludes that tafamidis, acoramidis, and vutrisiran, based on the current scientific data, are considered similarly effective for most patients with confirmed ATTR-CM. An exception applies to patients with hereditary ATTR-CM and a mixed phenotype (concurrent cardiomyopathy and polyneuropathy), for whom vutrisiran is recommended as first-line therapy. Combination therapy is safe but, lacking randomized data regarding efficacy, cannot be recommended at present. Treatment decisions should incorporate patient preferences, comorbidities, mode of administration, and local regulatory frameworks. Regular monitoring using clinical parameters, biomarkers including TTR serum levels, and cardiac imaging is recommended.</p><p><strong>Conclusions: </strong>This consensus provides a practical framework for the specific treatment of ATTR-CM in Germany, aiming for early treatment initiation. Local standards and shared decision-making remain essential for the establishment of ATTR-CM therapy in an individual patient.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Memory of the renin-angiotensin system following heart transplantation or implantation of a left ventricular assist device.","authors":"Suriya Prausmüller, Georg Spinka, Annika Weidenhammer, Noel G Panagiotides, Paul Willmann, Gregor Heitzinger, Henrike Arfsten, Johanna Schlein, Philipp E Bartko, Christian Hengstenberg, Keziban Uyanik-Ünal, Julia Riebandt, Andreas Zuckermann, Daniel Zimpfer, Martin Hülsmann, Noemi Pavo","doi":"10.1007/s00392-026-03018-x","DOIUrl":"https://doi.org/10.1007/s00392-026-03018-x","url":null,"abstract":"<p><strong>Background: </strong>Renin-angiotensin system (RAS) inhibitors, while not routinely recommended after heart transplantation (HT), are advised in left ventricular assist device (LVAD) recipients to promote reverse remodeling and support myocardial recovery. Whether restoring hemodynamics through HT or LVAD implantation sufficiently resolves neurohormonal activation remains uncertain.</p><p><strong>Methods: </strong>Patients with end-stage heart failure undergoing HT or LVAD implantation were enrolled in a prospective registry. NT-proBNP, plasma active renin concentration (ARC), aldosterone levels, and the complete profile of angiotensin metabolites were assessed before and after the intervention in 49 HT and 12 LVAD recipients.</p><p><strong>Results: </strong>The use of RAS inhibitors was significantly reduced after HT (p < 0.001) and remained comparable in LVAD patients (p = 0.453). Both HT and LVAD were associated with reductions in NTproBNP (3015 to 1140 pg/mL; p < 0.001; 8980 to 1836 pg/mL; p = 0.002) and ARC levels (278 to 87µIU/mL; p < 0.001; 847 to 131 µIU/mL; p = 0.074), which was accompanied by a decrease in the angiotensin burden of the classical RAS axis (AngI + AngII: 159 to 47 ng/L, p < 0.001; 214 to 42 ng/L, p = 0.155). However, no patient showed normalization of NT-proBNP levels. Additionally, plasma renin remained elevated in 76% of HT and 67% of LVAD recipients, accompanied by detectable Ang II levels.</p><p><strong>Conclusion: </strong>Continuing AngII spill-over after HT and LVAD may affect patient outcomes, potentially contributing to complications. The findings support the rationale for cardioprotective treatment, particularly with RAS inhibitors, in most patients, while further studies should address the long-term effect of this strategy.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The estimated plasma volume status is an independent predictor for mortality in patients undergoing transcatheter mitral valve repair.","authors":"Moritz Haus, Franziska Grewe, Valeska Bienert, Christian Schach, Andreas Luchner, Christoph Birner, Lars S Maier, Bernhard Unsöld, Michael Paulus, Christine Meindl, Kurt Debl","doi":"10.1007/s00392-026-03021-2","DOIUrl":"https://doi.org/10.1007/s00392-026-03021-2","url":null,"abstract":"<p><strong>Introduction: </strong>Fluid overload and congestion are common in patients with mitral regurgitation and are associated with poor outcome and increased mortality. However, assessment for subclinical congestion in patients undergoing transcatheter edge-to-edge mitral valve repair (M-TEER) remains challenging. Besides the established natriuretic peptides like NT-proBNP, the estimated plasma volume status (ePVS) has emerged as a prognostic marker for intravascular congestion in heart failure and valvular heart disease. This study evaluated the prognostic impact of preprocedural ePVS in patients undergoing M-TEER.</p><p><strong>Methods: </strong>311 patients undergoing M-TEER were prospectively enrolled. The ePVS as the difference between actual and ideal plasma volume was calculated based on Hakim's formula using hematocrit, body weight and sex dependent constants. Follow-up data were collected regularly after M-TEER. Based on 1-year mortality, cut-off values for ePVS and NT-proBNP were calculated.</p><p><strong>Results: </strong>Median ePVS was -3.8% (IQR -10.3% to 3.6%). An elevated ePVS above the cut-off was associated with higher Kaplan-Meier-estimated mortality at 1 year (14.4% vs. 4.7%) and 5 years (63.0% vs. 26.0%; log-rank p<0.001). Elevated ePVS and NTproBNP remained independently associated with mortality after multivariable adjustment (ePVS: HR 2.38, 95%CI 1.20-4.74; p=0.013; NT-proBNP: HR 4.30, 95%CI 1.50-12.31; p=0.007). Their combined assessment provided further risk stratification, with the highest risk in patients with both markers elevated compared with neither (HR 14.27, 95%CI 3.19-63.89; p<0.001).</p><p><strong>Conclusion: </strong>Elevated preprocedural ePVS and NT-proBNP were independent predictors of mortality after M-TEER. Their combined assessment provided further risk stratification and may improve risk assessment in this heterogeneous population.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations of CMR-based pulse wave velocity and aortic distensibility with infrarenal ultrasound-based aortic parameters in the Hamburg City Health Study.","authors":"Katharina Alina Riedl, Eleonora Di Carluccio, Gunnar Lund, Markus Huellebrand, Anja Hennemuth, Rickmer Braren, Paulus Kirchhof, Stefan Blankenberg, Lisa Tilemann, Andreas Ziegler, Christian- Alexander Behrendt, Kai Muellerleile, Tilo Kölbel","doi":"10.1007/s00392-026-03029-8","DOIUrl":"https://doi.org/10.1007/s00392-026-03029-8","url":null,"abstract":"<p><strong>Background: </strong>Although pulse wave velocity (PWV) and aortic distensibility (AD) can be readily obtained from cardiac magnetic resonance imaging (CMR), there is a paucity of data on their use for screening for abdominal aortic aneurysm (AAA) and cardiovascular risk stratification.</p><p><strong>Methods: </strong>Data from the Hamburg City Health Study (HCHS) were used: PWV, AD of the ascending (AD AoAsc) and descending aorta (AD AoDesc) were quantified using 2D-phase-contrast-velocity-encoding-CMR-sequences. The maximum diameter and peak flow velocity of the infrarenal aorta were quantified by ultrasound-measurements. Diameter thresholds for infrarenal ectasia (25-29 mm) and aneurysm (≥ 30 mm) were defined in accordance with current guidelines.</p><p><strong>Results: </strong>The cohort consisted of 2,093 participants (median age 66 years, 42% women). Median infrarenal aortic diameter was 18.1 mm [IQR 16.4, 19.9] and peak flow velocity 98.6 cm/s [IQR 83.6,115.9]. After adjustment for age and sex, there were significant associations of diameter with AD AoDesc (Coefficient -0.572 p = 0.009) and of peak flow velocity with PWV (Coefficient -0.399, p = 0.029). Participants with infrarenal ectasia or aneurysm (n = 55) had significantly higher median PWV, whereas AD AoAsc, AD AoDesc and peak flow velocity were significantly lower (p = 0.004, p = 0.042, p = 0.039, p < 0.001) compared with normal aortic diameter cohort. After adjustment for covariates, PWV and AD showed a significant predictive value neither for prevalent infrarenal ectasia or nor for aneurysm.</p><p><strong>Conclusion: </strong>CMR-based aortic stiffness parameters such as PWV and AD were associated with infrarenal aortic parameters. Their diagnostic, screening, and prognostic value remains to be investigated.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149015643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of vascular and cardiac parameters on quality of life in patients undergoing catheter ablation for atrial fibrillation.","authors":"Mathieu Kruska, Volker Liebe, Christian Fastner, Malte Kranert, Marion Jehle, Anselm Derda, Gerhard Schumacher, Ibrahim Akin, Daniel Duerschmied, Anna Hohneck","doi":"10.1007/s00392-026-03005-2","DOIUrl":"https://doi.org/10.1007/s00392-026-03005-2","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) impairs quality of life (QoL), and catheter ablation (CA) has been shown to improve QoL in symptomatic individuals. The structural and functional cardiovascular determinants of impaired QoL remain incompletely understood.</p><p><strong>Methods: </strong>Participants with symptomatic AF scheduled for CA were prospectively enrolled and underwent pulse wave analysis (PWA, VascAssist2.0), echocardiography, and 12-lead electrocardiogram. QoL was assessed using the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) questionnaire. Univariate Spearman rank-order correlation analyses were performed to assess associations between AFEQT scores and clinical, vascular, echocardiographic, and laboratory parameters.</p><p><strong>Results: </strong>Eighty-three patients (52 male, 31 female) with a median age of 72 (IQR 63-80) years were included. Most participants had paroxysmal AF (82%), moderate to severe symptom severity (median EHRA score 3 (IQR 2-3)), and reduced QoL (mean AFEQT score 60 ± 19). Lower AFEQT scores correlated with higher vascular resistance (r =  - 0.64, p < 0.001), increased arterial stiffness (r =  - 0.62, p < 0.001), and elevated central systolic blood pressure (r =  - 0.38, p < 0.001). Cardiac variables significantly and inversely correlated with AFEQT scores included left ventricular (LV) ejection fraction < 50% (r =  - 0.74, p < 0.001), diastolic LV dysfunction (r =  - 0.34, p = 0.004), heart failure (r =  - 0.39, p < 0.001), and log-NT-proBNP levels (r =  - 0.38, p < 0.001).</p><p><strong>Conclusion: </strong>Reduced QoL correlates with vascular and myocardial functional impairment in patients with AF scheduled for catheter ablation. The potential incremental value of multimodal cardiovascular assessment warrants further evaluation.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148967020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic implications of one-year left ventricular systolic function after heart transplantation.","authors":"Ahad Firoz, Imo Ebong, Martin Cadeiras, Huaqing Zhao, Shirin Jimenez","doi":"10.1007/s00392-026-03022-1","DOIUrl":"https://doi.org/10.1007/s00392-026-03022-1","url":null,"abstract":"<p><strong>Background: </strong>The role of donor left ventricular ejection fraction (LVEF) at heart procurement has been extensively studied. However, there remain scarce data on how 1-year post-heart transplant (HTx) LVEF affects recipient outcomes. Our study seeks to address this gap.</p><p><strong>Methodology: </strong>The OPTN database was analyzed for adult orthotopic HTx recipients between 2010-2022. Patients with missing LVEF data during their 1-year follow-up were excluded. Recipients were stratified into four groups based on their 1-year LVEF: preserved: ≥ 50%, mildly reduced: 40-49%, moderately reduced: 30-39%, and severely reduced: < 30%.</p><p><strong>Results: </strong>In total, 23,629 recipients were included in this analysis. Patients with a reduced 1-year LVEF had higher hospitalization rates, as well as acute graft rejection and renal failure necessitating dialysis in the postoperative and subacute period. There was an incremental increase in all-cause mortality as LVEF decreased: mildly reduced (HR = 1.28, p = 0.011), moderately reduced (HR = 1.90, p < 0.001), and severely reduced (HR = 2.06, p = 0.002). Cardiovascular-related mortality had parallel findings. Similarly, recipients with a reduced 1-year LVEF had a progressive increase in their CAV risk: mildly reduced (sHR = 1.28, p = 0.005), moderately reduced (sHR = 1.57, p = 0.004), and severely reduced (sHR = 1.65, p = 0.025).</p><p><strong>Conclusion: </strong>Recipients with mild, moderate, and severe reductions in 1-year LVEF had higher rates of hospitalization, renal failure, and acute rejection, as well as a significant increase in mortality and CAV risk independent of other clinically relevant variables. The clinical implications of our findings suggest that LVEF 1-year after HTx is a powerful prognostic indicator that can allow clinicians to identify high-risk recipients, screen for comorbidities, and treat or manage subsequent pathologic processes timely.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918723","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obesity paradox in heart failure with and without diabetes mellitus: a retrospective cohort study : Obesity paradox and DM in HF.","authors":"Ohchul Kwon, Minjae Yoon, Jin Joo Park","doi":"10.1007/s00392-026-03007-0","DOIUrl":"https://doi.org/10.1007/s00392-026-03007-0","url":null,"abstract":"<p><strong>Background: </strong>Both diabetes mellitus (DM) and obesity are established risk factors for heart failure (HF). While obesity worsens DM outcomes, it may paradoxically confer survival benefits in HF patients. This study investigated the impact of obesity-DM interaction on clinical outcomes in HF.</p><p><strong>Methods and results: </strong>We pooled data from two prospective Korean HF registries (KorHF, n = 3,200; KorAHF, n = 5,625). Patients were classified by BMI (≤ / > 23 kg/m²) and DM status. Primary endpoints were in-hospital and one-year post-discharge mortality. Among 8,383 patients (mean age 68.2 years; 52.0% male; mean BMI 23.3 kg/m²), 34.0% had DM. Patients were categorized as overweight non-diabetic (31%), overweight diabetic (19%), lean non-diabetic (35%), and lean diabetic (15%). Lean diabetic patients had the worst baseline characteristics and outcomes, while overweight non-diabetic patients had the most favorable profile. In this retrospective analysis, after multivariable adjustment, overweight diabetic patients had a significantly lower one-year mortality risk than lean diabetic patients (adjusted HR 0.65, 95% CI 0.53-0.79; P < 0.001), as did overweight non-diabetic patients. The association between overweight status and in-hospital mortality was attenuated and no longer statistically significant after adjustment (overweight diabetic: adjusted OR 0.68, 95% CI 0.45-1.03, P = 0.069). No significant BMI × DM interaction was observed.</p><p><strong>Conclusions: </strong>Overweight status was associated with better prognosis in HF patients regardless of DM status, confirming the obesity paradox in both diabetic and non-diabetic HF populations. This obesity paradox was robust for one-year mortality but, after multivariable adjustment, was not independently associated with in-hospital mortality. Given the observational design, these findings should be interpreted as associations rather than evidence of a causal effect.</p><p><strong>Trial registration: </strong>KorAHF, ClinicalTrials.gov NCT01389843 (propectively registered); KorHF, ClinicalTrials.gov NCT04329234 (prospectively registered).</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Routine versus selective use of a femoral protection wire in transfemoral TAVI: a single-centre analysis of vascular complications.","authors":"Marc Adrian Rogmann, Victor Klingemann, Max Meertens, Majid Ahoopai, Karl-Philipp Rommel, Philipp Lurz, Ralph S von Bardeleben, Martin Geyer","doi":"10.1007/s00392-026-03015-0","DOIUrl":"https://doi.org/10.1007/s00392-026-03015-0","url":null,"abstract":"<p><strong>Background: </strong>Transfemoral transcatheter aortic valve implantation (TAVI) is the treatment of choice for severe aortic stenosis in patients with elevated surgical risk. However, vascular complications remain a major source of morbidity and mortality. The protection wire technique was introduced to prevent major access-related complications, but its role in contemporary TAVI practice is uncertain.</p><p><strong>Aims: </strong>To evaluate whether routine protection wire use reduces vascular complications in contemporary transfemoral TAVI.</p><p><strong>Methods: </strong>We performed a retrospective, single-centre analysis of 1476 consecutive patients undergoing transfemoral TAVI between January 2020 and August 2023. Until November 2021, protection wire placement was standard-of-care (Group 1, n = 801); thereafter procedures were performed without routine protection wire use (Group 2, n = 675). Vascular complications were defined according to VARC-3 criteria. Multivariable logistic regression was used to identify independent predictors of minor and major vascular complications.</p><p><strong>Results: </strong>The composite of minor and major vascular complications occurred more frequently in Group 1 than in Group 2 (18.6% vs. 10.8%, p < 0.001). In Group 1, 34.8% of access-related complications were associated with the protection wire access. Major vascular complications were numerically less frequent in Group 2 (2.5% vs. 4.2%). Omission of routine protection wire placement was independently associated with a lower risk (OR 0.52, 95% CI 0.38-0.72, p < 0.001).</p><p><strong>Conclusion: </strong>In contemporary transfemoral TAVI, routine protection wire use was not associated with reduced major vascular complications and was linked to a higher rate of minor access site injuries. These findings support a restrictive rather than routine use of protection wires in current practice.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gaps in lipid management among high-risk patients without prior MI or stroke: the VESALIUS-REAL global study.","authors":"Queenie Chan, Jaimini Cegla, Ulrich Laufs, Jan H Cornel, Gaetano M De Ferrari, Emil Hagström, Huei-Kai Huang, José Lopez-Miranda, Suna Avcil, Corinne Brooks, Thomas Cars, Adrienne Y L Chan, Celine S L Chui, Michael Duxbury, Edward Chia-Cheng Lai, David Neasham, Andreas Ochs, James O'Kelly, Gabriel Paiva da Silva Lima, Naomi Reimes, Swati Sakhuja, Shih-Chieh Shao, Ju-Young Shin, Mahendra Sibartie, Ilona Verburg, Matthew J Budoff, Kyung Woo Park, Kenichi Tsujita, Kai Hang Yiu, Nafeesa Dhalwani, Ian C K Wong","doi":"10.1007/s00392-026-03014-1","DOIUrl":"https://doi.org/10.1007/s00392-026-03014-1","url":null,"abstract":"<p><strong>Background: </strong>Real-world evidence on lipid-lowering therapy (LLT) use and low-density lipoprotein cholesterol (LDL-C) control in patients at high cardiovascular (CV) risk without prior myocardial infarction (MI) or stroke remains limited. We evaluated LLT use, treatment intensification, LDL-C monitoring, and LDL-C goal attainment across North America, Europe, and Asia-Pacific.</p><p><strong>Methods: </strong>VESALIUS-REAL is a retrospective observational study using a common protocol across 11 databases between 2017 and 2022. Eligible patients (aged ≥ 50 years) had coronary artery disease, atherosclerotic cerebrovascular disease, peripheral artery disease, or high-risk diabetes, together with elevated lipids, and additional CV risk factors, but no history of MI or stroke or end-stage renal disease. The earliest date when all criteria were met was defined as the index date. LLT patterns and local guideline-recommended LDL-C goal achievement were summarised.</p><p><strong>Results: </strong>Among 1,126,756 patients (51% female), 60% were not on LLT at index. Among patients with 1-year follow-up (n = 830,516), 27% of untreated patients initiated LLT, and 9% of treated patients intensified therapy. Overall, 52% underwent LDL-C testing within 1 year. Among patients with LDL-C measurements during follow-up, 21% achieved their local guideline-recommended LDL-C goal with consistently low attainment in both sexes.</p><p><strong>Conclusions: </strong>Most patients at high CV risk were not optimally managed, with low rates of LLT initiation, treatment intensification, LDL-C monitoring, and LDL-C goal attainment across 11 databases. These findings highlight a substantial unmet clinical need for improved guideline-based lipid management to prevent first major CV events in high-risk populations.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Body composition phenotypes are key predictors of cardiovascular-kidney-metabolic multimorbidity and long-term mortality: insights from a population-based cohort study.","authors":"Gwyneth Kong, Made Ayu Utami Intaran, Ernest Su Wei Soh, Yalkin Yazicioglu, Rachel Goh, Srinithy Nagarajan, Jiong-Wei Wang, Xin Zhou, Xiao-Dong Zhou, Ming-Hua Zheng, Mark Y Chan, Anurag Mehta, Carel W le Roux, Mamas A Mamas, Muhammad Shahzeb Khan, Nicholas W S Chew","doi":"10.1007/s00392-026-03010-5","DOIUrl":"https://doi.org/10.1007/s00392-026-03010-5","url":null,"abstract":"<p><strong>Aims: </strong>Cardiovascular-kidney-metabolic (CKM) syndrome is associated with increased risks of cardiovascular disease (CVD) and all-cause mortality, but its relationship with body composition phenotypes remains unclear.</p><p><strong>Materials and methods: </strong>This population-based cohort study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018, linked to the National Death Index through December 31, 2019. Participants were stratified on body mass index (BMI) and waist-to-height ratio (WHtR): (1) obesity with central adiposity (high BMI, high WHtR), (2) obesity without central adiposity (high BMI, low WHtR), (3) normal weight with central adiposity (normal BMI, high WHtR), and (4) normal weight without central adiposity (normal BMI, low WHtR). CKM multimorbidity was defined as ≥ 2 of hypertension, hyperlipidemia, diabetes, chronic kidney disease, and/or CVD. Primary and secondary outcomes were all-cause and cardiovascular mortality. Associations were assessed using survey-weighted Cox proportional hazards models.</p><p><strong>Results: </strong>The weighted cohort represented 106.9 million US adults (mean age 47.2). Majority were normal weight without central adiposity (53.3%), followed by obesity with central adiposity (33.9%), normal weight with central adiposity (8.1%), and obesity without central adiposity (4.7%). Normal weight with central adiposity had highest CKM multimorbidity (46.5%), risk of all-cause mortality (adjusted hazard ratio [aHR] 1.87, 95% CI 1.08-3.25, p = 0.025) and cardiovascular mortality (aHR 7.76, 95% CI 1.01-59.76, p = 0.049). The Kaplan-Meier curves demonstrate that individuals with both CKM multimorbidity and normal weight with central adiposity demonstrated the poorest long-term survival (p < 0.001).</p><p><strong>Conclusions: </strong>Normal weight individuals with central adiposity bear the greatest CKM burden and mortality risk, highlighting limitations of BMI-based risk assessment.</p>","PeriodicalId":10474,"journal":{"name":"Clinical Research in Cardiology","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}