European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"Management of patients with congenital bleeding disorders and cardiac indications for antithrombotic therapy.","authors":"Dan Atar, Christophe Vandenbriele, Stefan Agewall, Bruna Gigante, Andreas Goette, Diana A Gorog, Pål A Holme, Konstantin A Krychtiuk, Bianca Rocca, Jolanta M Siller-Matula, Marco Valgimigli, Andrea Rubboli, Robert Klamroth","doi":"10.1093/ehjcvp/pvaf006","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf006","url":null,"abstract":"<p><p>Cardiologists have only had rare exposure to haemophilia patients and patients with other congenital bleeding disorders during the last decades, as these patients had a reduced life expectancy and were partly protected against thrombosis due to the bleeding disorder.. With the availability of effective and safe replacement therapies of clotting factors, the average life expectancy in these populations of patients has significantly increased, and thrombotic complications may occur. The European Society of Cardiology (ESC) Working Group on Thrombosis has taken the initiative to broaden the spectrum of these haematological conditions to include patients with a larger variety of congenital bleeding disorders with concomitant cardiac conditions as compared to a recent position paper by the European Haematology Association (EHA) in collaboration with other societies (ISTH, EAHAD, ESO). Management of antithrombotic therapy or thromboprophylaxis in these individuals is challenging due to the wide phenotypes encompassed by congenital bleeding disorders. These include abnormalities in both primary haemostasis (involving von Willebrand factor and platelet function) and secondary haemostasis (related to coagulation factors and fibrinogen). Bleeding disorders range from mild to very severe. Based on existing literature, we provide clinical consensus statements on optimizing antithrombotic treatment strategies for patients with congenital bleeding disorders and highlight the current gaps in knowledge in these complex clinical settings. Of importance, an individualized approach to antithrombotic therapy is warranted to properly balance the two risks of thrombosis and bleeding. Adoption of the safest interventional techniques, reduction of the intensity and/or duration of antithrombotic therapies, and attention to the safe levels of clotting factors is generally advised.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143718426","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":"Apixaban outcomes in AF patients with single dose-reduction criterion: ASPIRE 1-year results.","authors":"So-Ryoung Lee, JungMin Choi, Soonil Kwon, Hyo-Jeong Ahn, Kyung-Yeon Lee, Jong-Il Choi, Sung Ho Lee, Jung Ho Heo, Il-Young Oh, Young Keun On, Hee Tae Yu, Kwang-No Lee, Nam-Ho Kim, Hyung Wook Park, Ki Hong Lee, Seung Yong Shin, Hyoung-Seob Park, Seongwook Han, Seil Oh, Gregory Y H Lip, Jong-Sung Park, Eue-Keun Choi","doi":"10.1093/ehjcvp/pvaf018","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf018","url":null,"abstract":"<p><strong>Aims: </strong>This study, using a prospective cohort, evaluated the effectiveness and safety of off-label reduced-dose apixaban versus the on-label dose in atrial fibrillation (AF) patients meeting a single dose reduction criterion.</p><p><strong>Methods and results: </strong>The efficAcy and Safety of aPixaban In Real-world practice in Korean frail patients with AF (ASPIRE) study is a multicenter, prospective observational cohort involving AF patients who met a single dose reduction criterion of apixaban. Patients were divided into two groups: on-label standard dose (5 mg twice daily) and off-label reduced dose (2.5 mg twice daily). The primary effectiveness outcome was stroke/systemic embolism (SSE), and the primary safety outcome was major bleeding. Of 1 944 patients (mean age 74.3 ± 7.9 years, 56% women), 997 (51%) were receiving off-label reduced dose apixaban. The off-label reduced dose group was older, had more comorbidities, higher concomitant antiplatelet use, and higher CHA2DS2-VASc and HAS-BLED scores. During follow-up (1.0 ± 0.2 year), crude incidence rates were 0.9 vs. 0.7 per 100 person-years for SSE and 0.5 vs. 1.0 for major bleeding in the on-label vs. off-label groups. After inverse probability of treatment weighting, the off-label reduced dose group showed no significant differences in the risk of SSE (HR 0.67, 95% CI 0.28-1.59, p = 0.370) and major bleeding (HR 1.38, 95% CI 0.44-4.35, p = 0.578) compared to the on-label standard dose group.</p><p><strong>Conclusion: </strong>In Korean patients with AF meeting a single dose reduction criterion of apixaban, off-label reduced-dose apixaban showed no significant differences in SSE and major bleeding compared to the on-label standard dose. These findings suggest that individualized anticoagulation strategies, such as reduced dose apixaban, may be beneficial for patients with a high risk of bleeding.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143669309","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":"CLEAR results, cloudy impact: colchicine's neutral role in ST-segment elevation myocardial infarction.","authors":"Claudio Laudani, Antonio Abbate, Dominick J Angiolillo, Mattia Galli","doi":"10.1093/ehjcvp/pvaf011","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf011","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143624077","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 SGLT2i on kidney outcomes of individuals with type 2 diabetes according to body mass index: nationwide cohort study.","authors":"Takahiro Jimba, Hidehiro Kaneko, Yuta Suzuki, Akira Okada, Tatsuhiko Azegami, Toshiyuki Ko, Katsuhito Fujiu, Hiroyuki Morita, Norifumi Takeda, Kaori Hayashi, Takashi Yokoo, Koichi Node, Issei Komuro, Hideo Yasunaga, Masaomi Nangaku, Norihiko Takeda","doi":"10.1093/ehjcvp/pvae094","DOIUrl":"10.1093/ehjcvp/pvae094","url":null,"abstract":"<p><strong>Aims: </strong>To investigate the clinical significance of the modification of the kidney protective effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors by baseline body mass index (BMI).</p><p><strong>Methods and results: </strong>We included individuals with SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP4) inhibitors newly prescribed for type 2 diabetes using a nationwide epidemiological cohort and performed propensity score matching (1:2). The primary outcome was the annual eGFR decline, assessed using a linear mixed-effects model, compared between individuals with SGLT2 inhibitors and DPP4 inhibitors. We investigated the interaction effect of BMI at the time of prescription using a three-knot restricted cubic spline model. We analysed 2165 individuals with SGLT2 inhibitor prescriptions and 4330 individuals with DPP4 inhibitor prescriptions. Overall, the annual decline in eGFR was less pronounced in the group treated with SGLT2 inhibitors than in those treated with DPP4 inhibitors (-1.34 mL/min/1.73 m2 vs. -1.49 mL/min/1.73 m2). The advantage of SGLT2 inhibitors in mitigating eGFR decline was augmented in the individuals with higher BMI (P-value for interaction 0.0017). Furthermore, even upon adjusting the definition of outcomes to encompass a 30 or 40% reduction in eGFR, the potential advantages of SGLT2 inhibitors over DPP4 inhibitors persisted, with a trend of augmented effects with higher BMI. This interaction effect was evident in the individuals with preserved kidney function.</p><p><strong>Conclusion: </strong>Our nationwide epidemiological study substantiated the improved kidney outcomes in the SGLT2 inhibitor users compared with the DPP4 inhibitor users across a wide range of BMI, which was pronounced for individuals with higher BMI.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"155-163"},"PeriodicalIF":5.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078968","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}

{"title":"Targeting lipoprotein(a): Pharmacotherapy in focus.","authors":"Doreen Su-Yin Tan, Zi Heng Ooi, Claire Sook Fui Lew","doi":"10.1093/ehjcvp/pvae102","DOIUrl":"10.1093/ehjcvp/pvae102","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"114-115"},"PeriodicalIF":5.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142921091","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}

{"title":"Comparative cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors in atherosclerotic cardiovascular disease phenotypes: a systematic review and meta-analysis.","authors":"Yu-Min Lin, Jheng-Yan Wu, Mei-Chuan Lee, Chen-Lun Su, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Chia-Te Liao","doi":"10.1093/ehjcvp/pvae093","DOIUrl":"10.1093/ehjcvp/pvae093","url":null,"abstract":"<p><strong>Background: </strong>Atherosclerotic cardiovascular disease (ASCVD) encompasses various phenotypes with elevated risks of major adverse cardiovascular events (MACEs). This study aimed to assess the comparative cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is) across diverse ASCVD phenotypes.</p><p><strong>Methods and results: </strong>We conducted a systematic review and meta-analysis of randomized controlled trials evaluating GLP-1 RAs or SGLT2is against placebo or standard care in ASCVD patients. Primary outcomes included MACE, defined as cardiovascular mortality, non-fatal myocardial infarction, and non-fatal stroke. Risk ratios (RRs) with 95% confidence interval (CI) were calculated using a random-effects model.Twenty-six trials (151 789 patients) were included. Both GLP-1 RAs and SGLT2is significantly reduced MACE rates in ASCVD patients (RR 0.85; 95% CI 0.80-0.91 for both). GLP-1 RAs showed significant effectiveness in peripheral artery disease (RR 0.86; 95% CI 0.76-0.98) and post-acute cardiovascular events (RR 0.90; 95% CI 0.83-0.97). In ASCVD with heart failure, both drug classes reduced MACE (GLP-1 RAs: RR 0.73; 95% CI 0.63-0.84; SGLT2is: RR 0.86; 95% CI 0.78-0.95). SGLT2is significantly reduced MACE in ASCVD with chronic kidney disease (RR 0.84; 95% CI 0.72-0.99), particularly in severe albuminuria (RR 0.61; 95% CI 0.37-0.99).</p><p><strong>Conclusion: </strong>GLP-1 RAs and SGLT2is exhibit distinct cardiovascular effectiveness profiles across ASCVD phenotypes. GLP-1 RAs show particular benefits in peripheral artery disease and post-acute cardiovascular events, while SGLT2is demonstrate unique advantages in ASCVD with comorbid chronic kidney disease. Both are effective in heart failure. These findings support tailored treatment strategies for diverse ASCVD participants based on specific comorbidities and risk factors.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"174-189"},"PeriodicalIF":5.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382004","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}

{"title":"Acute effects of empagliflozin on left atrial and ventricular filling parameters using echocardiography-a subanalysis of the EMPAG-HF trial.","authors":"Jurgen Bogoviku, Tien Dung Nguyen, Julian Georg Westphal, Pawel Aftanski, Sven Moebius-Winkler, Franz Haertel, Sissy Grund, Ali Hamadanchi, Martin Busch, Paul Christian Schulze","doi":"10.1093/ehjcvp/pvaf003","DOIUrl":"10.1093/ehjcvp/pvaf003","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose co-transporter 2 (SGLT2) inhibitors improve prognosis in chronic heart failure as part of currently recommended therapeutic strategies. Transthoracic echocardiography (TTE) is frequently used to assess heart function and dimensions in acute heart failure to lead therapy and assess volume status. Immediate changes, especially of left heart haemodynamic parameters, measured by echocardiography in patients with acute heart failure treated with SGLT2 inhibitors, remain unknown.</p><p><strong>Aim: </strong>The aim of this pre-defined secondary analysis was to assess whether treatment with empagliflozin 25 mg/day in patients with acute heart failure improves echocardiographic parameters of load, left ventricular or right ventricular function.</p><p><strong>Methods and results: </strong>In the single-centre, prospective, double-blind, placebo-controlled EMPAG-HF trial, patients with acute decompensated heart failure (ADHF) were screened and randomized within 12 h following hospital admission to receive either empagliflozin or placebo in addition to standard medical treatment over 5 days. Sixty patients were enrolled and randomized irrespective of left ventricular ejection fraction or diabetes. All patients received 2D TTE on admission (tB = at baseline) and after completing the study treatment (tC = time after completing study medication) (according to study design). The recorded loops were analysed using dedicated software (Image-Arena™ Version 4.6; TomTec Imaging Systems). After 5 days of treatment, patients in the empagliflozin cohort showed a relevant decrease in left atrial volume [LAV: ∆tB-tC = 30.9 ± 27.4; 95% confidence interval (CI) 20.1-41.7) compared to placebo ∆tB-tC = 10.5 ± 26; 95% CI 0.4-20.5; P = <0.001] and left atrial end-systolic volume index (LAESVI: ∆tB-tC = 15.7 ± 15.1; 95% CI 9.8-21.6 vs. placebo ∆tB-tC = 9.7 ± 10.2; 95% CI 5.7-13.6; P = 0.016) compared to placebo.</p><p><strong>Conclusion: </strong>Immediate addition of empagliflozin to standard therapy improves echocardiographic parameters of LAV in patients following recompensation of ADHF.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"190-197"},"PeriodicalIF":5.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143556305","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}

{"title":"Aspirin in patients with glucose-6-phosphate dehydrogenase deficiency: a true clinical issue?","authors":"Gianmarco Sarto, Emanuele Soraci, Sebastiano Sciarretta, Mattia Galli","doi":"10.1093/ehjcvp/pvae101","DOIUrl":"10.1093/ehjcvp/pvae101","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"112-113"},"PeriodicalIF":5.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142914045","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}

{"title":"The untapped potential of guideline-directed heart failure pharmacotherapy: consequences of missed opportunities.","authors":"Ester J Herrmann, Samuel Sossalla","doi":"10.1093/ehjcvp/pvae096","DOIUrl":"10.1093/ehjcvp/pvae096","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"107-108"},"PeriodicalIF":5.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905742/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885445","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}

{"title":"Impact of a personalized, strike early and strong lipid-lowering approach on low-density lipoprotein-cholesterol levels and cardiovascular outcome in patients with acute myocardial infarction.","authors":"Giuseppe Patti, Luca Cumitini, Manuel Bosco, Alessandra Marengo, Domenico D'Amario, Marco Mennuni, Martina Solli, Leonardo Grisafi","doi":"10.1093/ehjcvp/pvaf004","DOIUrl":"10.1093/ehjcvp/pvaf004","url":null,"abstract":"<p><strong>Aims: </strong>Considering the lack of evidence, we evaluated the impact on cardiovascular outcome of the systematic introduction in our institution of a personalized strike early and strong (SES) approach for lipid-lowering therapy (LLT) in patients admitted for acute myocardial infarction (MI).</p><p><strong>Methods and results: </strong>We retrospectively analysed data from 500 consecutive patients hospitalized across three periods: Period A (N = 198, January-June 2019), when the low-density lipoprotein cholesterol (LDL-C) goal was <70 mg/dL and a stepwise LLT approach was recommended; Period B (N = 180, January-June 2021), when the LDL-C goal was <55 mg/dL and a stepwise approach was recommended; Period C (N = 122, January-June 2023), when the LDL-C goal was <55 mg/dL and our SES protocol was implemented. Primary endpoints were achievement of the LDL-C goal during follow-up and 1-year incidence of major adverse cardiovascular events (MACE). Compared to the other periods, in Period C, there was a higher use of potent statins, alone or in combination with ezetimibe, and of proprotein convertase subtilisin/kexin type 9 inhibitor inhibitors at discharge. This translated into higher achievement of the LDL-C goal (83% vs. 55% in Period A and 43% in Period B; P < 0.001) and reduced incidence of MACE (3% vs. 12% and 11%; P = 0.026). MACE rates were lowest in patients with early and sustained LDL-C <55 mg/dL and in those achieving both LDL-C <55 mg/dL and ≥50% LDL-C reduction.</p><p><strong>Conclusion: </strong>The systematic introduction of a personalized, SES strategy for LLT in patients with acute MI led to greater achievement of LDL-C goal and lower risk of MACE at 1 year vs. the stepwise approach.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"143-154"},"PeriodicalIF":5.3,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037560","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}