European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"Management of dyslipidaemia in patients with comorbidities - facing the challenge: Heart failure.","authors":"Heinz Drexel, Matthias Frick, Andreas Zirlik, Alexander Niessner, Kurt Huber, Juan Tamargo, Dobromir Dobrev, Arthur Mader, Stefan Agewall","doi":"10.1093/ehjcvp/pvag033","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag033","url":null,"abstract":"<p><p>The combined prevalence of heart failure (HF) with coronary atherosclerosis is frequent and often causally linked. The aim of this review is to elucidate whether lipid lowering drugs (LLDs) are useful in this context. The role of LLDs is interesting in two ways: incidence of HF patients treated with LLD versus outcomes in patients with a history of HF. Rosuvastatin and alirocumab have been tested in outcome trials specifically on patients with HF, the results are neutral since no benefit arose. To the contrary, use of statins in individuals without HF at baseline has been demonstrated to weakly but significantly reduce the incidence of HF. Overall, there is no notion that statins or other LLD are harmful in patients with HF. We will discuss the contribution of systemic inflammation and consider ischaemic versus non-ischaemic HF. We conclude that in contrast to other comorbidities like e.g. type 2 diabetes mellitus (T2DM), in HF we face a below-than-average efficacy of LLDs in terms of reducing hard cardiovascular endpoints.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834857","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 and Safety of SGLT2 Inhibitor Initiation in Sacubitril-Valsartan Users with Heart Failure: A Population-Based Cohort Study.","authors":"Che-Yuan Wu, Baiju R Shah, Justin A Ezekowitz, Abhinav Sharma, Tianru Wang, C Fangyun Wu, Peter P Liu, Jodi D Edwards, Walter Swardfager","doi":"10.1093/ehjcvp/pvag031","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag031","url":null,"abstract":"<p><strong>Background: </strong>Large-scale real-world evidence regarding outcomes of sodium-glucose cotransporter-2 inhibitors (SGLT2i) initiation added to sacubitril-valsartan is currently limited. We aim to investigate effectiveness and safety of SGLT2i initiation among older sacubitril-valsartan users with heart failure in routine clinical practice.</p><p><strong>Methods: </strong>This prevalent new-user cohort study used linkable administrative data in Ontario, Canada, to emulate a target trial. In sacubitril-valsartan users with heart failure aged ≥66 years, SGLT2i initiators were matched on time-conditional propensity scores to non-initiators (October 2019 to June 2024). The primary effectiveness outcome was a composite of hospitalization for heart failure (HHF) or all-cause mortality. We also studied safety outcomes, including acute kidney injury (AKI), genital infection, urinary tract infection (UTI), falls, hospitalization for hypotension, diabetic ketoacidosis (DKA), and hypoglycemia.</p><p><strong>Results: </strong>Among 5,000 matched pairs, SGLT2i initiation was associated with lower HHF or all-cause mortality (hazard ratio [HR] 0.71, 95% confidence interval 0.64-0.78; 1-year absolute risk: 13.9% versus 19.2%). SGLT2i initiation was associated with a higher genital infection risk (2.36, 1.58-3.51; 1.8% versus 0.7%) but not with higher rates of falls, hospitalization for hypotension, or UTI. DKA was uncommon among SGLT2i users with diabetes as were hypoglycemic events among SGLT2i users without diabetes. SGLT2i initiation showed lower AKI among those with diabetes (0.78, 0.66-0.94) but not among those without diabetes (1.01, 0.66-0.94; HR homogeneity: p=0.035).</p><p><strong>Conclusions: </strong>This observational real-world evidence study supports effectiveness of SGLT2i among older sacubitril-valsartan users with heart failure, and suggests no increase in the safety outcomes studied, except genital infection.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834515","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":"Abbreviated DAPT after PCI with drug coated balloons in acute coronary syndromes - insights from the SWEDEHEART registry.","authors":"Anton Håkansson, Sacharias von Koch, Axel Dahlgren, Christian Reitan, Sasha Koul, Stefan James, Tomas Jernberg, Per Grimfjärd, Elmir Omerovic, Oskar Angerås, David Erlinge, Moman A Mohammad","doi":"10.1093/ehjcvp/pvag032","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag032","url":null,"abstract":"<p><strong>Aims: </strong>The absence of stent implantation when using drug-coated balloons (DCB) may decrease the required duration of dual antiplatelet therapy (DAPT). In the light of this, this study aimed to evaluate outcomes for patients with acute coronary syndromes treated with abbreviated versus standard DAPT after DCB-only PCI.</p><p><strong>Methods and results: </strong>Patients enrolled in the SWEDEHEART registry between June 2013 and February 2022, treated exclusively with DCBs for ACS, were included. Only patients discharged with ticagrelor as P2Y12-inhibition were included. Patients were categorized by intended DAPT duration at discharge. The primary outcome was net adverse clinical events (NACE) at one year from discharge date, defined as the first occurrence of all-cause death, stroke, myocardial infarction, or major bleeding. The primary analysis used inverse-probability-of-treatment-weighted (IPTW) Cox regression. Among 1,128 patients (141 abbreviated DAPT, 986 standard DAPT), NACE occurred in 25 patients (crude 17.7%; weighted 17.8%) in the abbreviated-DAPT arm and 133 patients (crude 13.5%; weighted 13.8%) in the standard-DAPT arm, corresponding to a weighted hazard ratio of 1.29 (95% CI 0.81-2.03; p=0.28). Results were consistent across pre-specified sensitivity analyses. Due to the small sample size, variance was generally high.</p><p><strong>Conclusion: </strong>In this nationwide registry-based analysis, abbreviated DAPT following DCB-only PCI in ACS was not associated with a statistically significant difference in NACE. However, the confidence intervals were wide and did not exclude clinically meaningful harm. The findings should be regarded as hypothesis-generating and indicate the need for more comprehensive evidence before abbreviated DAPT is routinely adopted in this setting.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835496","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 intensive blood pressure and blood glucose control on cardiovascular outcomes driven by reductions in cardiovascular death and nephropathy: Win ratio analysis of ADVANCE Trial.","authors":"Severine Bompoint, Laurent Billot, Anushka Patel, Mark Woodward, Katie Harris, Stephen Harrap, Giuseppe Mancia, Neil Poulter, John Chalmers","doi":"10.1093/ehjcvp/pvag026","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag026","url":null,"abstract":"<p><strong>Background and aims: </strong>To re-analyse the ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) trial using the win ratio approach to better understand the relative contributions of individual outcomes in a composite endpoint.</p><p><strong>Methods: </strong>We applied an unmatched win ratio analysis to the 11,140 participants of the ADVANCE trial, comparing intervention and control groups for blood pressure and glucose control. Outcomes were prioritised hierarchically by severity: cardiovascular death, non-fatal stroke, non-fatal myocardial infarction, nephropathy, and retinopathy. The ADVANCE trial is registered with ClinicalTrials.gov, number NCT00145925.</p><p><strong>Results: </strong>For blood pressure lowering, the perindopril-indapamide group had a win ratio of 1.11 (95% CI 1.01 to 1.22, p=0.028) compared to placebo and a net benefit of 1.5% (95% CI 0.2% to 2.8%) for a number needed to treat (NNT) of 68 patients. For intensive glucose control, the win ratio was 1.10 (95% CI 1.01 to 1.20, p=0.027) compared to standard glucose control with a net benefit of 1.6% (95% CI 0.2% to 3.0%) for a NNT of 63 patients. When both interventions were combined the win ratio increased to 1.19 (95% CI 1.04 to 1.35, p=0.010) and the NNT decreased to 41 patients. Cardiovascular death and nephropathy were the main contributors to the observed benefits.</p><p><strong>Conclusions: </strong>The win ratio approach confirms the robustness of the original ADVANCE findings while providing a more detailed understanding of the relative importance of individual outcomes. This method enhances the interpretation and communication of composite endpoint analyses.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766444","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":"Initiation of Eplerenone vs Spironolactone and All-cause Mortality in HFrEF: Linked Database Study.","authors":"Henrik Svanström, Anders Hviid, Björn Pasternak","doi":"10.1093/ehjcvp/pvag030","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag030","url":null,"abstract":"<p><strong>Aims: </strong>Mineralocorticoid receptor antagonists (MRAs) are recommended as part of guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF). The comparative effectiveness of spironolactone and eplerenone, however, remains uncertain.</p><p><strong>Methods and results: </strong>This was a non-interventional database study using nationwide Danish health registries, January 1, 2020-June 30, 2025. Patients aged ≥45 years with HFrEF (ejection fraction ≤40%) initiating eplerenone or spironolactone were included. An active-comparator, new-user design and inverse-probability-of-treatment weighting based on propensity scores was used. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, heart failure hospitalization, and their composite. Weighted hazard ratios (wHRs) were estimated using Cox proportional hazards models.A total of 4550 patients initiating eplerenone and 6651 initiating spironolactone were included. Median follow-up was 2.3 years. There were 571 deaths in the eplerenone group (5.0 per 100 person-years) and 1168 in the spironolactone group (7.0 per 100 person-years). A lower risk of death was observed with eplerenone (wHR, 0.83; 95% CI, 0.75-0.93), corresponding to an absolute rate difference of -1.10 per 100 person-years (95% CI, -0.50 to -1.70). For secondary outcomes, wHRs were 0.89 (95% CI, 0.81-0.98) for cardiovascular death or heart failure hospitalization, 0.79 (95% CI, 0.67-0.92) for cardiovascular death, and 0.97 (95% CI, 0.87-1.09) for heart failure hospitalization.Effect estimates were attenuated in per-protocol analyses.</p><p><strong>Conclusion: </strong>In this large nationwide study, initiation of eplerenone was associated with lower risks of all-cause and cardiovascular mortality compared with spironolactone, with findings suggesting a contribution of better treatment persistence.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147765941","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":"From Stabilization to Silencing in Transthyretin Amyloid Cardiomyopathy: Why Sequencing Should Be Treat-to-Trajectory, Not \"One-and-Done.","authors":"Arif Albulushi, Tasneem Al Rashdi, Hatem Al-Farhan, Gamal Aly","doi":"10.1093/ehjcvp/pvag013","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag013","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766378","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":"Correction to: Cardiovascular pharmacotherapy in 2025.","authors":"","doi":"10.1093/ehjcvp/pvag028","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag028","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766397","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":"Implementation of novel antithrombotic treatment strategies and outcome improvements in patients with myocardial infarction and atrial fibrillation over 20 years: a nationwide cohort study.","authors":"Christian Losciale, Lars Lindhagen, Lars Wallentin, Tomas Jernberg, Joakim Alfredsson, Jonas Oldgren, Gorav Batra","doi":"10.1093/ehjcvp/pvag027","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag027","url":null,"abstract":"<p><strong>Background: </strong>Patients with acute myocardial infarction (MI) and atrial fibrillation (AF) present challenges in antithrombotic treatment. Effects of newer treatment strategies on outcomes remain uncertain. We assessed implementation of antithrombotic treatment and occurrence of cardiovascular (CV) events and major bleeding in patients with MI and AF.</p><p><strong>Methods: </strong>Nationwide data from SWEDEHEART and national health registries were used to identify 71,513 survivors of an acute MI with AF between 2000-2021. Changes in antithrombotic therapies over time in 2-year cohorts were analysed, and associations with one-year outcomes were assessed. The outcomes were ischaemic stroke or systemic embolism, MI, major bleeding, CV mortality and all-cause mortality. Logistic regression was used to standardise for changes in patient characteristics and treatment over time.</p><p><strong>Results: </strong>Oral anticoagulant use increased from 21% in 2000-2001 to 75% in 2020-2021, largely due to adoption of direct oral anticoagulants (DOACs) after the first DOAC approval in 2011, most often combined with a single antiplatelet. Over time, particularly in the last decade, one-year risk of ischaemic stroke or systemic embolism declined from 6.0% to 2.1%, and CV mortality decreased from 19.8% to 10.5%. Major bleeding increased from 3.9% to 7.6% in 2014-2015, then declined to 6.4% in 2020-2021, simultaneously with adoption of single rather than dual antiplatelet therapy in combination with DOAC.</p><p><strong>Conclusions: </strong>Between 2000 and 2021, among patients with MI and AF, we observed reductions in one-year risks of ischaemic stroke or systemic embolism and CV mortality, occurring during a period of increased prescription of oral anticoagulants, particularly DOACs.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766416","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":"Beyond the review: additional non-oncologic drugs with clinically significant cardiovascular effects.","authors":"Lorenz Van der Linden, Thomas Vanassche","doi":"10.1093/ehjcvp/pvag029","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag029","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766433","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":"Monoclonal antibodies targeting IL-5/5R or IL-4/13 pathways in eosinophilic myocarditis: a single-center experience and systematic literature review.","authors":"A S Giordani, C Menghi, A Baritussio, F Scognamiglio, C Vicenzetto, F Davanzo, L Iorio, R Marcolongo, M De Gaspari, S Rizzo, C Basso, R Padoan, A L P Caforio","doi":"10.1093/ehjcvp/pvag025","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag025","url":null,"abstract":"<p><strong>Aims: </strong>Eosinophilic myocarditis (EM) is a rare inflammatory heart disease often associated with eosinophilic granulomatosis with polyangiitis or hypereosinophilic syndrome. While anti-IL-5/5R and anti-IL-4/13 monoclonal antibodies (mAbs) efficacy in systemic eosinophilic diseases is established, data on EM are lacking. We aimed to: (1) characterize a single-center cohort of EM patients treated with mepolizumab, benralizumab, or dupilumab in combination with glucocorticoids and/or immunosuppressants; (2) systematically review published cases, comparing them with a contemporary cohort; (3) evaluate myocardial response and safety of mAbs in EM, in comparison with a historical cohort treated without mAbs at our center.</p><p><strong>Methods and results: </strong>Thirty-seven EM patients were included (19 from a contemporary cohort, 18 from the literature; 51% male; median age 47 years). Biologic treatments were mepolizumab (81%), benralizumab (14%), and dupilumab (5%). Median time to mAb initiation was 2.5 months; treatment duration 24 months. No EM relapses, deaths, or heart transplantations occurred. Glucocorticoids were tapered and withdrawn in 89% of cases, with no mAb discontinuations due to adverse events. In the contemporary cohort, mAb therapy was associated with improved LVEF (47% to 55%, p = 0.004), TnI normalization (95% to 12%, p < 0.001), and eosinophil reduction (95% to 11%, p < 0.001). Compared to EM patients managed with conventional immunosuppressants alone, the mAb group had no myocarditis relapses (0% vs. 25%) and lower follow-up eosinophil counts (0.04 ×109/L vs 0.85 ×109/L).</p><p><strong>Conclusion: </strong>In EM within eosinophilic disease, anti-IL-5/5R and anti-IL-4/13 mAbs showed steroid-sparing effects and favorable safety, suggesting potential benefit for disease control.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147728461","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}