European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"Average daily ischemic and bleeding risk following acute coronary syndrome: Insights from the FORCE-ACS registry.","authors":"Jaouad Azzahhafi, Dean R P P Chan Pin Yin, Niels M R van der Sangen, Wout W A van den Broek, Shabiga Sivanesan, Qiu Ying F van de Pol, Ronald J Walhout, Melvyn Tjon Joe Gin, Ron Pisters, Deborah M Nicastia, Jorina Langerveld, Georgios J Vlachojannis, Rutger J van Bommel, Yolande Appelman, José P S Henriques, Wouter J Kikkert, Jurriën M Ten Berg","doi":"10.1093/ehjcvp/pvag084","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag084","url":null,"abstract":"<p><strong>Aims: </strong>To characterize ischemic and bleeding events and compare the average daily ischemic rate (ADIR) and average daily bleeding rate (ADBR) during three years post-ACS.</p><p><strong>Methods and results: </strong>Data were derived from ACS patients enrolled in the prospective multicenter FORCE-ACS registry in nine Dutch hospitals between 2015 and 2019. ADIR and ADBR, expressed as events per 100 person-days, were calculated by dividing the total number of events by total follow-up time in the acute (day 0 to 1), subacute (day 1 to 30), late (day 30 to 365) and very late (day 365 to 1095) phase. Ischemic events comprised cardiovascular death, myocardial infarction and definite stent thrombosis; bleeding events comprised Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding. The Wilcoxon signed rank test compared the ADIR and ADBR per phase.During three years, 929 ischemic events occurred in 808 patients (16.1%) and 1,694 bleeding events in 1,177 patients (23.4%). The ADBR was higher than ADIR in the acute (1.41 vs 0.68) and late phase (0.04 vs 0.02). No significant difference was observed in the subacute (0.23 vs 0.13) and very late phase. Overall, the ADBR exceeded the ADIR (0.03 vs 0.02), with the highest difference during the first year.</p><p><strong>Conclusions: </strong>Ischemic and bleeding events are most prevalent in the first 30 days post-ACS. Both ADIR and ADBR decrease over time, with the excess of ADBR over ADIR being most pronounced during the first year of follow-up.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080052","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":"Statins for primary prevention in the elderly.","authors":"Jessica Schubert, Margret Leosdottir","doi":"10.1093/ehjcvp/pvag082","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag082","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149080058","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":"Clopidogrel in-laboratory versus outpatient preloading in chronic coronary syndrome patients undergoing diagnostic coronary angiography with potential ad-hoc percutaneous coronary intervention.","authors":"Rosanne F Vogel, Elsbeth C Noppers, Niels J Verouden, Jose P S Henriques, Maik J Grundeken, Alexander W den Hartog, Alex Nap, Jorrit S Lemkes, Bimmer E P M Claessen, Ronak Delewi","doi":"10.1093/ehjcvp/pvag083","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag083","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149073759","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":"Rewriting Heart Health: Epigenetic Drugs in Cardiovascular Medicine.","authors":"Natalia Atzemian, Ludovica Di Venanzio, Shafeeq Ahmed Mohammed, Sarah Costantino, Frank Ruschitzka, Francesco Paneni","doi":"10.1093/ehjcvp/pvag075","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag075","url":null,"abstract":"<p><p>Cardiovascular disease reflects not only genetic predisposition and haemodynamic stress but also reversible alterations in chromatin organisation and transcriptional programming, a layer of regulation that is, in principle, amenable to pharmacological intervention. Purpose-built epigenetic drugs, DNA methyltransferase inhibitors, histone deacetylase inhibitors, histone acetyltransferase inhibitors, bromodomain and extraterminal domain inhibitors, enhancer of zeste homolog 2 inhibitors, and RNA-based therapeutics, target this machinery directly. In parallel, established cardiovascular therapies, including statins, renin-angiotensin-aldosterone system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, antithrombotic agents, sodium-glucose cotransporter-2 inhibitors, and incretin-based therapies, appear to modulate the epigenome as an underappreciated component of their action, a concept termed \"pharmaco-epigenetics\". This review appraises both axes side by side, with explicit attention to clinical maturity, including the level of evidence, human validation, development stage, and the interpretation of hypothesis-generating findings. Key translational barriers, cardiac-targeted delivery, biomarkers of target engagement, and interindividual epigenetic variability, are outlined alongside priorities for future trial design.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037181","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":"Coated or chewable Aspirin and a hybrid air pollution mitigation strategy in patients with atherosclerotic disease: Rationale and Design of the COATED-AIR Randomized Trial.","authors":"Behnood Bikdeli, Azita H Talasaz, Hooman Bakhshandeh, Mohammad Sadegh Hassanvand, Hessam Kakavand, Sepehr Jamalkhani, Sina Rashedi, Sara Tayyebi, Mohammadreza Babaei, Erfan Kohansal, Hamed Ghoshouni, Yasmin Mohtasham Kia, Mahsa Nikkhoo, Bahram Mohebbi, Maryam Aghakouchakzadeh, Saeed Alipour-Parsa, Armin Elahifar, Ehsan Khalilipur, Razieh Omidvar, Maryam Mehrpooya, Seyed Hashem Sezavar, David Jimenez, Luis Jara Palomares, Saeideh Mazloomzadeh, Naser Hadavand, Mehdi Ansari Dogaheh, Majid Maleki, Feridoun Noohi, Luis Ortega-Paz, Jayant K Raikhelkar, Philippe Gabriel Steg, Renato D Lopes, Raffaele De Caterina, Mehdi H Shishehbor, Loren Laine, Dominick J Angiolillo, Sanjay Rajagopalan, Ajay J Kirtane, Gregory Piazza, Gregory Y H Lip, Roxana Mehran, Harlan M Krumholz, Paul M Ridker, Parham Sadeghipour","doi":"10.1093/ehjcvp/pvag071","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag071","url":null,"abstract":"<p><strong>Background: </strong>Although enteric-coated aspirin is widely used instead of chewable formulations in patients with atherosclerotic cardiovascular diseases (ASCVD), its effects on cardiovascular and gastrointestinal outcomes remain uncertain. Separately, air pollution is a driver of cardiovascular risk, yet individual-level interventions have not been tested in outcomes trials.</p><p><strong>Methods and results: </strong>The Coated Or Chewable Aspirin in Patients with Established AThErosclerotic Disease and a Hybrid Strategy to Mitigate the Adverse Effects of AIR Pollution (COATED-AIR) is a randomized trial with a 2x2 factorial design planned to address these knowledge gaps. Patients with ASCVD receiving low-dose aspirin are considered for inclusion. Major exclusion criteria consist of being within 72 hours of acute/unstable ASCVD or revascularization, triple antithrombotic therapy, active/recent bleeding, life expectancy <1 year, or other barriers or unwillingness for enrollment. Eligible consenting patients are randomized, in a double-blind fashion, to enteric coated vs chewable aspirin 81mg daily, and (via factorial randomization) to a hybrid strategy to mitigate the adverse effects of air pollution vs usual care. The hybrid strategy includes 1. an educational flashcard, 2. real-time air quality alerts via cellular text messages, and recommendations to 2a. limit outdoor activity or 2b. to use a KN-95 facemask when outdoors, and 2c. to increase citrus fruit intake on days with elevated pollution levels. The primary efficacy outcome for the aspirin randomization is a composite of fatal/nonfatal ischemic stroke, thrombotic/thromboembolic myocardial infarction, and acute limb ischemia. For the AIR randomization, other forms of cardiovascular death are additionally included in the primary composite outcome. The median planned duration of follow-up is 2 years. Enrollment was completed on 01/28/2026. Clinical follow-up and blinded event adjudications are ongoing.</p><p><strong>Conclusion: </strong>COATED-AIR will determine whether aspirin coating affects its safety or effectiveness, and whether individual-level strategies can mitigate cardiovascular risks from air pollution in patients with ASCVD.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024186","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":"API-CAT investigators' decisions on anticoagulation following extended treatment for cancer-associated thrombosis.","authors":"Isabelle Mahé, Florent Happe, Manuel Monreal, Helia Robert-Ebadi, Philippe Debourdeau, Jean-Roch Fabreguettes, Sandrine Accassat, Patrick Mismetti, Philippe Girard, Silvy Laporte, Céline Chapelle","doi":"10.1093/ehjcvp/pvag046","DOIUrl":"10.1093/ehjcvp/pvag046","url":null,"abstract":"<p><strong>Aims: </strong>The API-CAT trial demonstrated that reduced-dose apixaban (2.5 mg twice daily) was noninferior to full-dose apixaban (5 mg twice daily) for the prevention of recurrent venous thromboembolism in patients with cancer, while resulting in fewer clinically relevant bleeding events. Although these findings are expected to influence clinical practice, real-world data on physicians' anticoagulation decisions in this setting remain limited. To describe investigators' anticoagulant treatment decisions for patients enrolled in the API-CAT trial after discontinuation of blinded study treatment and prior to trial unblinding and dissemination of results.</p><p><strong>Methods and results: </strong>This descriptive analysis included patients from the prospective, multicentre, randomized, double-blind API-CAT trial who received at least one dose of study medication. Investigators prospectively documented anticoagulation management following either premature or planned discontinuation of blinded apixaban. Decisions were categorized as treatment discontinuation, continuation at a reduced dose, or continuation at a full dose. Descriptive analyses examined treatment choices according to patient characteristics, cancer features, and contextual factors. Of 1766 randomized patients, 1458 (82.6%) were included in the analysis. After discontinuation of study treatment, anticoagulation was stopped in 198 patients (13.6%) and continued in 1260 (86.4%). Among those continuing therapy, 790 patients (62.7%) received full-dose anticoagulation, 465 (36.9%) received a reduced dose, 5 unknown. Direct oral anticoagulants (DOACs) were prescribed in 89.6% of cases, and low-molecular-weight heparin in 9.9%. Treatment decisions were generally consistent across patient and cancer characteristics but varied according to timing of treatment discontinuation, physician specialty, and country.</p><p><strong>Conclusion: </strong>Prior to unblinding of the API-CAT trial, treatment decisions appeared poorly driven by clinical characteristics, reflecting a 'therapeutic grey zone' where anticoagulation was continued in most patients but with highly variable dosing. This exploratory snapshot provides a baseline to monitor the anticipated shift towards wider adoption of reduced-dose apixaban for extended anticoagulation following publication of the API-CAT results. The substantial proportion of treatment discontinuation highlights the need for further studies to identify patients who may safely stop therapy.</p><p><strong>Trial registration: </strong>API-CAT ClinicalTrials.gov number, NCT03692065.</p><p><strong>Coordination: </strong>Assistance Publique Hôpitaux de Paris, France.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"447-457"},"PeriodicalIF":8.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338209","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":"A bleeding score identifies who bleeds, not who benefits: anticoagulation decisions in post-operative atrial fibrillation after coronary surgery.","authors":"Xiang Zhou, Hongyan Liu, Zhengdong Hua","doi":"10.1093/ehjcvp/pvag049","DOIUrl":"10.1093/ehjcvp/pvag049","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"490-491"},"PeriodicalIF":8.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367460","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":"Response to Lu Li and colleagues.","authors":"Angelo Avogaro, Mauro Gori, Giuseppe Grandaliano, Massimo Iacoviello, Roberto Trevisan","doi":"10.1093/ehjcvp/pvag062","DOIUrl":"10.1093/ehjcvp/pvag062","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"498"},"PeriodicalIF":8.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863873","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":"Can ARNI Prevent Atrial Fibrillation in Heart Failure with Reduced Ejection Fraction? Real-World Evidence Meets the Randomized Benchmark.","authors":"Enrico Volpe, Stanislovas Jankauskas, Pasquale Mone, Shivangi Pande, Maria Laura Danza, Gaetano Santulli","doi":"10.1093/ehjcvp/pvag080","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvag080","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":8.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016120","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":"Bleeding risk assessment in patients with new-onset atrial fibrillation after coronary surgery (reply).","authors":"Anders Jeppsson, Mary Rezk, Florian E M Herrmann","doi":"10.1093/ehjcvp/pvag052","DOIUrl":"10.1093/ehjcvp/pvag052","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"494-495"},"PeriodicalIF":8.2,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13593198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148410859","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}