European Heart Journal - Cardiovascular Pharmacotherapy最新文献

{"title":"2024 ESC Guidelines for the management of elevated blood pressure and hypertension: what is new in pharmacotherapy?","authors":"Cian P McCarthy, Rosa Maria Bruno, John W McEvoy, Rhian M Touyz","doi":"10.1093/ehjcvp/pvae084","DOIUrl":"10.1093/ehjcvp/pvae084","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"7-9"},"PeriodicalIF":5.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497519","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":"Subcutaneous furosemide in heart failure: a systematic review.","authors":"Joanna Osmanska, Mark C Petrie, Kieran F Docherty, Matthew M Y Lee, John J V McMurray, Ross T Campbell","doi":"10.1093/ehjcvp/pvae083","DOIUrl":"10.1093/ehjcvp/pvae083","url":null,"abstract":"<p><strong>Background and aim: </strong>Intravenous loop diuretics are the primary treatment for congestion in patients with decompensated heart failure (HF). Furosemide is the most commonly used loop diuretic and is licensed for administration either orally, intramuscularly or intravenously but not subcutaneously. Recently developed, pH-neutral, concentrated, and 'skin-friendly' preparations of furosemide have been developed which allow subcutaneous administration. In this systematic review, we summarize and critically appraise the current evidence for subcutaneous furosemide in patients with HF.</p><p><strong>Methods and results: </strong>The electronic databases MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry were searched up to 30 September 2024. Of the 17 studies identified, 5 were randomized controlled trials (RCTs), 2 were non-randomized controlled studies, 3 were prospective observational cohort studies, and 7 were retrospective observational studies.All RCTs utilized novel pH-neutral, subcutaneous preparations of furosemide. Bioavailability of novel subcutaneous preparations were similar to intravenous furosemide 10 mg/mL: 99.7% for an 8 mg/mL preparation and 112% for a 30 mg/mL preparation. Natriuresis and diuresis were also similar with novel subcutaneous and conventional intravenous furosemide. Adverse events related to novel preparations included infusion site pain or discomfort, localized skin erythema and minimal swelling. All studies of subcutaneous conventional furosemide were non-randomized with very few data regarding bioavailability or diuretic and natriuretic effect. Subcutaneous conventional furosemide was associated with substantial skin irritation (affecting 3-23% of patients), and skin infections requiring treatment with antibiotics (3-17%).</p><p><strong>Conclusion: </strong>Novel, pH-neutral preparations of subcutaneous furosemide achieved similar diuresis, natriuresis, and bioavailability to intravenous furosemide, and were well tolerated. Novel preparations may be a treatment option for patients with HF.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"94-104"},"PeriodicalIF":5.3,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11805693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617261","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":"Inotropes and mortality in patients with cardiogenic shock: more questions than answers.","authors":"Achim Lother, Dawid Staudacher","doi":"10.1093/ehjcvp/pvaf010","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf010","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370430","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":"Valve Thrombosis and Antithrombotic Therapy After Bioprosthetic Mitral Valve Replacement: A Systematic Review And Meta-Analysis.","authors":"Mark J Zorman, Jonathan Vibhishanan, Katerina Dangas, James Castle, Ka Hou Christien Li, Marco Coronelli, Kate Eastwick-Jones, Alexander Swan, Nicky Johnson, Anurag Choksey, Helen Yan, Sam G C Scott, Matthew Henry, Mark Philip Cassar, Cara Barnes, Joao Ferreira-Martins, James Newton, Sam Dawkins, Mohamad Alkhouli, Charanjit Rihal, Mackram F Eleid, Sorin V Pislaru, Mayra E Guerrero, Jose Ordonez-Mena, Thomas J Cahill","doi":"10.1093/ehjcvp/pvaf005","DOIUrl":"https://doi.org/10.1093/ehjcvp/pvaf005","url":null,"abstract":"<p><strong>Aims: </strong>Transcatheter mitral valve replacement (TMVR) has become a feasible alternative to surgical mitral valve replacement (SMVR) in selected patients at high surgical risk. The risk of valve thrombosis following SMVR and TMVR, and the optimal antithrombotic therapy following these procedures, remains uncertain. We aimed to compare the incidence of bioprosthetic mitral valve thrombosis (bMVT) after SMVR and TMVR, and the incidence of bMVT between patients on different antithrombotic regimens.</p><p><strong>Methods and results: </strong>A literature search of Medline, Embase and Cochrane Library was performed between January 2000 and August 2024. Random-effects models were used to derive pooled estimates of the incidence of bMVT in the absence of prior or active endocarditis and valve thrombosis. 47 studies (6170 patients, total follow-up 9541.8 patient-years) were eligible for inclusion. The overall incidence of bMVT was 5.05 (95%CI 3.18-8.01, I2 = 82%) per 100-patient-years. Subclinical bMVT was more common than clinically significant bMVT: incidence 19.11 vs 7.91 per 100-patient-years, adjusted incidence rate ratio (aIRR) 4.62 (95%CI 1.39-15.36), p = 0.012. bMVT was numerically more common after TMVR than SMVR, but the comparison was not statistically significant: incidence 7.03 vs 0.58 per 100-patient-years, aIRR 2.19 (95%CI 0.72-6.72), p = 0.170. Patients on vitamin-K antagonists (VKA) had a lower incidence of bMVT than patients on direct oral anticoagulants (DOAC; incidence 5.72 vs 17.08, aIRR 0.31, 95%CI 0.13-0.73, p = 0.007).</p><p><strong>Conclusions: </strong>bMVT is not uncommon, with numerically higher incidence in transcatheter compared to surgical valves, but the comparison was not statistically significant. VKAs are associated with a lower incidence of bMVT compared to DOACs.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188738","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":"Incidence and outcomes of transient new-onset atrial fibrillation complicating acute coronary syndromes: results from a systematic review and meta-analysis.","authors":"Nadia Salerno, Jessica Ielapi, Angelica Cersosimo, Isabella Leo, Jolanda Sabatino, Salvatore De Rosa, Sabato Sorrentino, Daniele Torella","doi":"10.1093/ehjcvp/pvae066","DOIUrl":"10.1093/ehjcvp/pvae066","url":null,"abstract":"<p><strong>Background: </strong>The overall risk of long-term adverse events of a transient episode of new-onset atrial fibrillation (AF) in patients with acute coronary syndrome (ACS) remains uncertain. This meta-analysis aimed to assess the prognostic impact of transient new-onset AF complicating ACS.</p><p><strong>Methods and results: </strong>Cohort studies examining the risk of adverse events in patients with transient new-onset AF compared to those in sinus rhythm after ACS were identified through a comprehensive search of MEDLINE, Scopus, Cochrane, and Google Scholar Library. Studies reporting the incidence of ischaemic stroke events, recurrent AF, or all-cause mortality at the longest follow-up were included. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CI) were synthesized using inverse variance-weighted random-effects meta-analysis. In the seven observational studies included, comprising 151 735 patients, 6 597 (4.3%) experienced transient new-onset AF, which was associated with an increased risk of ischaemic stroke, recurrent AF, or all-cause mortality (HR: 2.24, 95% CI: 1.75-2.85; P < 0.0001; I2 = 30.76%; seven studies). The results remained consistent across each individual endpoint, including ischaemic stroke (HR 2.38, 95% CI: 1.64-3.44; P < 0.01; I2 = 50.2%; five studies), recurrent AF (HR 4.68, 95% CI: 2.07-10.59; P = 0.0002; I2 = 50.2%; four studies), and all-cause mortality (HR 1.36, 95% CI: 1.08-1.71; P = 0.0089; I2 = 53.25%; four studies). Meta-regression analyses revealed a significant increase in these adverse events associated with ST-elevation myocardial infarction (P = 0.001), while there was a tendency for their decrease associated with oral anticoagulant prescription at discharge (P = 0.07).</p><p><strong>Conclusions: </strong>The occurrence of transient new-onset AF is associated with an elevated long-term risk of stroke, recurrent AF, and all-cause mortality in patients with ACS. Consequently, these data urge randomized clinical trials to assess the best antithrombotic regimen while potentially helping the current treatment decision-making process for these patients.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"652-661"},"PeriodicalIF":5.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544441","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":"Prevention is the key.","authors":"Stefan Agewall","doi":"10.1093/ehjcvp/pvae090","DOIUrl":"10.1093/ehjcvp/pvae090","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":"10 8","pages":"649-651"},"PeriodicalIF":5.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724144/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142964227","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":"Estimated impact of guidelines-based initiation of dual antihypertensive therapy on long-term cardiovascular outcomes in 1.1 million individuals.","authors":"Antonio Coca, Claudio Borghi, George S Stergiou, Irfan Khan, Alexandra Koumas, Jacques Blacher, Mohamed Abdel-Moneim","doi":"10.1093/ehjcvp/pvae048","DOIUrl":"10.1093/ehjcvp/pvae048","url":null,"abstract":"<p><strong>Aims: </strong>Guidelines recommend initiation of dual combination antihypertensive therapy, preferably single-pill combination (SPC), in most patients with hypertension. Evidence on narrowing gaps in clinical practice relative to guidelines is limited.</p><p><strong>Methods and results: </strong>Monte Carlo simulation was applied to 1.1 million patients qualifying for dual combination therapy from a previously conducted retrospective analysis of clinical practice, hospital statistics, and national statistics in the UK. We provide 10-year Kaplan-Meier event rates for the primary endpoint representing a composite of non-fatal myocardial infarction, non-fatal stroke (ischaemic or haemorrhagic), non-fatal heart failure hospitalization, or cardiovascular death. Cox model results from a previously conducted study were utilized to estimate baseline risk, together with evidence on risk reduction from the Blood Pressure Lowering Treatment Trialists' Collaboration (BPLTTC) meta-analysis and published evidence on blood pressure-lowering efficacy of antihypertensive therapies. In the overall population, estimated 10-year event rates for the primary endpoint in patients with 100% persistence in monotherapy were 17.0% for irbesartan and 17.6% for ramipril. These rates were only modestly better than those observed in clinical practice (17.8%). In patients with 100% persistence in dual therapy, estimated event rates were 13.6% for combinations of irbesartan + amlodipine [absolute risk reduction (ARR) = 8.7% compared with untreated] and 14.3% for ramipril + amlodipine (ARR = 8.0% compared with untreated). The absolute risk of the primary endpoint was reduced by 15.9% in patients with atherosclerotic cardiovascular disease (ASCVD) and 6.6% in those without ASCVD. Similarly, the absolute risk was reduced by 11.7% in patients with diabetes and 7.8% in those without diabetes.</p><p><strong>Conclusions: </strong>This study represents the first to investigate guidelines-based treatment in hypertensive patients and demonstrates the opportunity for considerable risk reduction by ensuring recommended dual therapy in clinical practice, particularly in the form of SPC with high persistence, relative to no treatment or monotherapy.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"697-707"},"PeriodicalIF":5.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724143/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141563077","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":"Effect of a single pill concept on clinical and pharmacoeconomic outcomes in cardiovascular diseases.","authors":"Burkhard Weisser, Sven Wassmann, Hans-Georg Predel, Roland E Schmieder, Anton Gillessen, Thomas Wilke, Jörg Blettenberg, Olaf Randerath, Antje Mevius, Michael Böhm","doi":"10.1093/ehjcvp/pvae059","DOIUrl":"10.1093/ehjcvp/pvae059","url":null,"abstract":"<p><strong>Aims: </strong>Our study aimed to assess whether a single pill concept (SPC) is superior to a multi-pill concept (MPC) in reducing cardiovascular (CV) events, all-cause death, and costs in CV patients.</p><p><strong>Method and results: </strong>Anonymized medical claims data covering 2012-2018, including patients with hypertension, dyslipidaemia, and CV diseases who started a drug therapy either as SPC or identical MPC were analysed after 1:1-propensity score matching. Hospitalizations with predefined CV events, all-cause mortality, and costs were studied in 25 311 patients with SPC and 25 311 patients with MPC using incidence rate ratios (IRRs) and non-parametric tests for continuous variables.IRRs were significantly lower for SPC: stroke (IRR = 0.77; 95% CI 0.67-0.88; P < 0.001), transitory ischaemic attack (IRR = 0.61; 95% CI 0.48-0.78; P < 0.001), myocardial infarction (IRR = 0.76; 95% CI 0.63-0.90; P = 0.0016), coronary artery disease (IRR = 0.66; 95% CI 0.57-0.77; P < 0.001), heart failure (IRR = 0.59; 95% CI 0.54-0.64; P < 0.001), acute renal failure (IRR = 0.54; 95% CI 0.56-0.64; P < 0.001), all cause hospitalization (IRR = 0.72; 95% CI 0.71-0.74; P < 0.001), CV hospitalization (IRR = 0.63; 95% CI 0.57-0.69; P < 0.001), and all-cause mortality (IRR = 0.62; 95% CI 0.57-0.68; P < 0.001). Mean time to first events and time to death were also in favour of SPC. Mean total costs were 4708€ for SPC vs. 5.669€ for MPC, respectively (mean ratio 0.830, P < 0.001).</p><p><strong>Conclusion: </strong>SPC is associated with lower incidence rates of CV events, time to CV events, and all-cause death, and is superior regarding pharmacoeconomic parameters and should therefore become standard of care to improve outcomes and reduce healthcare costs.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"686-693"},"PeriodicalIF":5.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724138/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859429","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":"Role of PCSK9 inhibitors in venous thromboembolism: current evidence and unmet clinical needs.","authors":"Marco Zuin, Alberto Corsini, Chiara Dalla Valle, Catia De Rosa, Alessandro Maloberti, Marco Mojoli, Massimiliano Rizzo, Francesco Ciccirillo, Alfredo Madrid, Carmine Riccio, Massimo Grimaldi, Furio Colivicchi, Fabrizio Oliva, Pier Luigi Temporelli","doi":"10.1093/ehjcvp/pvae076","DOIUrl":"10.1093/ehjcvp/pvae076","url":null,"abstract":"<p><p>Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) have recently emerged as promising therapeutic agents for lowering low-density lipoprotein cholesterol and reducing the risk of cardiovascular events. Moreover, preliminary evidence from randomized controlled trials (RCTs) suggests that PCSK9i may also offer beneficial effects for patients following venous thromboembolism (VTE), with the most significant reductions in risk appearing over time, particularly beyond the first year of treatment. However, there is a lack of randomized controlled data supporting their efficacy and safety in conjunction with standard anticoagulation therapy. This article aims to critically evaluate the existing evidence for the use of PCSK9i as a complementary therapy for VTE risk reduction, while also identifying unmet clinical and research needs and proposing potential strategies to address these knowledge gaps.</p>","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"719-724"},"PeriodicalIF":5.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461064","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":"Reaping the rewards of a simplified dosing regimen.","authors":"Peter E Penson, Maciej Banach","doi":"10.1093/ehjcvp/pvae073","DOIUrl":"10.1093/ehjcvp/pvae073","url":null,"abstract":"","PeriodicalId":11982,"journal":{"name":"European Heart Journal - Cardiovascular Pharmacotherapy","volume":" ","pages":"694-696"},"PeriodicalIF":5.3,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11724140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142582478","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}