Herz最新文献

{"title":"Predicting LDL-cholesterol reduction variability on statin-ezetimibe therapy: insights from \"Jena auf Ziel\".","authors":"Umidakhon Makhmudova, Dieter Lütjohann, Franz Haertel, Anja Kerksiek, Robert Römer, Pellumb Haxhikadrija, Aurel Maloku, Beasat Samadifar, Sylvia Otto, P Christian Schulze, Oliver Weingärtner","doi":"10.1007/s00059-026-05393-7","DOIUrl":"https://doi.org/10.1007/s00059-026-05393-7","url":null,"abstract":"<p><strong>Background and aims: </strong>Low-density lipoprotein cholesterol (LDL-C) is a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). ESC/EAS guidelines recommend reducing LDL-C < 1.4 mmol/L and > 50% from baseline in patients with myocardial infarction. \"Jena auf Ziel\" (JaZ) is a prospective cohort study in which early combination therapy with atorvastatin 80 mg and ezetimibe 10 mg was initiated on admission in patients with ST-elevation myocardial infarction (STEMI) to reduce LDL‑C levels early and effectively.</p><p><strong>Methods: </strong>In this secondary analysis, we included 42 patients who were naïve to lipid-lowering therapy (LLT) on admission. Aim of the current analysis was to assess individual variations in LDL‑C response and to investigate the associations between plasma surrogate markers of cholesterol metabolism at baseline and LDL‑C reductions after 4-6 weeks on combined LLT.</p><p><strong>Results: </strong>Combined LLT with atorvastatin 80 mg and ezetimibe 10 mg reduced LDL‑C after 6 weeks in all patients very effectively (47.7-92.5%) across all quartiles of cholesterol absorption and synthesis markers. No statistically significant differences in LDL‑C reduction were observed across quartiles of cholesterol metabolism markers, although Pearson correlation analysis indicated a modest association between sitosterol:cholesterol and LDL‑C response. The median LDL‑C reduction was > 60% in all quartiles of cholesterol absorption (sitosterol:cholesterol, campesterol:cholesterol, cholestanol:cholesterol) and synthesis markers (lathosterol:cholesterol). We found no statistically significant differences regarding the LDL‑C change from baseline (%) in quartiles of sitosterol:cholesterol, campesterol:cholesterol, cholestanol:cholesterol (markers of cholesterol absorption), and lathosterol:cholesterol (marker of cholesterol synthesis). However, Pearson correlation values indicated a correlation between sitosterol:cholesterol and LDL‑C reduction with higher ratios being associated with less pronounced LDL‑C reduction.</p><p><strong>Conclusion: </strong>Upfront dual therapy with atorvastatin (80 mg) and ezetimibe (10 mg) achieved robust LDL‑C reduction with low interindividual variability in treatment-naive individuals. We found no significant association between baseline cholesterol metabolism markers and treatment response. This supports current guideline recommendations for immediate combination therapy in very high-risk patients, irrespective of their baseline metabolic phenotype.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effects of air pollution on cardiovascular health].","authors":"Marin Kuntic, Andreas Daiber, Omar Hahad, Jos Lelieveld, Thomas Münzel","doi":"10.1007/s00059-026-05388-4","DOIUrl":"10.1007/s00059-026-05388-4","url":null,"abstract":"<p><p>Ambient air pollution is a leading modifiable environmental determinant of cardiovascular morbidity and mortality worldwide. Long-term and short-term exposure to fine particulate matter and traffic-related pollutants is consistently associated with an increased risk of ischemic heart disease, stroke, heart failure, arrhythmia and cardiovascular death. Mechanistic studies demonstrate that inhaled pollutants induce pulmonary and systemic oxidative stress, inflammation, endothelial dysfunction, autonomic imbalance and prothrombotic changes, providing biological plausibility for these associations. Air pollution rarely acts in isolation but clusters with other environmental stressors, such as transportation noise, heat and limited access to green space and disproportionately affects socioeconomically disadvantaged and medically vulnerable groups. This review summarizes the current evidence on the cardiovascular effects of air pollution, highlights high-risk populations and discusses clinical, public health and policy strategies to reduce exposure and vulnerability. We argue that contemporary cardiovascular prevention must adopt an exposome-oriented perspective and engage with transport, energy, housing and urban planning policies to effectively protect vulnerable patients and communities.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"268-275"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bleeding risk associated with the co-use of direct oral anticoagulants and non-dihydropyridine calcium channel blockers: a meta-analysis.","authors":"Francinny Alves Kelly, Elisa Andrade de Faria, Clara Rocha Dantas, Aminah Abrão Fauaz Ritter Lima, Barbara Antonia Dups Talah, Artur de Oliveira Macena Lôbo, Antonio Gabriele Laurinavicius, Fernanda Marciano Consolim-Colombo","doi":"10.1007/s00059-025-05353-7","DOIUrl":"10.1007/s00059-025-05353-7","url":null,"abstract":"<p><strong>Background: </strong>Oral anticoagulation is a cornerstone of stroke prevention in patients with atrial fibrillation (AF) and elevated thromboembolic risk. However, evidence regarding the association between co-use of direct oral anticoagulants (DOACs) and non-dihydropyridine calcium-channel blockers (CCBs) and bleeding risk remains controversial.</p><p><strong>Methods: </strong>We systematically searched PubMed, Embase, and the Cochrane Library for randomized clinical trials, cohort, and case-control studies evaluating bleeding risk associated with DOAC + CCB co-use in patients with AF. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for binary outcomes.</p><p><strong>Results: </strong>Nine studies met inclusion criteria, comprising 408,276 patients overall, of whom 67,359 were using DOACs + CCBs. Meta-analysis showed a significantly higher incidence of major bleeding with DOAC + CCB co-use compared with DOAC alone (OR 1.21 [95% CI 1.18-1.43]; p < 0.001; I² = 21%). By contrast, there was no significant difference in any bleeding events between groups (OR 1.21 [95% CI 0.83-1.77]; p = 0.31; I² = 77%).</p><p><strong>Conclusion: </strong>Co-use of DOACs and non-dihydropyridine CCBs is associated with an increased risk of major bleeding, whereas the overall risk of any bleeding does not differ significantly. Large randomized controlled trials are warranted to confirm these findings and to further evaluate the safety of this combination.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"311-317"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145707831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[The cardiovascular exposome: areas of action for prevention and practical cardiology].","authors":"Andreas Daiber, Thomas Münzel, Christoph Maack, Omar Hahad, Marin Kuntic","doi":"10.1007/s00059-026-05380-y","DOIUrl":"10.1007/s00059-026-05380-y","url":null,"abstract":"<p><p>Environmental risk factors are recognized as essential determinants of the cardiovascular disease burden but are still poorly represented in clinical guidelines. External environmental exposures such as air pollution, traffic noise, heat, light pollution, chemical contamination of soil and water as well as urban planning, our social environment and lifestyle contribute significantly to the global disease burden and premature deaths. In particular, cardiovascular morbidity and mortality are significantly influenced by these environmental stressors. The exposome concept provides an overarching framework for this by associating lifelong external exposures with changes in biological processes such as oxidative stress, inflammatory responses, vascular damage, metabolic dysregulation, disturbances of circadian regulation, our circadian clock, and the resulting chronic diseases and deaths. Environmental exposures not only increase the risk of chronic diseases in healthy individuals but also amplify classic risk factors, worsen the prognosis for vulnerable groups, and thus open concrete prevention and intervention opportunities in outpatient and inpatient care. Practicing cardiologists can systematically integrate environmental exposures into medical history taking, identify particularly at-risk individuals, recommend behavior-related protective measures, work interdisciplinarily with general practitioners and occupational physicians, and at the same time advocate for heart-healthier living environments in health policy. This review summarizes the current evidence on the impact of the exposome on cardiovascular health and derives recommendations for cardiologists from it. The goal is to view the exposome from the perspective of daily care: from risk stratification to patient-centered interventions to structural measures at the level of practice, clinic, and society.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"254-265"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148251255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Noise and the heart].","authors":"Omar Hahad, Marin Kuntic, Christoph Maack, Andreas Daiber, Thomas Münzel","doi":"10.1007/s00059-026-05383-9","DOIUrl":"10.1007/s00059-026-05383-9","url":null,"abstract":"<p><p>Traffic-related environmental noise represents a widespread and relevant environmental factor in Europe that is associated with a substantial burden of disease. Current estimates indicate that a significant proportion of the population is exposed to noise levels linked to adverse health effects. Cardiovascular diseases are among the most extensively studied outcomes in this context. Epidemiological studies consistently demonstrate associations between long-term exposure to traffic noise and an increased risk of arterial hypertension, ischemic heart disease, myocardial infarction, heart failure and arrhythmias. These associations are often dose-dependent and also remain even after adjustment for air pollution. Experimental human studies provide complementary mechanistic evidence, showing that even short-term noise exposure can impair endothelial function, activate autonomic stress responses and disrupt sleep. Underlying mechanisms include activation of the sympathetic nervous system, dysregulation of the hypothalamic-pituitary-adrenal axis, oxidative stress and inflammatory processes. Overall, the available evidence supports a stronger consideration of traffic noise as a modifiable risk factor for cardiovascular disease. In addition to individual-level measures to reduce exposure, population-based strategies for noise reduction are essential.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"276-283"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Advancing cardiovascular prevention : Evidence-based design of healthy and sustainable food environments].","authors":"Niklas Oppenrieder, Christoph Maack, Andreas Daiber, Omar Hahad","doi":"10.1007/s00059-026-05387-5","DOIUrl":"10.1007/s00059-026-05387-5","url":null,"abstract":"<p><p>Malnutrition is among the leading modifiable risk factors for cardiovascular diseases worldwide. Current international guidelines consistently recommend predominantly plant-based dietary patterns rich in vegetables, fruits, whole grains, legumes and unsaturated fats. At the same time, the diet affects not only individual health but also the ecological foundations of future health. The nutrition system substantially contributes to greenhouse gas emissions, biodiversity loss, land-use change and freshwater consumption. This article argues that nutrition should therefore be understood as a dual lever for prevention: both for reducing cardiovascular disease and for stabilizing health-relevant ecological systems. While evidence supporting the cardiovascular benefits of high-quality plant-based diets continues to grow, implementation at the population level remains insufficient. The article discusses the limited long-term effectiveness of purely educational and individual responsibility-focused approaches and contrasts these with the more consistent evidence supporting structural interventions. In particular, fiscal policies, restrictions on unhealthy food marketing, healthy food standards in public institutions and modifications of food environments have demonstrated robust effects on dietary behavior and health outcomes. Against this background an expansion of cardiovascular prevention towards the active shaping of healthy and sustainable food environments is proposed. Physicians and medical societies could play a substantially stronger role in advocating evidence-based structural prevention policies.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"293-299"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148382038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Procedural hospital volume and outcome after transcatheter edge-to-edge mitral valve repair : Analysis of the German mandatory quality registry.","authors":"Julinda Mehilli, Maike Bestehorn, Christian Perings, Volker Schächinger, Hendrik Schmidt, Ralf Zahn, Christoph Stellbrink, Ilka Ott, Raffi Bekeredjian, Florian Zauner, Kurt Bestehorn","doi":"10.1007/s00059-025-05348-4","DOIUrl":"10.1007/s00059-025-05348-4","url":null,"abstract":"<p><strong>Background: </strong>Studies assessing transcatheter edge-to-edge mitral valve repair (M-TEER) suggest lower rates of in-hospital mortality (IHM) at high-volume hospitals, and guidelines recommend minimum caseloads to assure quality standards.</p><p><strong>Methods: </strong>Data from all patients undergoing M‑TEER procedures at 154 hospitals in the German mandatory quality assurance registry in 2020 were analyzed. The observed IHM was adjusted against the expected mortality predicted by the German MKL-KATH score (O/E) and EuroScore II (O/E2). Regression analyses and volume quartile analyses were performed on hospital volume (HV), IHM rate, O/E, and intra-hospital complications. Additionally, binomial analysis was performed to verify results.</p><p><strong>Results: </strong>A total of 5099 patients (age 77.9 ± 2.5 years, mean EuroScore II 17.9 ± 5.9%) underwent M‑TEER procedures during the study period. The mean observed IHM was 1.79 ± 3.4%. Neither unadjusted nor risk-adjusted IHM was related to HV in linear regression (adjusted p = 0.56) or logistic regression (p = 0.515) analyses. The IHM rates for the first and fourth quartiles were nearly identical (p = 0.842). Any selected volume cut-off could not differentiate between hospitals with unacceptable (> 95th percentile O/E of all hospitals), acceptable (O/E ≤ 95th percentile), or better-than-average quality (O/E < 1). A caseload cut-off of 30cases per year would exclude 83 hospitals with acceptable or 72 with better-than-risk-adjusted quality (54% and 47% of all hospitals, respectively).</p><p><strong>Conclusion: </strong>Hospital volume is an imprecise surrogate for assessing the quality of hospitals performing M‑TEER. The association between HV and IHM in patients undergoing elective M‑TEER in Germany was weak and not consistent across various analytical approaches. Other instruments may be more suitable for identifying hospitals with critical performance levels.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"300-310"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145470947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Heart and climate].","authors":"Christoph Maack, Andreas Daiber, Alexandra Schneider, Jos Lelieveld, Omar Hahad","doi":"10.1007/s00059-026-05384-8","DOIUrl":"10.1007/s00059-026-05384-8","url":null,"abstract":"<p><p>Temperature changes affect cardiovascular health through multiple physiological and environmental pathways. Cold exposure activates the sympathetic nervous system and the renin-angiotensin-aldosterone system, increases blood pressure, cardiac afterload and myocardial oxygen demand and can thereby promote ischemia, angina pectoris and myocardial infarction. In contrast, exposure to heat causes vasodilation, fluid loss through sweating, tachycardia and a rise in myocardial oxygen demand; dehydration, inflammation and prothrombotic changes can further increase the risk of acute cardiovascular events and renal dysfunction. Epidemiological data consistently show a U-shaped association between ambient temperature and cardiovascular mortality, with older adults and patients with pre-existing cardiovascular disease being particularly vulnerable. Air pollution, especially fine particulate matter, ozone and nitrogen dioxide can amplify heat-related risks. Beyond the immediate effects of temperature extremes, long-term adaptation leads to a shift in the minimum mortality temperature toward warmer conditions, while climate change increases exposure to heat waves and warm nights. We summarize the underlying pathophysiological mechanisms, clinical consequences and the growing relevance of temperature-related cardiovascular risks for public health. Effective climate adaptation, reduction of urban heat islands, promotion of low-emission transport and health-oriented urban planning are essential components in the prevention of temperature-associated morbidity and mortality.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"284-292"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Herz-Kreislauf-Prävention neu denken: Das Herz schlägt nicht im luftleeren Raum.","authors":"Thomas Münzel, Christoph Maack","doi":"10.1007/s00059-026-05386-6","DOIUrl":"https://doi.org/10.1007/s00059-026-05386-6","url":null,"abstract":"","PeriodicalId":12863,"journal":{"name":"Herz","volume":"51 4","pages":"249-253"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148678240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Management of elevated blood pressure and hypertension : Focus on risk reduction].","authors":"Raphael S Schmieder, Heribert Schunkert","doi":"10.1007/s00059-026-05385-7","DOIUrl":"10.1007/s00059-026-05385-7","url":null,"abstract":"<p><p>The 2024 hypertension guidelines from the European Society of Cardiology (ESC) introduce the category of 'elevated blood pressure' (120-139/70-89 mm Hg) and emphasise the importance of early prevention in individuals with such blood pressure levels and comorbid conditions. As blood pressure is recognised as a continuous risk factor, early initiation of antihypertensive treatment may be recommended even below the hypertensive range, depending on overall cardiovascular risk. All affected individuals should adopt a healthy lifestyle: regular exercise, balanced diet, reduced alcohol and salt intake, weight loss, and smoking cessation. If blood pressure remains > 130/80 mm Hg after three months and the patient has cardiovascular disease, heart failure, or a moderate to high risk, pharmacotherapy is advised. At ≥ 140/90 mm Hg, lifestyle measures and low-dose dual combination therapy should be initiated concurrently. The target systolic blood pressure is 120-129 mm Hg, with exceptions for individuals with frailty or those aged > 85 years. For resistant hypertension, spironolactone is the recommended pharmacological therapy, while renal denervation is listed as an interventional option.</p>","PeriodicalId":12863,"journal":{"name":"Herz","volume":" ","pages":"318-328"},"PeriodicalIF":1.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}