Heart, Lung and Circulation最新文献

{"title":"Does Sex Affect the Efficacy, Safety, and Quality of Life Outcomes for Patients Using Angiotensin Receptor Neprilysin Inhibitor, Soluble Guanylate Cyclase Stimulators, and Cardiac Myosin Activators in Heart Failure? A Systematic Review.","authors":"Amanda Veiga Barbosa, Lucas Caetano Araújo Silva, Inajara Rotta, Patricia Melo Aguiar","doi":"10.1016/j.hlc.2025.04.082","DOIUrl":"https://doi.org/10.1016/j.hlc.2025.04.082","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a condition with significant differences between men and women, due to pathophysiology disparities attributed to hormonal factors and different comorbidities rates. There are no guidelines specifically tailored for women. The objective of the study is to summarise the current evidence of efficacy, safety, and impact on quality of life associated with angiotensin receptor neprilysin inhibitor, guanylate cyclase stimulators, and cardiac myosin activators drugs across different sexes.</p><p><strong>Methods: </strong>We performed a systematic search on PubMed, EMBASE, Cochrane Central, and Google Scholar databases for randomised controlled trials (RCTs), including patients with HF with reduced ejection fraction or HF with preserved ejection fraction. The outcomes were N-terminal pro-B-type natriuretic peptide hormone levels, functional capacity, ventricular remodelling, safety results, and quality of life. The risk of bias was assessed using the Risk of Bias 2 tool.</p><p><strong>Results: </strong>This review included data from eight RCTs (10 studies), involving a total of 15,021 patients, of whom 48% were women. HF with preserved ejection fraction was studied in five RCTs, and HF with reduced ejection fraction in three RCTs. Regarding clinical outcomes, six RCTs evaluated N-terminal pro-B-type natriuretic peptide hormone levels, all comparing sacubitril-valsartan with standard therapy, while two others compared functional capacity between the sexes, two analysed safety outcomes by sex subgroups, and only one RCT compared men and women for the ventricular remodelling outcome. Two RCTs assessed differences in quality of life between men and women. None of the studies showed any statistical difference between the subgroups and most outcomes demonstrated a low risk of bias.</p><p><strong>Conclusions: </strong>This review shows consistent efficacy, safety and quality of life across both sexes for HF treatments.</p>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250829","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":"Diabetes and Cardiometabolic Care, Pharmacotherapy, and Patient Outcomes in Two Regional Aboriginal Primary Care Health Centres: Lessons to be Learnt","authors":"Annabelle G. Hayes FRACP ,&nbsp;Odette Pearson BAppHSc, GCert HE, PhD ,&nbsp;Chinmay S. Marathe FRACP ,&nbsp;David Jesudason FRACP, PhD","doi":"10.1016/j.hlc.2025.06.1019","DOIUrl":"10.1016/j.hlc.2025.06.1019","url":null,"abstract":"<div><h3>Background</h3><div>Type 2 diabetes mellitus (T2DM) affects Aboriginal Australian populations six times more frequently than non-Indigenous Australians, with disparity increasing by remoteness. Contemporary guidelines recommend optimising cardiometabolic care, including achieving a target glycated haemoglobin (HbA1c) &lt;7%, blood pressure &lt;130/80 mmHg, and use of pharmacotherapy, including the maximal tolerated statin dose and consideration of sodium–glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists in selected subpopulations.</div></div><div><h3>Aim</h3><div>This study aimed to determine whether cardiometabolic treatment targets and pharmacological management met best practice guidelines in two rural Aboriginal Community Controlled Health Organisations.</div></div><div><h3>Method</h3><div>A retrospective audit of electronic medical records was conducted in two rural Aboriginal Community Controlled Health Organisations between January 2020 and January 2021. Data were collected for people aged over 18 years who regularly attended the clinic, identified as Aboriginal, and had a documented diagnosis of T2DM.</div></div><div><h3>Results</h3><div>A total of 274 patients met the inclusion criteria, 64% of whom were female. The median age of T2DM diagnosis was 44 years (interquartile range 32–50), with a median diabetes duration of 9 years (3–17), HbA1c 8.0% (6.9–9.4), body mass index 31.6 kg/m² (27–36.3), urine albumin–creatinine ratio (ACR) 3.8 mg/mol (1.1–20.0), and mean low density lipoprotein cholesterol 2.1 mmol/L (±0.8). Capture rates were 70% for HbA1c, 51% for urine ACR, and 51% for lipid studies. Among recorded results, 51/193 (26%) of HbA1c were &lt;7%, 80/228 (35%) of blood pressure readings were below 130/80 mmHg. Nephropathy was present in 42% of patients, and obesity in 61%. Clinically significant albuminuria was observed in 69/140 (50%) of patients with available ACR data. Statins were prescribed in 50%, sodium–glucose co-transporter 2 inhibitors in 20%, and glucagon-like peptide-1 receptor agonists in 7% of the population.</div></div><div><h3>Conclusions</h3><div>This study has characterised a population with an early age of T2DM diagnosis, high rates of nephropathy and obesity, and suboptimal glycaemic control. Prescription rates of modern therapies were low. These findings highlight areas for targeted improvement in the quality of cardiometabolic care, including the increased use of modern diabetes agents.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1069-1077"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952061","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 Impact of Cardiovascular-Kidney-Metabolic Syndrome Staging on Depression Risk: A National Study","authors":"Bowen Zha MD ,&nbsp;Angshu Cai MD ,&nbsp;Hongrui Yu MD ,&nbsp;Zhexue Wang MD","doi":"10.1016/j.hlc.2025.06.1017","DOIUrl":"10.1016/j.hlc.2025.06.1017","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular-kidney-metabolic (CKM) syndrome, recently defined by the American Heart Association, encompasses cardiovascular disease, chronic kidney disease, and metabolic disorders. However, its association with depression across different stages remains unclear.</div></div><div><h3>Method</h3><div>We analysed 4,097 adults from National Health and Nutrition Examination Survey 2005–2020. Depression was assessed using the Patient Health Questionnaire-9, and CKM stages were classified according to the 2023 American Heart Association guidelines. Survey-weighted multivariable logistic regression was used to examine associations, with subgroup and sensitivity analyses.</div></div><div><h3>Results</h3><div>The odds of depression increased progressively with CKM severity, with the highest risk observed in Stage 4 (odds ratio [OR] 1.112; 95% confidence interval [CI] 1.039–1.190; p=0.003). Significant associations were also found in Stages 2 and 3. Subgroup analyses revealed stronger associations in females (OR 1.180; 95% CI 1.053–1.322; p=0.005), older adults (OR 1.125; 95% CI 1.081–1.171; p&lt;0.001), Mexican Americans (OR 1.260; 95% CI 1.118–1.419; p&lt;0.001), and individuals with low education (OR 1.463; 95% CI 1.302–1.644; p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>Advancing CKM stage is significantly associated with increased depression risk, particularly among vulnerable sociodemographic groups. These findings highlight the need for integrated mental health strategies in managing CKM syndrome.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1131-1138"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144992371","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":"Connecting the Dots: Hepatic Steatosis as a Central Player in the Choreography of the Liver-Cardiovascular-Kidney-Metabolic Syndrome","authors":"Richard H. Goodheart MD ,&nbsp;Oyekoya T. Ayonrinde PhD, FRACP, FAASLD, FASGE ∗","doi":"10.1016/j.hlc.2025.08.009","DOIUrl":"10.1016/j.hlc.2025.08.009","url":null,"abstract":"<div><div>Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, with a reach extending beyond the liver to include other metabolic syndrome-related disorders. Cardiovascular disease and type 2 diabetes mellitus are recognised non-communicable disorders and often downstream complications of MASLD and share similar risk factors. However, MASLD has not been afforded parity alongside other cardiometabolic non-communicable disorders, including the cardiovascular-kidney-metabolic (CKM) syndrome. Notably, MASLD is an independent risk factor for increased all-cause mortality and cardiovascular disease. This review aims to position MASLD as a central player in lipid metabolism, systemic inflammation, and insulin resistance, which are key features in the pathogenesis of the CKM syndrome.</div><div>MASLD is an integral player enjoining the liver to the CKM syndrome as the liver-CKM syndrome. Increasing interdisciplinary awareness of this will enhance patient care.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1050-1059"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033291","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 Effect of Body Size and Obesity on Cardiovascular Haemodynamics and Myocardial Mechanics","authors":"Christine M. Madronio MPH, MPhil ,&nbsp;Shahab Pathan MBBS, MPH ,&nbsp;Gary K.K. Low MBBS, MPH, PhD ,&nbsp;Nishant Nundlall MBBS ,&nbsp;Kathryn Williams MBBS, PhD ,&nbsp;Sally Badorrek MSc, APD ,&nbsp;Michael Devadas MBBS ,&nbsp;Lynette Gallaty BBehavSt, GradDip ,&nbsp;Kedar Madan MBBS ,&nbsp;Han Loh MBBS ,&nbsp;Shiva Ahmad BMedSci, GradDip ,&nbsp;Kazuaki Negishi MSc, MD, PhD ,&nbsp;Faraz Pathan MBBS, PhD","doi":"10.1016/j.hlc.2025.08.014","DOIUrl":"10.1016/j.hlc.2025.08.014","url":null,"abstract":"<div><h3>Background</h3><div>To improve management of cardiovascular-kidney-metabolic syndrome, a better understanding of the early effects of body size on the heart is crucial and remains under investigation, considering the increasing global prevalence of obesity. Most data available on cardiovascular haemodynamics come from echocardiography despite the known challenges in image acquisition in the context of overweight and obesity. Using cardiac magnetic resonance imaging, we aimed to further investigate the effect of body size on cardiac output (CO) and other early imaging biomarkers of cardiovascular disease.</div></div><div><h3>Method</h3><div>Participants including healthy volunteers and individuals with obesity who were planning to undergo bariatric surgery were recruited from two completed studies. The participants underwent cardiac magnetic resonance imaging. Measures of cardiovascular haemodynamics and myocardial mechanics were collected, including CO, stroke volume, heart rate, chamber volumes, and myocardial strain. The relationship of these variables with body size were assessed.</div></div><div><h3>Results</h3><div>A total of 57 participants were recruited (79% female; mean age, 41 years). A positive linear relationship was observed between CO vs body mass index (BMI) (p&lt;0.01) and body surface area (BSA) (p&lt;0.01). A similar trend was seen with stroke volume vs BSA (p&lt;0.01) and BMI (p&lt;0.01). Indexation to BSA rendered chamber volumes similar. We found significant differences in left and right atrial strain between the groups. Regression analysis demonstrated an association between left ventricular global longitudinal strain and right atrial strain with BSA and between left ventricular global longitudinal strain, right ventricular free wall strain, and right atrial strain with BMI.</div></div><div><h3>Conclusions</h3><div>Obesity is associated with increased CO; this increase is a result of cardiac remodelling and consequent increase in stroke volume. Obesity is associated with an impairment of subclinical markers of cardiovascular disease measured using multichamber strain.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1109-1118"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058341","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":"A new model to study rheumatic heart disease","authors":"","doi":"10.1016/j.hlc.2025.09.002","DOIUrl":"10.1016/j.hlc.2025.09.002","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Page 1139"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145227556","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":"Real-World Prescribing of Renal and Cardiovascular Protective Drugs in Patients With Type 2 Diabetes and Chronic Kidney Disease: Analysis of Data From a Western Australian Quaternary Hospital","authors":"Nick S.R. Lan MBBS, MClinRes ,&nbsp;Ben McFadden BSc, MRes ,&nbsp;Andrew Johnson BPsych, MBiostat, PhD ,&nbsp;Phillip Shedden BMedia, GradCertDataSc ,&nbsp;P. Gerry Fegan MD ,&nbsp;Harish Puttagunta MBBS ,&nbsp;Sharon Ho BPharm ,&nbsp;Richard Gillett BA ,&nbsp;Ramyasuda Swaminathan MBBS, MCR ,&nbsp;Girish Dwivedi MD, PhD","doi":"10.1016/j.hlc.2025.07.007","DOIUrl":"10.1016/j.hlc.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>In patients with type 2 diabetes (T2D) and chronic kidney disease (CKD), sodium-glucose cotransporter 2 (SGLT2) inhibitors, semaglutide (glucagon-like peptide-1 [GLP-1] agonist), and finerenone (non-steroidal mineralocorticoid receptor antagonist) improve renal and cardiovascular outcomes. We assessed real-world prescribing of these drugs in patients with T2D and CKD.</div></div><div><h3>Method</h3><div>The ReDiCare project retrospectively identified patients with T2D and CKD admitted to an Australian hospital between January 2020 and September 2024 using International Statistical Classification of Diseases and Related Health Problems 10th Revision Australian Modification codes. CKD was also defined as an estimated glomerular filtration rate (eGFR) &lt;60 mL/min/1.73 m² for &gt;3 months. Patients with an eGFR &lt;15 mL/min/1.73 m², acute kidney injury, renal transplant, or those receiving dialysis were excluded. Drugs prescribed at discharge were obtained.</div></div><div><h3>Results</h3><div>Of 2,216 patients (mean age 78.2±10.9 years and 41.3% female), an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker was prescribed in 1,243 (56.1%) patients, an SGLT2 inhibitor in 472 (21.3%), a GLP-1 agonist in 163 (7.4%), and a mineralocorticoid receptor antagonist in 305 (13.8%). Specifically, semaglutide was prescribed in 79 (3.6%) patients and finerenone in three (0.1%). Overall, 735 (33.2%) patients were prescribed none, 919 (41.5%) one, 433 (19.5%) two, 115 (5.2%) three, and 14 (0.6%) all four drug groups. From January to March 2020 to July to September 2024, there was an increased prescribing of SGLT2 inhibitors (7.9%–38.7%; p&lt;0.001) and GLP-1 agonists (6.3%–11.7%; p=0.007).</div></div><div><h3>Conclusions</h3><div>In patients admitted to the hospital with T2D and CKD, one-quarter were prescribed an SGLT2 inhibitor and/or a GLP-1 agonist at discharge. Further studies are required to identify barriers and enablers to prescribing these drugs.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1089-1097"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006038","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 Correlation Between Triglyceride-Glucose Index and Its Associated Indices With All-Cause and Cardiovascular Mortality in Patients With Advanced-Stage Cardiovascular-Kidney-Metabolic Syndrome","authors":"Zhaoqi Yan MD ,&nbsp;Yifeng Xu MD ,&nbsp;Xiufan Du MM","doi":"10.1016/j.hlc.2025.06.1036","DOIUrl":"10.1016/j.hlc.2025.06.1036","url":null,"abstract":"<div><h3>Aim</h3><div>The American Heart Association (AHA) introduced the Cardiovascular-Kidney-Metabolic (CKM) syndrome in 2023, emphasising low survival rates in advanced CKM patients. This study explores the predictive value of the triglyceride-glucose (TyG) index and its associated indices for all-cause and cardiovascular mortality in these patients.</div></div><div><h3>Methods</h3><div>Data from 5,858 patients with advanced CKM (defined as stage 3/4 CKM per AHA criteria) were extracted from the National Health and Nutrition Examination Survey (NHANES), USA. The median follow-up duration for mortality outcomes was 8.21 years. Patients were categorised into tertiles (T) based on the TyG index and its associated indices (TyG-waist-to-height ratio [TyG-WHtR] and TyG-weight-waist index [TyG-WWI]; T1, T2, T3). Cox proportional hazards regression was used to analyse the prognostic value of these indices, adjusting for various covariates, and the results were presented as hazard ratio (HR) and 95% confidence interval (CI). Restricted cubic splines (RCS) assessed linear or nonlinear relationships between these indices and advanced CKM risk, with subgroup analyses for stratified examination.</div></div><div><h3>Results</h3><div>A total of 5,826 and 5,150 patients were included for the analysis of all-cause mortality and cardiovascular mortality, respectively. Multivariable Cox regression demonstrated that in the T3 group, both TyG-WHtR (HR 1.33, 95% CI 1.04–1.70) and TyG-WWI (1.40, 1.01–1.95) were significantly associated with all-cause mortality. Similar associations were observed for cardiovascular mortality, with TyG-WHtR (1.47, 1.06–1.88) and TyG-WWI (1.71, 1.06–2.78) showing comparable effects. Both indices exhibited a J-shaped association with mortality, with significant increases in HRs for all-cause mortality observed at TyG-WHtR ≥5.43 and TyG-WWI ≥99.03, while cardiovascular mortality HRs showed a significant rise at TyG-WWI ≥98.87.</div></div><div><h3>Conclusion</h3><div>This study is the first known to link TyG-WHtR and TyG-WWI with all-cause and cardiovascular mortality in advanced CKM patients, indicating their significant predictive value for this population.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1119-1130"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052893","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":"Cardiovascular-Kidney-Metabolic Syndrome: Rethinking Risk, Redefining Care","authors":"Nick S.R. Lan MBBS, MClinRes, MSc, FRACP ,&nbsp;Peter J. Psaltis MBBS, PhD, FRACP ,&nbsp;Radica Alicic MD, FHM, FACP ,&nbsp;Clare Arnott MBBS, PhD, FRACP","doi":"10.1016/j.hlc.2025.09.001","DOIUrl":"10.1016/j.hlc.2025.09.001","url":null,"abstract":"","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 987-990"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145227559","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":"Implementation Barriers to Evidence-Based Cardiovascular-Kidney-Metabolic Syndrome Management","authors":"Gina Davis BMedSc, MD, MMed ,&nbsp;Dana Kim MBBS ,&nbsp;Min Jun MScMed(ClinEpi), PhD ,&nbsp;Sradha S Kotwal MBChB, PhD, FRACP","doi":"10.1016/j.hlc.2025.05.095","DOIUrl":"10.1016/j.hlc.2025.05.095","url":null,"abstract":"<div><div>Cardiovascular-kidney-metabolic (CKM) syndrome is a newly defined health syndrome, encompassing the overlapping pathophysiology and risk factors of cardiovascular and kidney disease, obesity, and type 2 diabetes. It is the leading cause of morbidity and mortality worldwide, with an annual health cost of approximately AUD $24 billion in Australia alone. A disproportionate burden is observed among those with adverse social determinants of health. Despite compelling evidence demonstrating improved metabolic risk factors and reduced risk of kidney failure and cardiovascular events, uptake of traditional and novel cardio-kidney metabolic therapies, including sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists, remains low. This delay underscores many challenges to optimal CKM syndrome care, including system barriers such as public health policy, siloed health care, and inequitable access to pharmacotherapies; provider barriers, including lack of awareness and clinical inertia; and patient barriers such as social determinants of health. A global shift in the approach to healthcare that focuses on multidimensional, multidisciplinary care and provision of pharmacotherapies in patient groups most at risk is required to change the trajectory of this public health emergency.</div></div>","PeriodicalId":13000,"journal":{"name":"Heart, Lung and Circulation","volume":"34 10","pages":"Pages 1060-1068"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952004","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}