JAMA cardiology最新文献

{"title":"Leveraging Preexisting Cardiovascular Data to Improve the Detection and Treatment of Hypertension","authors":"Adam N. Berman, Michael K. Hidrue, Curtis Ginder, Linnea Shirkey, Japneet Kwatra, Anna C. O’Kelly, Sean P. Murphy, Jennifer M. Searl Como, Danielle Daly, Yee-Ping Sun, William T. Curry, Marcela G. del Carmen, Ron Blankstein, John A. Dodson, David A. Morrow, Benjamin M. Scirica, Niteesh K. Choudhry, James L. Januzzi, Jason H. Wasfy","doi":"10.1001/jamacardio.2025.0871","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0871","url":null,"abstract":"ImportanceHypertension is often underrecognized, leading to preventable morbidity and mortality. Tailored data systems combined with care augmented by trained nonphysicians have the potential to improve cardiovascular care.ObjectiveTo determine whether previously collected cardiovascular imaging data could be harnessed to improve the detection and treatment of hypertension through a system-level intervention.Design, Setting, and ParticipantsThe NOTIFY-LVH trial was a 2-arm, pragmatic randomized clinical trial conducted from March 2023 through June 2024 within the Mass General Brigham health care system, a multi-institutional network serving the greater Boston, Massachusetts, area. The study included individuals with a Mass General Brigham primary care affiliation who had left ventricular hypertrophy (LVH) on a prior echocardiogram, had no established cardiomyopathy diagnosis, and were not being treated with antihypertensive medications. Patients were followed for 12 months postintervention.InterventionPopulation health coordinators contacted clinicians of patients randomized to the intervention, notifying them of LVH and offering assistance with follow-up care. A clinical support pathway—including 24-hour ambulatory blood pressure monitoring or cardiology referrals—was provided to aid LVH evaluation.Main Outcomes and MeasuresThe primary outcome was the initiation of an antihypertensive medication. Secondary outcomes included new hypertension and cardiomyopathy diagnoses.ResultsA total of 648 patients were randomized—326 to the intervention and 322 to the control. Mean (SD) patient age was 59.4 (10.8) years and 248 patients (38.3%) were female. A total of 102 patients (15.7%) had a baseline diagnosis of hypertension and 109 patients (20.1%) had a mean outpatient blood pressure of 130/80 mm Hg or higher. Over 12 months, 53 patients (16.3%) in the intervention arm were prescribed an antihypertensive medication vs 16 patients (5.0%) in the control arm (adjusted odds ratio [OR], 3.76; 95% CI, 2.09-6.75; <jats:italic>P</jats:italic> < .001). Individuals in the intervention group were also more likely to be diagnosed with hypertension (adjusted OR, 4.43; 95% CI, 2.36-8.33; <jats:italic>P</jats:italic> < .001). Cardiomyopathy diagnoses did not significantly differ between groups.Conclusions and RelevanceIn the NOTIFY-LVH randomized clinical trial, a centralized population health coordinator–led notification and clinical support pathway for individuals with LVH on prior echocardiograms increased the initial treatment of hypertension. This work highlights the potential benefit of leveraging preexisting but potentially underutilized cardiovascular data to improve health care delivery through mechanisms augmenting the traditional ambulatory care system.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://www.clinicaltrials.gov/study/NCT05713916","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"29 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737023","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":"Cardiovascular Health Among Rural and Urban US Adults—Healthcare, Lifestyle, and Social Factors","authors":"Michael Liu, Lucas X. Marinacci, Karen E. Joynt Maddox, Rishi K. Wadhera","doi":"10.1001/jamacardio.2025.0538","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0538","url":null,"abstract":"ImportanceImproving cardiovascular health in rural areas is a national priority in the US. However, little is known about the current state of rural cardiovascular health and the underlying drivers of any rural-urban disparities.ObjectiveTo compare rates of cardiometabolic risk factors and cardiovascular diseases between rural and urban US adults and to evaluate the extent to which health care access, lifestyle factors, and social risk factors contribute to any rural-urban differences.Design, Setting, and ParticipantsThis nationally representative cross-sectional study analyzed data from US adults aged 20 years or older residing in rural vs urban areas using the 2022 National Health Interview Survey. Data were analyzed between August 2024 and February 2025.ExposureCounty-level rurality.Main Outcomes and MeasuresThe primary outcomes were age-standardized rates of cardiometabolic risk factors (hypertension, hyperlipidemia, obesity, and diabetes) and cardiovascular diseases (coronary heart disease [CHD] and stroke).ResultsThe study population consisted of 27 172 adults, including 4256 adults (14.0%) residing in rural areas, 14 741 (54.8%) in small or medium metropolitan areas, and 8175 (31.2%) in urban areas. Mean (SD) participant age was 49.1 (17.8) years, and 4399 participants (50.8%) were female. Compared with their urban counterparts, rural adults were more likely to smoke, be insufficiently physically active, and have more social risk factors. Age-standardized rates of cardiometabolic risk factors were significantly higher in rural areas, including hypertension (37.1% vs 30.9%; rate ratio [RR], 1.20; 95% CI, 1.13-1.27), hyperlipidemia (29.3% vs 26.7%; RR, 1.10; 95% CI, 1.03-1.18), obesity (41.1% vs 30.0%; RR, 1.37; 95% CI, 1.27-1.47), and diabetes (11.2% vs 9.8%; RR, 1.15; 95% CI, 1.02-1.29). The same pattern was observed for CHD (6.7% vs 4.3%; RR, 1.58; 95% CI, 1.35-1.85), but no differences were observed for stroke. The magnitude of rural-urban disparities was largest among young adults (aged 20-39 years) for hypertension (RR, 1.44; 95% CI, 1.12-1.86), obesity (RR, 1.54; 95% CI, 1.34-1.77), and diabetes (RR, 2.59; 95% CI, 1.54-4.38). Rural-urban disparities in cardiovascular health were not meaningfully attenuated after adjustment for measures of health care access (insurance coverage, usual source of care, and recent health care utilization) and lifestyle factors (smoking and physical activity). However, accounting for social risk factors (poverty, education level, food insecurity, and home ownership) completely attenuated rural-urban disparities in hypertension (adjusted RR [aRR], 0.99; 95% CI, 0.93-1.06), diabetes (aRR, 1.02; 95% CI, 0.90-1.15), and CHD (aRR, 1.08; 95% CI, 0.91-1.29), but only partially attenuated disparities in obesity (aRR, 1.29; 95% CI, 1.20-1.39).Conclusions and RelevanceThis national cross-sectional study found substantial rural-urban disparities in cardiometabolic risk factors and cardiovascular diseases, which were ","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"18 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737022","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":"Mode of Death in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction","authors":"Akshay S. Desai, Pardeep S. Jhund, Muthiah Vaduganathan, Brian L. Claggett, Jonathan W. Cunningham, Maria A. Pabon, Carolyn S. P. Lam, Michele Senni, Sanjiv Shah, Adriaan A. Voors, Faiez Zannad, Bertram Pitt, Flaviana Amarante, James Lay-Flurrie, Markus F. Scheerer, Andrea Lage, John J. V. McMurray, Scott D. Solomon","doi":"10.1001/jamacardio.2025.0860","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0860","url":null,"abstract":"ImportanceThe mode of death in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or heart failure with preserved ejection fraction (HFpEF) remains poorly understood and may vary by EF.ObjectiveTo evaluate the mode of death according to EF and the treatment effect of finerenone on cause-specific mortality in patients with HFmrEF/HFpEF.Design, Setting, and ParticipantsThis was a prespecified secondary analysis of the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) randomized clinical trial, which evaluated clinical outcomes in 6001 patients with HF and EF greater than or equal to 40% randomly assigned to finerenone or placebo. The mode of death in relation to baseline EF categories (&amp;amp;lt;50%, ≥50-&amp;amp;lt;60%, and ≥60%) was examined, and the effect of randomized treatment on cause-specific death in Cox regression models was assessed. Data analysis was conducted between September 2024 and January 2025.InterventionsFinerenone vs placebo.Main Outcomes and MeasuresMode of death as centrally adjudicated by a clinical end points committee.ResultsOf 1013 patients (16.9%; median [IQR] age, 76 [69-82] years; 594 male [58.6%]) who died during median (IQR) follow-up of 32 (23-36) months, mode of death was ascribed to cardiovascular causes in 502 (49.6%), noncardiovascular causes in 368 (36.3%), and undetermined cause in 143 (14.1%). Of cardiovascular deaths, 215 (42.8%) were due to sudden death, 163 (32.4%) to HF, 48 (9.6%) to stroke, 25 (5.0%) to myocardial infarction, and 51 (10.2%) to other cardiovascular causes. The proportion of all-cause, cardiovascular, and sudden death was higher in those with EF less than 50%. The proportion of deaths related to HF was similar across EF categories, and the proportion of deaths due to myocardial infarction, stroke, and other cardiovascular causes was low regardless of EF. Randomization to finerenone did not significantly reduce death or cause-specific death compared with placebo in any EF category.Conclusions and RelevanceAmong patients with HFmrEF/HFpEF in the FINEARTS-HF randomized clinical trial, higher proportions of cardiovascular and overall mortality in those with EF less than 50% were related principally to higher proportions of sudden death. A clear treatment effect of finerenone on cardiovascular or cause-specific mortality was not identified, although the trial was likely underpowered for these outcomes.Trial RegistrationClinicalTrials.gov Identifier: <jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" ext-link-type=\"uri\" xlink:href=\"https://clinicaltrials.gov/study/NCT04435626\">NCT04435626</jats:ext-link>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"62 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736540","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":"Finerenone and Atrial Fibrillation in Heart Failure","authors":"Shingo Matsumoto, Alasdair D. Henderson, Pardeep S. Jhund, Johann Bauersachs, Ovidiu Chioncel, Brian L. Claggett, Josep Comin-Colet, Akshay S. Desai, Gerasimos Filippatos, Carolyn S. P. Lam, Bertram Pitt, Markus Florian Scheerer, James Lay-Flurrie, Flaviana Amarante, Meike Brinker, Morten Schou, Michele Senni, Sanjiv J. Shah, Adriaan A. Voors, Faiez Zannad, Shelley Zieroth, Muthiah Vaduganathan, Scott D. Solomon, John J. V. McMurray","doi":"10.1001/jamacardio.2025.0848","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0848","url":null,"abstract":"ImportanceHeart failure (HF) with mildly reduced or preserved ejection fraction and atrial fibrillation (AF) are closely intertwined.ObjectiveTo examine the efficacy and safety of the nonsteroidal mineralocorticoid receptor antagonist finerenone in patients with HF with mildly reduced or preserved ejection fraction according to the absence or presence of AF and the type of AF (paroxysmal vs persistent or permanent).Design, Setting, and ParticipantsPrespecified analyses were conducted in the Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure (FINEARTS-HF) randomized clinical trial. The trial was conducted across 653 sites in 37 countries. Participants were adults aged 40 years and older with symptomatic HF and left ventricular ejection fraction of 40% or greater, randomized between September 2020 and January 2023. Data analysis was conducted from September 1 to October 1, 2024.InterventionFinerenone (titrated to 20 mg or 40 mg) or placebo.Main Outcomes and MeasuresThe primary outcome was the composite of total HF events and cardiovascular death. New-onset AF or atrial flutter (AFL) was a prespecified exploratory outcome.ResultsAmong 5984 patients (mean [SD] age, 72.0 [9.6] years; 2724 [45.5%] female) with known AF status at baseline, 1384 (23.1%) had paroxysmal AF and 1886 (31.5%) had persistent or permanent AF. Patients with both types of AF were older and had worse HF status compared with those without AF (2714 patients [45.4%]). Both types of AF were associated with a higher unadjusted risk of the primary outcome compared with no AF (event rate per 100 person-years of follow-up, 20.3 [95% CI, 17.9-23.1] with paroxysmal AF, 19.8 [95% CI, 17.8-22.0] with persistent or permanent AF, and 11.9 [95% CI, 10.7-13.3] with no AF; rate ratio [RR], 1.62 [95% CI, 1.37-1.92] with paroxysmal AF and 1.66 [95% CI, 1.43-1.93] with persistent or permanent AF vs no AF); however, the associations were attenuated after adjustment for known prognostic variables. The benefit of finerenone on the primary outcome (overall RR, 0.84 [95% CI, 0.74-0.95]) was not modified by baseline AF status (RR, 0.80 [95% CI, 0.65-0.98] with no AF, 0.83 [95% CI, 0.65-1.06] with paroxysmal AF, and 0.85 [95% CI, 0.69-1.05] with persistent or permanent AF; &lt;jats:italic&gt;P&lt;/jats:italic&gt; for interaction = .94). New-onset AF or AFL occurred in 6.5% of patients and was associated with a higher subsequent adjusted risk of the primary outcome (rate ratio, 3.65 [95% CI, 2.57-5.18]; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &amp;amp;lt; .001). The subdistribution hazard ratio for new-onset AF or AFL among those receiving finerenone vs placebo was 0.77 (95% CI, 0.57-1.04; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .09).Conclusions and RelevanceThe efficacy of finerenone was consistent regardless of AF status. New-onset AF was associated with a substantially higher risk of subsequent outcomes.Trial RegistrationClinicalTrials.gov Identifier: &lt;jats:ext-link xmlns:xlink=\"http:/","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"37 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143736461","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":"The Role of Cardiovascular Disease Journals in Reporting Sex and Gender in Research.","authors":"C Noel Bairey Merz, Robert O Bonow, Mercedes Carnethon, Filippo Crea, Joseph A Hill, Harlan M Krumholz, Roxana Mehran, Erica S Spatz","doi":"10.1001/jamacardio.2025.0788","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0788","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143730096","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":"Encouraging Pharmacist Referrals for Evidence-Based Statin Initiation: Two Cluster Randomized Clinical Trials.","authors":"Alexander C Fanaroff, Qian Huang, Kayla Clark, Laurie A Norton, Wendell E Kellum, Dwight Eichelberger, John C Wood, Zachary Bricker, Andrea G Dooley Wood, Greta Kemmer, Jennifer I Smith, Srinath Adusumalli, Mary E Putt, Kevin G Volpp","doi":"10.1001/jamacardio.2025.0244","DOIUrl":"10.1001/jamacardio.2025.0244","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Importance: &lt;/strong&gt;Despite statins' benefit in preventing major adverse cardiovascular events, most patients with an indication for statin therapy are not appropriately treated. Clinicians' limited time and lack of systematic efforts to address preventive care likely contribute to gaps in statin prescribing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To determine the effect on statin prescribing of 2 interventions to refer appropriate patients to a pharmacist for lipid management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design, setting, and participants: &lt;/strong&gt;These 2 pragmatic cluster randomized clinical trials were conducted among 12 total primary care practices in a community health system. Trial 1 was a delayed-intervention design of a visit-based intervention with randomization at the clinician level in a single clinic, and trial 2 was a parallel-arm trial of an asynchronous intervention with randomization at the clinic level in 11 clinics. Patients who were assigned to a primary care clinician at a participating practice, had an indication for a high-intensity or moderate-intensity statin, and were either not prescribed a statin or prescribed an inappropriately low statin dose were eligible for inclusion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Trial 1 tested an interruptive electronic health record alert that appeared during eligible patients' visits and facilitated referral to a pharmacist, while trial 2 tested an order for pharmacist referral placed by the study team for cosignature by the primary care clinician without regard to the timing of a clinic visit.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome and measure: &lt;/strong&gt;The primary outcome was the proportion of patients prescribed a statin.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 1412 patients were enrolled in trial 1 and 1950 in trial 2. Across both trials, mean (SD) patient age was 65.6 (9.9) years, and 1485 patients (44.2%) were female. Mean (SD) baseline 10-year risk of major cardiovascular events was 17.9% (9.4). In trial 1, the interruptive alert was not associated with a significant increase in statin prescriptions compared with usual care (15.6% vs 11.6%; unadjusted absolute difference, 3.9 percentage points; 95% CI, -0.4 to 8.3). In trial 2, semiautomated pharmacist referrals were associated with an increase in statin prescriptions by 16 percentage points compared with usual care (31.6% vs 15.2%; unadjusted absolute difference, 16.4 percentage points; 95% CI, 12.7-20.1).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions and relevance: &lt;/strong&gt;In these 2 cluster randomized clinical trials, visit-based interruptive alerts were not associated with a significant increase in statin prescribing compared with usual care, whereas a strategy of asynchronous semiautomated referral for pharmacist comanagement was associated with a substantial increase. This strategy of asynchronous semiautomated referrals for pharmacist involvement in lipid management could be a scalable and effective approach to increasing statin prescribing for patients at hig","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709812","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":"Aortic Valve Intervention for Asymptomatic Aortic Stenosis.","authors":"Rick A Nishimura, Patrick T O'Gara, Robert O Bonow","doi":"10.1001/jamacardio.2025.0483","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0483","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709809","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":"Asundexian or Apixaban in Patients With Atrial Fibrillation According to Prior Oral Anticoagulant Use: A Subgroup Analysis of the OCEANIC-AF Randomized Clinical Trial.","authors":"John H Alexander, Elizabeth J Lydon, Jonathan P Piccini, Thomas Viethen, Jonas Oldgren, Shaun G Goodman, Jan Steffel, Andrea M Russo, Isabelle C van Gelder, Keith C Ferdinand, Renato D Lopes, Hardi Mundl, Bela Benczur, Juan José Gómez-Doblas, Michael Glikson, Assen Goudev, Erik L Grove, Sigrun Halvorsen, Tuomas Kiviniemi, Anne-Céline Martin, Roopinder K Sandhu, Dragos Vinereanu, Frank W Rockhold, Valeria Caso, Rosa Coppolecchia, Manesh R Patel","doi":"10.1001/jamacardio.2025.0277","DOIUrl":"10.1001/jamacardio.2025.0277","url":null,"abstract":"<p><strong>Importance: </strong>In patients with atrial fibrillation (AF), oral anticoagulants (OACs) reduce the risk of stroke.</p><p><strong>Objective: </strong>To investigate if patients with less prior OAC exposure respond differently to a new OAC than patients with more OAC exposure.</p><p><strong>Design, setting, and participants: </strong>In this prespecified exploratory subgroup analysis of the Oral Factor 11a Inhibitor Asundexian as Novel Antithrombotic-Atrial Fibrillation (OCEANIC-AF) randomized clinical trial, patients enrolled in the OCEANIC-AF trial were categorized as OAC naive or OAC experienced based on whether they had 6 or fewer weeks or more than 6 weeks of prior OAC use. The effect of asundexian vs apixaban was then compared on outcomes among patients who were OAC naive and OAC experienced. The study setting included 1035 sites in 38 countries, and participants were those enrolled in the OCEANIC-AF trial. Data were analyzed from June to July 2024.</p><p><strong>Interventions: </strong>Asundexian, a novel factor XIa inhibitor, was compared with apixaban in patients with AF.</p><p><strong>Main outcomes and measures: </strong>The primary efficacy outcome was stroke or systemic embolism. The main safety outcome was major bleeding.</p><p><strong>Results: </strong>Of patients in the OCEANIC-AF trial, 2493 (17%) were OAC naive (mean [SD] age, 72.6 [8.6] years; 1464 male [59%]) and 12 317 (83%) were OAC experienced (mean [SD] age, 74.2 [7.5] years; 8132 male [66%]). In the asundexian arm, patients who were OAC naive had a stroke or systemic embolism rate of 0.8% (10 of 1238) compared with 1.4% (88 of 6177) in those who were OAC experienced. In the apixaban arm, patients who were OAC naive had a stroke or systemic embolism rate of 0.6% (7 of 1255) compared with 0.3% (19 of 6140) in those who were OAC experienced. Thus, patients who were OAC naive had a smaller increase in stroke or systemic embolism with asundexian compared with apixaban (hazard ratio [HR], 1.42; 95% CI, 0.54-3.73) than patients who were OAC experienced (HR, 4.66; 95% CI, 2.84-7.65; P for interaction =.03). Bleeding rates were lower among both OAC-naive patients (0.2% [2 of 1228]) and OAC-experienced patients (0.2% [15 of 6145]) assigned asundexian than among OAC-naive patients (1.0% [13 of 1249]) and OAC-experienced patients (0.7% [40 of 6115]) assigned apixaban.</p><p><strong>Conclusions and relevance: </strong>In the OCEANIC-AF randomized clinical trial, patients with AF who were OAC naive had a smaller increase in stroke or systemic embolism and a similar lower rate of bleeding with asundexian compared with apixaban than patients who were OAC experienced. The mechanism of these findings is unknown and deserves further research.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT05643573.</p>","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":""},"PeriodicalIF":14.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11947966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709811","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":"Joint Associations of APOC3 and LDL-C–Lowering Variants With the Risk of Coronary Heart Disease","authors":"Wenxiu Wang, Rui Li, Zimin Song, Ninghao Huang, Tao Huang, Xinwei Hua, Yi-Da Tang","doi":"10.1001/jamacardio.2025.0195","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0195","url":null,"abstract":"ImportanceDespite substantial progress in low-density lipoprotein cholesterol (LDL-C)–lowering strategies, residual cardiovascular risk remains. Apolipoprotein C3 (APOC3) has emerged as a novel target for lowering triglycerides. Multiple clinical trials of small-interfering RNA therapeutics targeting APOC3 are currently underway.ObjectiveTo investigate whether genetically predicted lower APOC3 is associated with a reduction in cardiovascular risk and if the combined exposure to <jats:italic>APOC3</jats:italic> and LDL-C–lowering variants is associated with a reduction in the risk of coronary heart disease (CHD).Design, Setting, and ParticipantsThis was a population-based genetic association study with 2 × 2 factorial mendelian randomization. Included were participants of European ancestry in the UK Biobank. Data were analyzed from November 2023 to July 2024.ExposuresGenetic scores were constructed to mimic the effects of APOC3, 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors.Main Outcomes and MeasuresPlasma lipid and lipoprotein levels, CHD, and type 2 diabetes (T2D).ResultsThis study included 401 548 UK Biobank participants (mean [SD] age, 56.9 [8.0] years; 216 901 female [54.0%]). Genetically predicted lower APOC3 was associated with a lower risk of CHD (odds ratio [OR], 0.96; 95% CI, 0.93-0.98) and T2D (0.97; 95% CI, 0.95-0.99). Genetically lower APOC3 and PCSK9 were associated with a similar magnitude of risk reduction in CHD per 10-mg/dL decrease in apolipoprotein B (ApoB) level (APOC3: 0.70; 95% CI, 0.59-0.83; PCSK9: 0.71; 95% CI, 0.65-0.77). Combined exposure to genetically lower APOC3 and PCSK9 was associated with an additive lower risk of CHD (APOC3: 0.96; 95% CI, 0.92-0.99; PCSK9: 0.93; 95% CI, 0.90-0.97; combined: 0.90; 95% CI, 0.86-0.93). Genetically lower HMGCR was also associated with a lower risk of CHD, and the risk was further reduced when combined with APOC3 (0.93; 95% CI, 0.90-0.97).Conclusions and RelevanceGenetically predicted lower APOC3 was associated with a reduced risk of CHD that is comparable with that associated with lower PCSK9 per unit decrease in ApoB. Combined exposure to <jats:italic>APOC3</jats:italic> and LDL-C–lowering variants was associated with an additive reduction in CHD risk. Future studies are warranted to investigate the therapeutic potential of these combined therapies, particularly among high-risk patients who cannot achieve therapeutic targets with existing lipid-lowering therapies.","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":"91 1","pages":""},"PeriodicalIF":24.0,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143653586","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":"JAMA Cardiology Peer Reviewers in 2024.","authors":"","doi":"10.1001/jamacardio.2025.0242","DOIUrl":"https://doi.org/10.1001/jamacardio.2025.0242","url":null,"abstract":"","PeriodicalId":14657,"journal":{"name":"JAMA cardiology","volume":" ","pages":"e250242"},"PeriodicalIF":14.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657087","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}