Journal of the American College of Cardiology最新文献

{"title":"How PARTHENOPE Charts the Course Toward Precision DAPT: Navigating Future Science in Antiplatelet Therapy.","authors":"Seng Chan You, Behnood Bikdeli, Zhenqui Lin, John Bittl, David J Cohen, Harlan M Krumholz","doi":"10.1016/j.jacc.2025.08.045","DOIUrl":"10.1016/j.jacc.2025.08.045","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958385","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":"Personalized or Standard Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention: The PARTHENOPE Randomized Trial.","authors":"Raffaele Piccolo, Paolo Calabrò, Greta Carrara, Fiorenzo Simonetti, Attilio Varricchio, Tiziana Attisano, Giovanni Napolitano, Ciro De Simone, Gerardo Carpinella, Eugenio Stabile, Plinio Cirillo, Luigi Di Serafino, Gianluca Caiazzo, Tullio Tesorio, Marco Boccalatte, Bernardino Tuccillo, Marisa Avvedimento, Attilio Leone, Gennaro Galasso, Arturo Cesaro, Rocco Perrotta, Tullio Niglio, Domenico Simone Castiello, Maddalena Immobile Molaro, Luca Bardi, Alessandra Spinelli, Stefano Cristiano, Michele Bellino, Sergio Leonardi, Simone Biscaglia, Francesco Costa, Salvatore Cassese, Eugene McFadden, Dik Heg, Giulio G Stefanini, Anna Franzone, Davide Capodanno, Giovanni Esposito","doi":"10.1016/j.jacc.2025.08.040","DOIUrl":"10.1016/j.jacc.2025.08.040","url":null,"abstract":"<p><strong>Background: </strong>Dual antiplatelet therapy (DAPT) is recommended for patients undergoing percutaneous coronary intervention (PCI), although its optimal duration remains uncertain.</p><p><strong>Objectives: </strong>The authors performed a randomized trial comparing a personalized duration of DAPT, based on a risk score, for 3, 6, or 24 months with a standard duration of DAPT for 12 months after PCI.</p><p><strong>Methods: </strong>We randomly assigned 2,107 patients undergoing PCI to receive either a personalized or a standard DAPT. The primary endpoint was a net adverse clinical event (NACE) at 24 months, defined as the composite of all-cause death, myocardial infarction, stroke, urgent target vessel revascularization, or type 2, 3, or 5 bleeding according to the Bleeding Academic Research Consortium criteria.</p><p><strong>Results: </strong>At 24 months, NACE occurred in 196 of 1,055 patients (18.6%) in the personalized DAPT group and in 232 of 1,052 patients (22.2%) in the standard DAPT group (difference, 3.54 percentage points; 95% CI: -6.99 to -0.99; P = 0.040). This difference was mainly related to decreased rates of myocardial infarction (difference, -2.29 percentage points; 95% CI: -4.43 to -0.14) and urgent target vessel revascularization (difference, -1.30 percentage points; 95% CI: -2.55 to -0.05). Bleeding occurred at similar rates between the 2 groups (difference, -0.41 percentage points; 95% CI: -2.92 to 2.10).</p><p><strong>Conclusions: </strong>In patients undergoing PCI, a personalized DAPT duration from 3 to 24 months based on a clinical risk score led to a lowered risk of NACE than standard care consisting of 12 months of DAPT. (Personalized Vs. Standard Duration of Dual Antiplatelet Therapy and New-generation Polymer-Free vs- Biodegradable-Polymer DES [PARTHENOPE]; NCT04135989).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958619","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":"A Tad Bit of Extra Clarity About Clots: Why JACC Took Interest in TADCLOT.","authors":"Behnood Bikdeli, David J Cohen, John A Bittl, Harlan M Krumholz","doi":"10.1016/j.jacc.2025.08.049","DOIUrl":"10.1016/j.jacc.2025.08.049","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958742","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":"Colchicine and Longitudinal Dynamics of Clonal Hematopoiesis: An Exploratory Substudy of the LoDoCo2 Trial.","authors":"Niekbachsh Mohammadnia, Liying Xue, Lucas T W Vestjens, Md Mesbah Uddin, Abhishek Niroula, Dominique P V de Kleijn, Arend Mosterd, Aernoud T L Fiolet, Tetsushi Nakao, John W Eikelboom, Aysun Cetinyurek-Yavuz, Gina M Peloso, Willem A Bax, Niels P Riksen, Pradeep Natarajan, Jan H Cornel, Saloua El Messaoudi, Michael C Honigberg","doi":"10.1016/j.jacc.2025.08.025","DOIUrl":"10.1016/j.jacc.2025.08.025","url":null,"abstract":"<p><strong>Background: </strong>Clonal hematopoiesis (CH) is an aging-related hematologic condition associated with increased risk for cardiovascular events. Larger CH clones associate more strongly with cardiovascular risk. Preclinical data indicate that inflammatory signaling drives expansion of CH clones and CH-associated cardiovascular disease. However, the effect of anti-inflammatory therapies on CH clonal dynamics in humans is unclear.</p><p><strong>Objectives: </strong>The goal of this study was to test the association of randomization to colchicine vs placebo with CH growth in participants with chronic coronary artery disease. It also assessed the association of colchicine use with change in inflammatory biomarkers over time according to CH status.</p><p><strong>Methods: </strong>In this exploratory substudy of the LoDoCo2 (Low-Dose Colchicine 2) trial, high-coverage targeted sequencing was used to detect CH driver mutations and to quantify variant allele frequency at 4 timepoints: baseline, after a 30-day open-label colchicine run-in phase (0.5 mg daily), 1 year postrandomization to colchicine or placebo, and at end of study (median follow-up of 25.0 months). Clonal dynamics were assessed by using a generalized linear mixed model. High-sensitivity C-reactive protein and interleukin-6 were additionally measured at baseline, randomization, and 1 year postrandomization.</p><p><strong>Results: </strong>In total, 854 participants contributed 2,047 observations across 4 timepoints, including before and after the prerandomization colchicine run-in period. Randomization to placebo was associated with a 14.9% annual increase in CH clone size (β_time = 0.14; 95% CI: 0.08 to 0.21) vs a nonsignificant 6.3% increase with colchicine (β_time on colchicine: 0.06; 95% CI: -0.01 to 0.14), although this difference between treatment arms was not statistically significant (P_interaction = 0.13). Compared with placebo, colchicine was associated with attenuated clonal growth in TET2 CH (β_time on colchicine: 0.09 [95% CI: -0.04 to 0.22]; β_time placebo: 0.27 [95% CI: 0.16 to 0.37]; P_interaction= 0.04). Among individuals with non-DNMT3A CH, interleukin-6 levels increased to a lesser extent in those receiving colchicine vs placebo over 1 year (30.0% vs 98.1% increase, respectively; P_interaction = 0.01).</p><p><strong>Conclusions: </strong>In this exploratory analysis, treatment with low-dose colchicine was associated with attenuated clonal expansion in TET2 CH. These findings suggest the potential for colchicine to curb the proliferative advantage of key CH driver mutations and to mitigate their associated risk of cardiovascular disease. Further validation in prospective studies is warranted.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958754","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":"Effect of Aficamten Compared With Metoprolol on Echocardiographic Measures in Symptomatic Obstructive Hypertrophic Cardiomyopathy: MAPLE-HCM.","authors":"Sheila M Hegde, Xiaowen Wang, Pablo Garcia-Pavia, Stoyan Getchevski, Ahmad Masri, Bela Merkely, Michael E Nassif, Maria Luisa Peña-Peña, Roberto Barriales-Villa, Ozlem Bilen, Melissa Burroughs, Brian Claggett, Juan Pablo Costabel, Edileide de Barros Correia, Anne M Dybro, Perry Elliott, Neal K Lakdawala, Amy Mann, Martin S Maron, Ajith Nair, Steen H Poulsen, Patricia Reant, P Christian Schulze, Andrew Wang, Regina Sohn, Indrias Berhane, Stephen B Heitner, Daniel L Jacoby, Stuart Kupfer, Fady I Malik, Amy Wohltman, Michael A Fifer, Scott D Solomon","doi":"10.1016/j.jacc.2025.08.022","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.08.022","url":null,"abstract":"<p><strong>Background: </strong>Beta-blockers have formed the mainstay of first-line therapy for symptomatic obstructive hypertrophic cardiomyopathy (HCM) for decades. Aficamten, compared with placebo, lowered left ventricular outflow tract gradients (LVOT-G), improved measures of left ventricular (LV) diastolic function, and showed evidence of favorable remodeling when added to standard of care medical therapy in SEQUOIA-HCM. The comparative effectiveness of monotherapy with aficamten vs metoprolol was investigated in MAPLE-HCM.</p><p><strong>Objectives: </strong>This study evaluated the effect of monotherapy with aficamten compared with metoprolol on cardiac structure and function in participants enrolled in the MAPLE-HCM study.</p><p><strong>Methods: </strong>Serial echocardiograms and other clinical measures were collected over 24 weeks in participants receiving escalating doses of aficamten 5 to 20 mg or metoprolol 50 to 200 mg.</p><p><strong>Results: </strong>The study enrolled 175 participants (mean age 58 ± 13 years, 42% women, 80% White, 14% Asian). Mean left ventricular ejection fraction (LVEF) was 68% ± 4% with resting and Valsalva LVOT-G of 47 ± 29 mm Hg and 74 ± 33 mm Hg, respectively. Compared with metoprolol, aficamten decreased resting LVOT-G (-30 mm Hg [95% CI: -37 to -23 mm Hg]; P < 0.001) and Valsalva LVOT-G (-35 mm Hg [95% CI: -44 to -26 mm Hg]; P < 0.001); reduced left atrial volume index (left atrial volume index -7.0 mL/m² [95% CI: -9.1 to -4.8 mL/m²]; P < 0.001); and improved E/e' (lateral E/e' -2.8 [95% CI: -4.0 to -1.6]; P < 0.001; septal E/e' -3.1 [95% CI: -4.5 to -1.7]; P < 0.001). Maximal wall thickness decreased (-1.0 mm [95% CI: -1.8 to -0.2 mm]; P = 0.02). LVEF, absolute LV global longitudinal strain, and absolute global circumferential strain decreased (LVEF -4% [95% CI: -5% to -3%]; global longitudinal strain -1.2% [95% CI: -1.8% to -0.5%]; global circumferential strain -2.5% [95% CI: -3.7% to -1.3%]; all P < 0.001) with no significant change in resting cardiac output between groups. Mitral valve systolic anterior motion and mitral regurgitation significantly decreased with aficamten at week 24.</p><p><strong>Conclusions: </strong>In addition to lowering Valsalva LVOT-G and left atrial volume index, treatment with aficamten compared with metoprolol over 24 weeks led to improvement in measures of LV diastolic function, mitral valve systolic anterior motion, and mitral regurgitation. Aficamten therapy resulted in modest reduction in LVEF compared with metoprolol. These exploratory findings further support the overall superiority of therapy with aficamten over metoprolol demonstrated in MAPLE-HCM with evidence of favorable changes in multiple echocardiographic measures of cardiac structure and function in patients with symptomatic obstructive HCM. (Metoprolol vs Aficamten in Patients with LVOT Obstruction on Exercise Capacity in HCM [MAPLE-HCM]; NCT05767346).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033559","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":"Lipoprotein(a) Levels and Time to Cardiovascular Benefit With Alirocumab in Patients With Recent Acute Coronary Syndrome.","authors":"Kausik K Ray, Michael Szarek, Deepak L Bhatt, Vera A Bittner, Sergio Fazio, Shaun G Goodman, Robert A Harrington, J Wouter Jukema, Harvey D White, Ph Gabriel Steg, Gregory G Schwartz","doi":"10.1016/j.jacc.2025.08.043","DOIUrl":"10.1016/j.jacc.2025.08.043","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958581","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":"Natriuretic Peptides, Body Mass Index, and Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction.","authors":"John W Ostrominski, Brendon L Neuen, Brian L Claggett, Inder S Anand, Akshay S Desai, Pardeep S Jhund, Carolyn S P Lam, Marc A Pfeffer, Bertram Pitt, Faiez Zannad, Michael R Zile, Milton Packer, Kieran F Docherty, John J V McMurray, Scott D Solomon, Muthiah Vaduganathan","doi":"10.1016/j.jacc.2025.08.028","DOIUrl":"10.1016/j.jacc.2025.08.028","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Natriuretic peptides are the primary biomarkers recommended in heart failure (HF) guidelines to risk stratify patients in clinical practice and serve as key eligibility criteria in contemporary clinical trials. However, threshold levels typically do not account for measures of adiposity, such as body mass index (BMI).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The purpose of this study was to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) with clinical outcomes in individuals with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), stratified according to BMI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;In this participant-level pooled analysis of 4 global, randomized, outcomes trials including adults with HFmrEF/HFpEF, the association between NT-proBNP and clinical outcomes (cardiovascular death or HF hospitalization, cardiovascular death, and all-cause death) was evaluated according to BMI as a continuous and categorical variable.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 14,750 participants (mean age, 72 ± 9 years; 50% female; mean BMI, 30 ± 6 kg/m&lt;sup&gt;2&lt;/sup&gt;; median NT-proBNP, 836 pg/mL), higher baseline BMI was significantly and nonlinearly associated with lower NT-proBNP levels. Over a median follow-up of 2.8 years, each doubling of baseline NT-proBNP was associated with a 40% higher covariate-adjusted rate of cardiovascular death or HF hospitalization (HR: 1.40; 95% CI: 1.36-1.43; P &lt; 0.001); however, this association appeared incrementally blunted with higher baseline BMI (P&lt;sub&gt;interaction&lt;/sub&gt; = 0.008). For the same absolute risk of cardiovascular death or HF hospitalization (5 events per 100 person-years), NT-proBNP levels in participants without atrial fibrillation were nearly 3-fold lower among those with BMI ≥35 kg/m&lt;sup&gt;2&lt;/sup&gt; (158 pg/mL) vs &lt;35 kg/m&lt;sup&gt;2&lt;/sup&gt; (450 pg/mL). At a contemporary NT-proBNP-based trial eligibility threshold, absolute risk of cardiovascular death or HF hospitalization ranged from 3.5 per 100 person-years among persons with BMI &lt;30 kg/m&lt;sup&gt;2&lt;/sup&gt; to 7.3 per 100 person-years among those with BMI ≥40 kg/m&lt;sup&gt;2&lt;/sup&gt;.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this analysis, current NT-proBNP thresholds substantially underestimated the absolute risk of adverse HF outcomes among persons with higher BMI. These data question single fixed thresholds and instead suggest that lower NT-proBNP cutoffs may more appropriately risk stratify patients with higher BMI. (Irbesartan in Heart Failure and Preserved Ejection Fraction [I-PRESERVE], NCT00095238; Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [TOPCAT], NCT00094302; Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin Receptor Blocker Global Outcomes in HF with Preserved Ejection Fraction [PARAGON-HF], NCT01920711; Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958643","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 Effects and Tolerability of GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of 99,599 Patients.","authors":"Mattia Galli, Stefano Benenati, Claudio Laudani, Beatrice Simeone, Gianmarco Sarto, Luis Ortega-Paz, Erica Rocco, Marco Bernardi, Luigi Spadafora, Domenico D'Amario, Ernesto Greco, Giacomo Frati, Massimo Federici, Roxana Mehran, Filippo Crea, Dominick J Angiolillo, Sebastiano Sciarretta","doi":"10.1016/j.jacc.2025.08.027","DOIUrl":"10.1016/j.jacc.2025.08.027","url":null,"abstract":"<p><strong>Background: </strong>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have demonstrated significant cardiovascular (CV) benefits, particularly in patients with diabetes mellitus, but the safety and efficacy of different GLP-1 RAs across diverse populations remain insufficiently defined.</p><p><strong>Objectives: </strong>Previous meta-analyses of GLP-1 RAs have been limited by restricted populations, omission of recent trials, or incomplete safety synthesis; this study integrates the latest evidence across 21 randomized controlled trials and diverse populations using advanced meta-analytic methods.</p><p><strong>Methods: </strong>Randomized controlled trials comparing GLP-1 RAs vs controls or placebo were included. Analyses were conducted in prespecified subgroups based on the GLP-1 RA used. Prespecified subgroups according to diabetes mellitus, kidney function, obesity, or heart failure were also performed. Main outcomes comprised mortality (all-cause and CV), trial-defined major adverse cardiovascular events (MACE) and serious adverse events. GRADE (Grading of Recommendations Assessment, Development and Evaluation) and trial sequential analyses were performed to evaluate certainty and conclusiveness of findings, respectively.</p><p><strong>Results: </strong>A total of 21 trials encompassing 99,599 patients were included. Eight different GLP-1 RAs were used (lixisenatide, liraglutide, exenatide, semaglutide, efpeglenatide, dulaglutide, albiglutide, and tirzepatide), each administered at therapeutic doses and compared vs placebo or controls. Mean follow-up duration was 2.4 years. We found conclusive, high-certainty evidence that GLP-1 RAs reduced all-cause death (incidence rate ratio [IRR]: 0.88; 95% CI: 0.84-0.92; needed to treat [NNT] = 121), CV death (IRR: 0.87; 95% CI: 0.81-0.92; NNT = 170), and MACE (IRR: 0.87; 95% CI: 0.83-0.91; NNT = 66), compared with controls. GLP-1 RAs reduced serious adverse events (-9%), myocardial infarction (-15%), acute kidney failure (-9%), heart failure (-15%), and infections (-10%), but increased gastrointestinal (+63%) and gallbladder (+26%) disorders. There were no differences in stroke, pancreatitis, or neoplasm between groups. Results were mostly consistent across subgroups. Analysis by GLP-1 RA type revealed potential differences in efficacy and safety profiles.</p><p><strong>Conclusions: </strong>GLP-1 RAs reduce mortality and MACE in high-risk populations, highlighting benefits beyond glycemic control. These come at increased gastrointestinal and gallbladder risks. Variation in efficacy and tolerability supports tailoring GLP-1 RA therapy to individual patient characteristics and treatment goals. (PROSPERO [GLP-1 RAs Reduce Mortality and Cardiovascular Events Across the Spectrum of Treated Patients: A Systematic Review and Meta-Analysis; CRD420251032222]).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958705","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":"Use of Risk Assessment to Guide Decision-Making for Blood Pressure Management in the Primary Prevention of Cardiovascular Disease: A Scientific Statement From the American Heart Association and American College of Cardiology.","authors":"Sadiya S Khan, Donald M Lloyd-Jones, Marwah Abdalla, Natalie A Bello, Ciantel A Blyler, Jocelyn Carter, Yvonne Commodore-Mensah, Keith C Ferdinand, Heather M Johnson, Daniel Jones, Amit Khera, Paul Muntner, Stacey Schott, Daichi Shimbo, Sidney C Smith, Sandra J Taler, Eugene Yang","doi":"10.1016/j.jacc.2025.08.001","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.08.001","url":null,"abstract":"<p><p>Risk assessment plays a central role in the primary prevention of cardiovascular disease. The 2017 High Blood Pressure Clinical Practice Guideline incorporated quantitative risk assessment for the first time to guide the initiation of antihypertensive drug therapy and recommended calculation of 10-year risk of atherosclerotic cardiovascular disease with the Pooled Cohort Equations. Although the 2025 High Blood Pressure Guideline reaffirmed this overarching paradigm for risk-based initiation of antihypertensive drug therapy, it updated the recommended risk model to the Predicting Risk of Cardiovascular Disease Events equations, which estimate 10-year risk of total cardiovascular disease (including atherosclerotic cardiovascular disease and heart failure), and defined a new risk threshold for initiation of antihypertensive therapy in patients with stage 1 hypertension. This American Heart Association/American College of Cardiology scientific statement summarizes the rationale to recommend the use of the Predicting Risk of Cardiovascular Disease Events equations, the evidence base for the new threshold of 10-year risk of cardiovascular disease of ≥7.5%, and the population-level implications of these revised recommendations. This scientific statement also offers practical advice for implementing risk assessment as the first step in the comprehensive approach to hypertension management with shared decision-making between patients and clinicians. Remaining gaps in awareness and treatment of hypertension underscore the need for innovative strategies to improve implementation of and adherence to risk-based guideline recommendations, including automation of risk assessment in electronic health records, decision-support aids, and refinement of risk assessment, to equitably improve the initiation of antihypertensive drug therapy, blood pressure control, and outcomes.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958714","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":"Reply: From the Hazards of Death to the Hazards of Indication Creep for TAVR.","authors":"Rohin K Reddy, James P Howard, Yousif Ahmad","doi":"10.1016/j.jacc.2025.06.025","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.025","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 8","pages":"e77"},"PeriodicalIF":22.3,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958828","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}