Journal of the American College of Cardiology最新文献

{"title":"Anthropometric Measures, Cardiovascular Outcomes, and Treatment Effects of Finerenone in Cardiovascular-Kidney-Metabolic Disease: Pooled Participant-Level Analysis of Three Global Trials.","authors":"John W Ostrominski, Josephine Harrington, Brian L Claggett, Gerasimos Filippatos, Akshay S Desai, Pardeep S Jhund, Alasdair D Henderson, Carolyn S P Lam, Michele Senni, Sanjiv J Shah, Adriaan A Voors, Faiez Zannad, Peter Rossing, Luis M Ruilope, Stefan D Anker, Bertram Pitt, Rajiv Agarwal, Meike D Brinker, Katja Rohwedder, James Lay-Flurrie, Andrea Lage, John J V McMurray, Scott D Solomon, Muthiah Vaduganathan","doi":"10.1016/j.jacc.2025.08.039","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.08.039","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a core pathophysiological contributor to cardiovascular, kidney, and metabolic (CKM) conditions. However, the association between different adiposity-related anthropometrics and cardiovascular outcomes in persons with CKM conditions has not been rigorously explored.</p><p><strong>Objectives: </strong>To examine cardiovascular outcomes and treatment effects of finerenone according to different adiposity-related anthropometrics.</p><p><strong>Methods: </strong>In this prespecified participant-level pooled analysis of FIDELIO-DKD, FIGARO-DKD, and FINEARTS-HF (FINE-HEART), cardiovascular outcomes and treatment effects of finerenone according to baseline body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR), and waist-hip ratio (WHR) were evaluated using multivariable-adjusted Cox proportional hazards regression and Poisson regression.</p><p><strong>Results: </strong>Of 18,759 participants with available data for all anthropometrics, 52% had a BMI ≥30 kg/m² and 98% had any excess adiposity. Among those with BMI <30 kg/m², 95% had increased abdominal adiposity, especially women and older adults. Higher BMI, WC, WHtR, and WHR were each significantly associated with a wide range of cardiovascular outcomes, including cardiovascular death or heart failure (HF) hospitalization and its individual components, major adverse cardiovascular events, new-onset atrial fibrillation, and incident HF hospitalization. BMI-adjusted WHtR and WHtR-adjusted BMI were each associated with a higher rate of cardiovascular death or HF hospitalization; participants with elevated BMI and WHtR experienced a higher rate of cardiovascular death or HF hospitalization compared with those with elevated BMI or WHtR alone (P<0.001). Benefits of finerenone on cardiovascular death or HF hospitalization were consistent irrespective of baseline BMI (P_interaction=0.27) or WHtR (P_interaction=0.26); absolute benefits appeared greater among participants with higher adiposity. Serious adverse events were less common with finerenone vs. placebo, irrespective of baseline BMI category (P_interaction=0.08).</p><p><strong>Conclusions: </strong>These findings suggest assessment of anthropometrics capturing abdominal adiposity, in addition to BMI, may enhance obesity identification and risk stratification among individuals with CKM conditions. Finerenone consistently reduced adverse cardiovascular outcomes across a wide range of adiposity.</p><p><strong>Prospero registration: </strong>CRD42024570467.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958740","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":"Treatment of Multilayer In-Stent Restenosis: Lifetime Management.","authors":"Angelo Oliva, Mauro Gitto, Roxana Mehran","doi":"10.1016/j.jacc.2025.06.035","DOIUrl":"10.1016/j.jacc.2025.06.035","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 7","pages":"512-514"},"PeriodicalIF":22.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847156","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":"Bleeding and Thrombotic Risk After Percutaneous Coronary Intervention: No Longer a Zero-Sum Game.","authors":"Usman Baber","doi":"10.1016/j.jacc.2025.06.018","DOIUrl":"10.1016/j.jacc.2025.06.018","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 7","pages":"499-501"},"PeriodicalIF":22.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847151","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 Adipokine Hypothesis of Heart Failure With a Preserved Ejection Fraction: A Novel Framework to Explain Pathogenesis and Guide Treatment.","authors":"Milton Packer","doi":"10.1016/j.jacc.2025.06.055","DOIUrl":"https://doi.org/10.1016/j.jacc.2025.06.055","url":null,"abstract":"<p><strong>Hypothesis: </strong>The paper proposes a novel unifying hypothesis-that heart failure with preserved ejection fraction (HFpEF) arises primarily from the expansion and dysfunctional transformation of visceral adipose tissue, leading to the secretion of altered suite of signaling molecules (adipokines), which causes systemic inflammation, plasma volume expansion, and cardiac hypertrophy and fibrosis.</p><p><strong>Elements of the framework: </strong>The framework groups adipokines into 3 domains. Domain I adipokines are cardioprotective molecules but are suppressed in patients with excess adiposity. Domain II adipokines are cardioprotective molecules that are up-regulated by adiposity as a compensatory response mechanism. Domain III adipokines, whose secretion is heightened in adiposity, have proinflammatory, prohypertrophic, profibrotic, and antinatriuretic effects. HFpEF results from an adiposity-driven imbalance that promotes Domain III adipokines but suppresses Domain I adipokines, with Domain II adipokines representing an inadequate counter-regulatory response.</p><p><strong>Key lines of evidence: </strong>1) Obesity and dietary nutrient excess are the major drivers of experimental HFpEF; 2) changes in visceral adiposity and circulating adipokines are observed years before and predict the diagnosis of HFpEF (but not heart failure with a reduced ejection fraction) in the general community; 3) central obesity or visceral adiposity is present in >95% of patients with HFpEF and tracks with disease severity; 4) obesity and HFpEF exhibit striking parallelism in their molecular, pathophysiological, and clinical features; 5) characteristic changes in the adipokine profile occur in parallel in central obesity and heart failure and are correlated with disease severity; 6) adipokines have established effects on cardiac structure and function that can lead to HFpEF; 7) bariatric surgery or drug treatments for HFpEF cause shrinkage of visceral fat depots (disproportionate to changes in body weight), while simultaneously increasing Domain I adipokines and decreasing Domain III adipokines; 8) excess adiposity appears to identify patients most likely to respond to current treatments for HFpEF; and 9) experimental interventions that target only adipose tissue to selectively increase or decrease its secretion of specific adipokines cause distant effects on the heart to modulate cardiac structure and the evolution of cardiomyopathy.</p><p><strong>Conclusions: </strong>The totality of evidence suggests that HFpEF evolves-not as a heterogenous disorder related to diverse comorbidities and not as a primary disorder of cardiomyocytes-but as an adipose-driven derangement that is disseminated (through endocrine-paracrine signaling) to the heart.</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958724","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":"Systolic Blood Pressure and All-Cause Mortality in Treated Hypertensive Adults Aged 80+ Years.","authors":"Anastasios Kollias, Aikaterini Komnianou, Konstantinos G Kyriakoulis","doi":"10.1016/j.jacc.2025.03.550","DOIUrl":"10.1016/j.jacc.2025.03.550","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 7","pages":"e65-e66"},"PeriodicalIF":22.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847154","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: Systolic Blood Pressure and All-Cause Mortality in Treated Hypertensive Adults Aged 80+ Years.","authors":"Huanhuan Yang, Yuan Lu","doi":"10.1016/j.jacc.2025.05.050","DOIUrl":"10.1016/j.jacc.2025.05.050","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 7","pages":"e67-e68"},"PeriodicalIF":22.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847153","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":"Paclitaxel-Coated Balloon for the Treatment of Multilayer In-Stent Restenosis: AGENT IDE Subgroup Analysis.","authors":"Ajay J Kirtane, Richard Shlofmitz, Jeffrey Moses, William Bachinsky, Suhail Dohad, Steven Rudick, Robert Stoler, Brian K Jefferson, William Nicholson, John Altman, Cinthia Bateman, Amar Krishnaswamy, J Aaron Grantham, Francis J Zidar, Jennifer A Tremmel, Cindy Grines, Mustafa I Ahmed, Azeem Latib, Behnam Tehrani, J Dawn Abbott, Wayne Batchelor, Rafael Cavalcante, Robert W Yeh","doi":"10.1016/j.jacc.2025.05.062","DOIUrl":"10.1016/j.jacc.2025.05.062","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronary in-stent restenosis (ISR) within multiple layers of stent pose a specific clinical challenge because of higher rates of recurrent restenosis as well as a desire to avoid an additional layer of stent. Drug-coated balloons (DCBs) provide an alternative antiproliferative therapeutic option for multilayer ISR.</p><p><strong>Objectives: </strong>We evaluated the efficacy and safety of a low-dose paclitaxel-coated vs uncoated balloon among patients with multilayer or single-layer ISR in the AGENT IDE (A Clinical Trial to Assess the Agent Paclitaxel Coated PTCA Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis) trial.</p><p><strong>Methods: </strong>AGENT IDE is a prospective, multicenter trial that randomized patients with ISR (reference vessel diameter >2.0 mm to ≤4.0 mm and lesion length <26 mm) in a 2:1 allocation to paclitaxel-coated or an uncoated balloon following successful lesion preparation. Randomization was stratified by multi- vs single-layer ISR as well as by center. The primary study endpoint was 1-year target lesion failure (TLF): composite occurrence of ischemia-driven target lesion revascularization (TLR), target vessel-related myocardial infarction (MI), or cardiac death.</p><p><strong>Results: </strong>Of the 600 patients randomized in the trial, multilayer ISR was present in 258 (44%) patients. Patients with multilayer ISR had higher rates of TLF at 1 year compared with those with single-layer ISR (29.0% vs 15.7%, P < 0.0001). The overall study results were consistent irrespective of multilayer vs single-layer ISR (P_interaction = 0.66). Among patients with multilayer ISR, TLF was lower with paclitaxel-coated balloon compared with an uncoated balloon (23.8% vs 40.0%; HR: 0.55; 95% CI: 0.34-0.87; P = 0.01), driven by reductions in both TLR and target vessel-related MI. Similar findings were observed among patients with single layer ISR (1-year TLF: 13.5% with paclitaxel-coated vs 20.2% with uncoated balloon; HR: 0.64; 95% CI: 0.37-1.11; P = 0.11), although absolute event rates were lower.</p><p><strong>Conclusions: </strong>Patients with ISR of multiple stent layers had higher rates of adverse stent-related events compared with patients with single-layer ISR. Treatment with a paclitaxel-coated balloon led to greater absolute risk reduction in 1-year TLF among patients with multilayer ISR compared with an uncoated balloon. (A Clinical Trial to Assess the Agent Paclitaxel Coated PTCA Balloon Catheter for the Treatment of Subjects With In-Stent Restenosis [ISR] [AGENT IDE]; NCT04647253).</p>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 7","pages":"502-511"},"PeriodicalIF":22.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847152","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 Clinicians in Advancing Cardiovascular Device Safety.","authors":"Kushal T Kadakia, Sanket S Dhruva, Harlan M Krumholz","doi":"10.1016/j.jacc.2025.05.015","DOIUrl":"10.1016/j.jacc.2025.05.015","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"86 7","pages":"481-484"},"PeriodicalIF":22.3,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144847155","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":"Home Blood Pressure Monitoring: Getting It Right This Time.","authors":"Jordana B Cohen, Marwah Abdalla, Daniel W Jones, Daichi Shimbo","doi":"10.1016/j.jacc.2025.08.007","DOIUrl":"10.1016/j.jacc.2025.08.007","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958837","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":"Blood Pressure Management Guideline Development: A Professional and Personal Journey.","authors":"Daniel W Jones, Sandra J Taler, Keith C Ferdinand","doi":"10.1016/j.jacc.2025.08.008","DOIUrl":"10.1016/j.jacc.2025.08.008","url":null,"abstract":"","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":" ","pages":""},"PeriodicalIF":22.3,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958702","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}