Journal of the American Heart Association最新文献

{"title":"Beta Blockers as Primary and Secondary Prevention for Aortic Dissections in Nonsyndromic Patients With Hypertension.","authors":"Mads Liisberg, Jes S Lindholt, Katrine L Larsen, Axel C P Diederichsen, Jesper Hallas, Oke Gerke, Anne N Lasota, Henrik K Jensen, Leila L Benhassen, Amalie L Mørkved, Reshaabi Srinanthalogen, Joachim S Skovbo, Lasse M Obel","doi":"10.1161/JAHA.124.040149","DOIUrl":"10.1161/JAHA.124.040149","url":null,"abstract":"<p><strong>Background: </strong>Recommendations for beta blockers in preventing aortic dissection (AD) and improving postdissection survival in nonsyndromic patients with hypertension are based on limited evidence.</p><p><strong>Methods: </strong>This nationwide, population-based study combined a nested case-control and historical cohort design. Using Danish health care registries, all hospitalized adult patients with AD from 1996 to 2016 were identified and validated. Patients with bicuspid aortic valves or connective tissue disorders were excluded. In the case-control analysis, 1657 validated AD cases were matched 1:10 (±1) with 16 139 controls with hypertension based on age, sex, index date, and cumulative antihypertensive drug use. Long-term beta blocker use was defined as ≥2000 defined daily doses (DDD). In the cohort analysis, 2120 validated survivors of AD were followed for 5 years to assess postdissection mortality stratified by beta blocker use.</p><p><strong>Results: </strong>Long-term beta blocker use was associated with increased odds of AD type A (adjusted odds ratio [aOR], 1.7 [95% CI, 1.3-2.3]) and AD type B (aOR, 3.7 [95% CI, 2.7-5.2]) compared with never-users. A dose-dependent risk increase was observed for AD type B (aOR, 1.4 [95% CI, 0.8-2.2] for DDD 100-199; aOR, 3.9 [95% CI, 1.6-9.8] for DDD ≥10 000). Beta blocker use was associated with higher 5-year all-cause mortality in survivors of AD type A (adjusted hazard ratio [aHR], 1.5 [95% CI, 0.99-2.23]) and AD type B (aHR, 1.5 [95 %CI, 1.0-2.3]) compared with never-users.</p><p><strong>Conclusions: </strong>Beta blocker use did not reduce AD risk or improve outcomes in survivors of AD compared with other antihypertensive agents. Although clinically relevant data as aortic diameters and blood pressure were not available, these findings challenge current clinical practice and highlight the need for randomized trials.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e040149"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276718","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":"Exercise Prescription in Arrhythmogenic Cardiomyopathy: Finding the Right Balance Between Risks and Benefits.","authors":"Lorenzo-Lupo Dei, Jennie Han, Silvio Romano, Luigi Sciarra, Angeliki Asimaki, Michael Papadakis, Sanjay Sharma, Gherardo Finocchiaro","doi":"10.1161/JAHA.124.039125","DOIUrl":"10.1161/JAHA.124.039125","url":null,"abstract":"<p><p>Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac condition, often caused by mutations in genes encoding desmosomal proteins. The pathologic hallmark of the disease is a fibrofatty replacement of the myocardium, which constitutes the substrate for potentially fatal ventricular arrhythmias. ACM is one of the most common etiology of sudden cardiac death in athletes and young individuals. Although it is well established that regular exercise confers multiple health benefits and better survival in the general population, intense exercise may accelerate the phenotypic expression and the propensity to ventricular arrhythmias in patients with ACM. This review discusses current evidence regarding the safety and the effects of exercise in ACM. We scrutinize research findings based on animal and human models that raise concerns on the possible detrimental role of intense exercise in this condition. Finally, we examine the current knowledge on exercise prescription focusing on the optimal amount of exercise that should be recommended to patients with ACM.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039125"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227641","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":"Trajectories of Cognitive Decline Before and After New-Onset Hypertension.","authors":"Qingmei Chen, Jianye Dong, Guo-Chong Chen, Haibin Li, Yueping Shen, Jianian Hua","doi":"10.1161/JAHA.124.039849","DOIUrl":"10.1161/JAHA.124.039849","url":null,"abstract":"<p><strong>Background: </strong>Whether cognitive function declines before and shortly after new-onset hypertension remains largely unknown.</p><p><strong>Methods and results: </strong>This prospective study used data from wave 2 (2004) to wave 9 (2018) of the English Longitudinal Study of Aging of participants who were free of hypertension at baseline. Our outcome variable was global cognitive <i>z</i> scores, derived from 3 cognitive tests: semantic fluency test, memory test, and orientation test. Over a median follow-up of 13.6 years, 1121 (37.8%) participants developed hypertension. Using linear mixed models, we compared the trajectories of cognitive function before and after hypertension onset, with a concurrent control group without hypertension. The cognitive decline rate among those who later developed hypertension during the period before hypertension onset was similar to the rate among those who remained hypertension-free throughout the study. Compared with the cognitive decline rate before hypertension, the rate of cognitive decline accelerated after the new onset of hypertension in global cognition (β, -0.019 SD/y [95% CI, -0.033 to -0.005]; <i>P</i>=0.007). Compared with participants developing hypertension between 55 and 64 years of age, those developing hypertension between 65 and 74 years of age experienced a more pronounced decline in global cognition after hypertension (β, -0.046 SD/y [95% CI, -0.077 to -0.014]; <i>P</i>=0.004).</p><p><strong>Conclusions: </strong>Participants experienced accelerated cognitive decline upon developing new-onset hypertension. Participants with older age at hypertension onset experienced an increased impact of cognitive decline following the onset of hypertension. Management of blood pressure in both midlife and later life may be crucial to protect cognitive health.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039849"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227647","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":"Omaveloxolone, But Not Dimethyl Fumarate, Improves Cardiac Function in Friedreich's Ataxia Mice With Severe Cardiomyopathy.","authors":"Lili Salinas, Francisco Figueroa, Claire B Montgomery, Phung N Thai, Nipavan Chiamvimonvat, Gino Cortopassi, Elena N Dedkova","doi":"10.1161/JAHA.124.038505","DOIUrl":"10.1161/JAHA.124.038505","url":null,"abstract":"<p><strong>Background: </strong>Friedreich's ataxia (FA) is a genetic disorder caused by a severe decrease in FXN (frataxin) protein expression in mitochondria. The clinical manifestation of this disorder is a cerebellar ataxia; however, the common lethal component in FA is cardiomyopathy.</p><p><strong>Methods: </strong>A conditional Fxn^flox/null::MCK-Cre knockout (FXN-cKO) mouse model was used to mimic the late-stage severe cardiomyopathy in FA. Nrf2 (nuclear factor erythroid 2-related factor 2) inducers, omaveloxolone and dimethyl fumarate (DMF), were independently tested in this mouse model to determine the effects on cardiac health and lifespan.</p><p><strong>Results: </strong>Omaveloxolone significantly improved cardiac contractile function and markers of heart failure in FA such as <i>Nppb</i>, <i>Aldh1a3</i>, and <i>Gdf15</i>. Despite improvement in cardiac function, omaveloxolone did not prevent premature death in FXN-cKO animals and notably accelerated death in FXN-cKO females. Omaveloxolone decreased oxidative stress and inflammatory marker IL1β (interleukin-1 beta), and stimulated <i>Nqo1</i> gene expression above control level. DMF restored elevated <i>HO-1</i> (<i>Hmox</i>) expression and significantly increased <i>Sirt1</i> expression. Although both omaveloxolone and DMF restored decreased SERCA2 (<i>Atp2a)</i> and MCU (<i>Mcu</i>) expression and ameliorated elevated phosphorylation of CaMKIIδ at Thr²⁸⁶ site in FA hearts, DMF did not improve cardiac contractile function and survival. Furthermore, neither omaveloxolone or DMF decreased hypertrophy and fibrosis (Masson trichrome staining and <i>Lgals3</i> expression) or rescued impaired mitochondrial function and integrative stress response in FXN-cKO hearts.</p><p><strong>Conclusions: </strong>These data demonstrate that omaveloxolone significantly improved contractile function but not survival in FA hearts because cardiac fibrosis and wall stress persisted even with omaveloxolone treatment. More studies are warranted to determine the cause of premature death in omaveloxolone-treated FXN-cKO female mice.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e038505"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276719","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":"Long-Term Outcomes in Patients With Hemorrhagic Moyamoya Disease Combined With Hypertension After Encephaloduroarteriosynangiosis.","authors":"Qingbao Guo, Manli Xie, Huanhuan Ji, Qian-Nan Wang, Xiangyang Bao, Lian Duan","doi":"10.1161/JAHA.124.039054","DOIUrl":"10.1161/JAHA.124.039054","url":null,"abstract":"<p><strong>Background: </strong>Although hypertension is prevalent in adults with moyamoya disease (MMD) and intracranial hemorrhage significantly worsens prognosis, the impact of hypertension on long-term outcomes after encephaloduroarteriosynangiosis in hemorrhagic MMD remains unclear; this retrospective cohort study used propensity score matching to compare outcomes between hypertensive and nonhypertensive patients and preliminarily assess the role of blood pressure management.</p><p><strong>Methods: </strong>After propensity score matching, long-term outcomes post- encephaloduroarteriosynangiosis in patients with hemorrhagic MMD with hypertension from January 2010 to December 2018 were analyzed. The clinical and radiological data were collected. Kaplan-Meier curves evaluated the relationship between recurrence-free survival, overall survival (OS), and hypertension. Univariate and multivariate Cox regression assessed independent factors influencing hematoma recurrence-free survival and OS. Subgroup analysis of patients with hemorrhagic MMD with hypertension assessed the impact of different blood management on long-term outcomes.</p><p><strong>Results: </strong>Kaplan-Meier curves showed a significant correlation between hypertension and decreased hematoma recurrence-free survival (<i>P</i>=0.004) and OS (<i>P</i>=0.014) during follow-up. The 5-year recurrence-free survival rate did not significantly differ between hypertensive and nonhypertensive groups (<i>P</i>=0.77). Hypertension was associated with reduced 10-year hematoma recurrence-free survival (<i>P</i>=0.004) and OS (<i>P</i>=0.014). In multivariate analysis, hypertension (<i>P</i>=0.015), perioperative complications (<i>P</i>=0.003), and choroidal anastomosis (<i>P</i>=0.0008) significantly influenced hematoma recurrence-free survival. Analysis of OS revealed significant differences for hypertension (<i>P</i>=0.018), follow-up duration (<i>P</i><0.001), choroidal anastomosis (<i>P</i>=0.041), and initial mRS (<i>P</i><0.001). Subgroup analysis showed that optimal blood pressure management significantly reduced hematoma recurrence (<i>P</i>=0.049) but did not improve OS (<i>P</i>=0.31).</p><p><strong>Conclusions: </strong>This study highlights significant differences in hematoma recurrence-free survival and OS between patients with hemorrhagic MMD with and without hypertension. A subgroup analysis of those with hypertension showed that optimal blood pressure control notably lowered hematoma recurrence but did not improve OS. For patients with hemorrhagic MMD with hypertension, optimizing blood pressure alone may be insufficient, emphasizing the importance of personalized integrated strategies for this patient subgroup.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039054"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303594","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 in Cardiac Rehabilitation: Applying the American Heart Association Life's Simple 7 Framework in a Center-Based Cohort.","authors":"Audry Chacin-Suarez, Tomoaki Hama, Matthew P Johnson, Helayna Abraham, Thomas P Olson, LaPrincess C Brewer","doi":"10.1161/JAHA.124.039010","DOIUrl":"10.1161/JAHA.124.039010","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) is a comprehensive secondary cardiovascular disease program with structured lifestyle interventions to reduce morbidity and mortality. The American Heart Association cardiovascular health (CVH) framework measures health-promoting behaviors and clinical factors, but it has not been rigorously evaluated in the CR setting.</p><p><strong>Methods: </strong>This retrospective cohort study analyzed patients attending CR from January 2018 to September 2020. Patients were evaluated at baseline (pre-CR) and completion (post-CR) using 3 clinical factors (blood pressure, cholesterol, and hemoglobin A1c) and 4 health behaviors (smoking, body mass index, physical activity, and diet). CVH score was computed as a composite of each Life's Simple 7 component by assigning 0 points for poor, 1 point for intermediate, or 2 points for ideal (range 0-14 points). CVH scores were further categorized as poor (0-6 points), intermediate (7-8 points), and ideal (9-14 points). Missing data in the analysis were accounted for using a multiple imputation procedure.</p><p><strong>Results: </strong>Patients (N=937) were aged 64.0±13.4 years old, 34% women, and attended 11±12 CR sessions. Pre-CR, 97.2% had poor CVH scores, 2.8% had intermediate scores, and none met ideal CVH criteria. Post-CR, there was a reduction in poor scores across all metrics except for hemoglobin A1c, which increased (40.6%-43.5%). Younger patients showed improvement in hemoglobin A1c, while older patients improved in body mass index and blood pressure.</p><p><strong>Conclusions: </strong>Our study demonstrates the efficacy of CR in improving CVH but underscores the need for better blood glucose management. Tailored interventions based on age and sex may further optimize outcomes for CR participants.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039010"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144227639","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":"Association of Intracranial Dolichoectasia and Cerebral Small Vessel Disease in Patients With Intracerebral Hemorrhage.","authors":"Kitti Thiankhaw, Larysa Panteleienko, Catriona R Stewart, Rupert Oliver, Dermot Mallon, Gareth Ambler, David J Werring","doi":"10.1161/JAHA.124.039039","DOIUrl":"10.1161/JAHA.124.039039","url":null,"abstract":"<p><strong>Background: </strong>Intracranial arterial dolichoectasia (IADE) is associated with cerebral small vessel disease (CSVD) in populations with ischemic stroke. Whether IADE is related to CSVD markers in patients with intracerebral hemorrhage (ICH) is unclear but might be relevant for CSVD diagnosis and prognosis. We aimed to investigate the prevalence and associations of IADE in patients with ICH.</p><p><strong>Methods: </strong>We included consecutive patients with ICH between February 2016 and September 2023. IADE was determined using magnetic resonance angiography based on validated scales assessing vessel diameter, length, and tortuosity. Neuroimaging markers of CSVD were investigated using validated magnetic resonance imaging rating scales. Left ventricular mass (LVM) was determined from transthoracic echocardiography. Multivariable binary logistic regression analyses were used to evaluate associations between IADE and CSVD.</p><p><strong>Results: </strong>We included 138 patients with a mean age of 66.7±11.8 years, 58.0% men. IADE was present in 16 patients (11.6%). LVM was greater in patients with IADE (183.0±61.3 g versus 155.3±51.2 g, <i>P</i>=0.04). Patients with ICH and IADE had significantly higher proportions of deep lacunes (43.8% versus 18.0%, <i>P</i>=0.02) and deep cerebral microbleeds (56.3% versus 27.1%, <i>P</i>=0.02) compared with individuals without IADE. IADE was independently associated with deep lacunes (adjusted odds ratio [OR], 3.10 [95% CI, 1.02-9.55], <i>P</i>=0.04), severe periventricular white matter hyperintensities (adjusted OR, 3.29 [95% CI, 1.00-10.94], <i>P</i>=0.04), and deep cerebral microbleeds (adjusted OR, 2.80 [95% CI, 1.04-8.65], <i>P</i>=0.04). Among these CSVD markers, IADE had a high predictive value for deep cerebral microbleeds with a receiver operating characteristic curve of 0.75 (95% CI, 0.66-0.85). There was no statistically significant association between IADE and lobar ICH (adjusted OR, 1.29 [95% CI, 0.36-4.64], <i>P</i>=0.70) or cerebral amyloid angiopathy (adjusted OR, 0.46 [95% CI, 0.13-1.67], <i>P</i>=0.24).</p><p><strong>Conclusions: </strong>IADE is found in approximately 12% of patients with ICH and is independently associated with neuroimaging markers of arteriolosclerosis but not cerebral amyloid angiopathy.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039039"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267847","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":"Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With 3-Vessel Coronary Artery Disease and Diabetes.","authors":"Ryaan El-Andari, Nicholas Fialka, Jimmy Kang, Yongzhe Hong, Padma Kaul, Finlay A McAlister, William Kent, Jeevan Nagendran, Jayan Nagendran","doi":"10.1161/JAHA.124.039663","DOIUrl":"10.1161/JAHA.124.039663","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) has been associated with reduced mortality, myocardial infarction, and repeat revascularization compared with percutaneous coronary intervention (PCI) for patients with 3-vessel coronary artery disease (CAD) and diabetes. The majority of previous studies have been limited to follow-up of <10 years. Herein, we compared CABG and PCI in patients with 3-vessel coronary artery disease and diabetes with a maximum long-term follow-up of 14 years.</p><p><strong>Methods: </strong>Patients with diabetes and 3-vessel coronary artery disease but without ST-segment-elevation myocardial infarction who underwent coronary angiography followed by CABG or PCI from 2009 to 2018 were included in this study. The primary outcome was mortality, and the secondary outcomes included myocardial infarction, stroke, or repeat revascularization. Outcomes were adjusted for age, sex, and clinical comorbidities.</p><p><strong>Results: </strong>A total of 1210 patients underwent PCI (median follow-up, 9.1 years) while 477 underwent CABG (median follow-up, 8.1 years). Patients who underwent CABG were less likely to experience mortality (49.6% versus 57.6%, <i>P</i>=0.003, adjusted hazard ratio [aHR], 0.75 [95% CI, 0.61-0.91]), myocardial infarction (15.6% versus 28.1%, <i>P</i><0.001, aHR, 0.45 [95% CI, 0.33-0.61]), or require repeat revascularization (7.7% versus 26.9%, <i>P</i><0.001, aHR, 0.21 [95% CI, 0.14-0.30]) at longest follow-up. Risk of rehospitalization (82.6% versus 83.4%, <i>P</i>=0.656) and stroke (11.6% versus 12.2%, <i>P</i>=0.794) did not significantly differ between groups.</p><p><strong>Conclusions: </strong>In this study, we describe one of the longest follow-up periods for patients with diabetes and 3-vessel coronary artery disease who underwent CABG or PCI and confirmed that the shorter-term benefits seen in randomized trials do translate into longer-term reductions in risk of death, myocardial infarction, or repeat revascularization.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039663"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267924","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":"Evaluation of Blood Pressure Control, Medication Adherence, and Therapeutic Inertia in US Patients With Hypertension Prescribed Multiple Antihypertensives.","authors":"Jeff T Mohl, Carlos A Moreno, Kay Sadik, Mukul Singhal, Alicia Rooney, Elizabeth L Ciemins","doi":"10.1161/JAHA.124.034787","DOIUrl":"10.1161/JAHA.124.034787","url":null,"abstract":"<p><strong>Background: </strong>Failure to control blood pressure (BP) despite multiple prescribed antihypertensive medications (AHMs) is widespread and leads to worse clinical outcomes. Recent changes to BP targets in US clinical guidelines require an updated evaluation of BP control including evaluations of nonadherence and therapeutic inertia.</p><p><strong>Methods: </strong>We leveraged clinical and insurance data sourced from >50 US health care organizations to identify >500 000 patients with established hypertension (>15-month history) concurrently prescribed ≥3 AHM classes in 2019. We characterized the prevalence of uncontrolled hypertension and describe patterns of nonadherence (lack of AHM fills covering >80% of days) and therapeutic inertia (failure to escalate AHM for patients persistently out of BP control). We described the associations with factors including race, ethnicity, sex, and insurance.</p><p><strong>Results: </strong>Among 565 737 patients prescribed ≥3 AHMs, 37.7% met the recommended BP target of <130/80 mm Hg. Black race (odds ratio [OR], 0.71 [95% CI, 0.70-0.73]) and uninsured status (OR, 0.81 [95% CI, 0.76-0.86]) were most associated with lack of BP control relative to White or commercially insured patients. In a subset of insured patients, nonadherence occurred in 52.7%, although BP control remained poor among adherent patients (43.0% versus 39.4% for nonadherent). Therapeutic inertia was widespread; 64.5% of patients persistently above the BP target had no medication escalation within 18 months.</p><p><strong>Conclusions: </strong>An evaluation of a US-based, large, real-world patient cohort demonstrates that most patients prescribed ≥3 AHMs fail to achieve the recommended BP target of <130/80, and both medication nonadherence and therapeutic inertia are widespread.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e034787"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303591","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":"Prognostic Factors Associated With Early Recovery From Veno-Arterial Extracorporeal Membrane Oxygenation Support in Patients With Fulminant Myocarditis.","authors":"Tomomi Ueda, Eisuke Amiya, Masaru Hatano, Kosuke Inoue, Junichi Ishida, Shun Minatsuki, Hiroki Yagi, Chie Bujo, Yoshitaka Isotani, Nobutaka Kakuda, Takanobu Yamada, Norifumi Takeda, Hiroshi Akazawa, Koshiro Kanaoka, Kenji Onoue, Yoshihiko Saito, Shungo Hikoso, Issei Komuro, Norihiko Takeda","doi":"10.1161/JAHA.124.039673","DOIUrl":"10.1161/JAHA.124.039673","url":null,"abstract":"<p><strong>Background: </strong>Fulminant myocarditis is life-threatening and often requires mechanical circulatory support. Predicting its clinical course is crucial, yet data on early recovery predictors, particularly with veno-arterial extracorporeal membrane oxygenation, remain lacking.</p><p><strong>Methods and results: </strong>We aimed to identify prognostic factors of early recovery in fulminant myocarditis requiring veno-arterial extracorporeal membrane oxygenation by retrospective analysis of a nationwide registry in Japan. Early recovery was defined as successful weaning from mechanical circulatory support within 7 days and discharge without heart transplantation or long-term mechanical circulatory support. A total of 343 patients were analyzed; 71 were classified as early recovery and 272 as nonearly recovery. The early recovery group was significantly younger, had higher white blood cell counts, and lower creatine kinase-myocardial band level than the nonearly recovery group. To enhance clinical interpretability, we dichotomized continuous variables using optimal cutoff values derived from the Youden index. Multivariable logistic regression analysis showed the independent factors of early recovery were age ≤40 years (odds ratio [OR], 3.25), white blood cell count ≥11 000/μL (OR, 3.10), and creatine kinase-myocardial band ≤61 U/L (OR, 2.46), and if all conditions were fulfilled, the early recovery rate increased to 61.5%. Additionally, although not statistically significant, the number of rehospitalization with cardiovascular causes, death, or heart transplantation at 1-year follow-up was higher in the nonearly recovery group.</p><p><strong>Conclusions: </strong>Our study suggested younger patients who have a strong inflammatory response but less myocardial damage on admission could recover earlier. Conversely, in cases where mechanical circulatory support duration is prolonged, careful monitoring is required for prolonged left ventricular dysfunction and subsequent prognosis.</p><p><strong>Registration: </strong>URL: https://www.umin.ac.jp/; Unique identifier: UMIN000039763.</p>","PeriodicalId":54370,"journal":{"name":"Journal of the American Heart Association","volume":" ","pages":"e039673"},"PeriodicalIF":5.0,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303596","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}