American Journal of Cardiovascular Drugs最新文献

{"title":"Geographic and Racial Variation in Oral Anticoagulant (OAC) Treatment Among Commercially Insured Patients with Non-valvular Atrial Fibrillation (NVAF) in the United States.","authors":"Brett D Atwater, Risho Singh, Shashi Parmar, Augustina Ogbonnaya, Amiee Kang, Nipun Atreja, Cristina Russ, Dong Cheng, Melissa Hagan, Serina Deeba, Dionne M Hines","doi":"10.1007/s40256-025-00728-x","DOIUrl":"https://doi.org/10.1007/s40256-025-00728-x","url":null,"abstract":"<p><strong>Background: </strong>Oral anticoagulants (OACs) are recommended for stroke reduction in non-valvular atrial fibrillation (NVAF). OAC use has been studied in Medicare populations, but data for younger, commercially insured populations are limited.</p><p><strong>Objective: </strong>This retrospective study aimed to describe the geographic variation of OAC use among commercially insured patients with NVAF at high risk of stroke (CHA₂DS₂-VASc score ≥ 2) in the USA.</p><p><strong>Methods: </strong>Geographic variation was assessed by 3-digit zip code and race among patients identified from the Komodo Health commercial database with a diagnosis of NVAF between January 1, 2016, and August 31, 2021. Continuous health plan enrollment for ≥ 12 months before and 12 months after the NVAF diagnosis was required.</p><p><strong>Results: </strong>A total of 619,111 patients with NVAF at high risk for stroke were identified, of whom approximately 50% were not treated with OACs. Of the half who received OACs, almost 85% received direct OACs (DOACs) and 15% received warfarin therapy. Overall, the highest untreated rates were observed in the South and West US regions, followed by the Midwest, then the Northeast. The highest DOAC treatment rates were in the Northeast for White patients and in the North and South for Black patients. The highest warfarin treatment rates were in the upper Midwest for White patients and the Midwest for Black patients.</p><p><strong>Conclusions: </strong>This study may help guide the identification of areas to target interventions to improve treatment rates and confirm prior findings of geographic and racial variations of OAC use in NVAF.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trimetazidine in Cardiovascular Disease and Beyond: A Comprehensive Review.","authors":"Harsh Goel, Nicholas Roma, Michael Morgan, Riya Arora, Nayanika Sreejith, Deepak Goyal, Sunil Nadar","doi":"10.1007/s40256-025-00724-1","DOIUrl":"https://doi.org/10.1007/s40256-025-00724-1","url":null,"abstract":"<p><p>Trimetazidine is a metabolic modulator that acts as a competitive inhibitor of the terminal enzyme in the β-oxidation pathway to shift energy substrate from free fatty acids to the more oxygen-efficient glucose metabolism. The resulting conservation of cellular adenosine triphosphate generation in the face of ischemia/hypoxia mediates the anti-ischemic efficacy of trimetazidine. Clinically, trimetazidine has been approved as an add-on treatment in patients with symptomatic angina that is poorly controlled with first-line agents or who cannot tolerate the first-line therapy. In addition, trimetazidine has demonstrated antioxidant, cytoprotective, and anti-apoptotic activity with applications beyond angina. The aim of this review was to summarize the mechanism of action and anti-anginal efficacy of trimetazidine and to discuss the putative role of these pleiotropic effects and the evidence behind its application in cardiovascular diseases in general.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-Effectiveness and Price Threshold Analysis of Tafolecimab in Chinese Patients with Elevated LDL Cholesterol Despite Statin Therapy.","authors":"Yuansheng Wan, Jinyu Liu, Xiaolian Zhan, Yu Zhang, Ruxu You","doi":"10.1007/s40256-025-00733-0","DOIUrl":"https://doi.org/10.1007/s40256-025-00733-0","url":null,"abstract":"<p><strong>Background: </strong>Tafolecimab is a novel PCSK9 inhibitor developed in China. In recently published phase III clinical trials, tafolecimab demonstrated long-term safety and efficacy in Chinese patients with hypercholesterolemia despite statin therapy. However, pharmacoeconomic studies of tafolecimab have yet to be published. This study aimed to explore the maximum cost-effective price of tafolecimab compared with statins alone for Chinese patients with hypercholesterolemia at various willingness-to-pay (WTP) thresholds.</p><p><strong>Methods: </strong>A Markov cohort state-transition model was employed to assess the cost-effectiveness of tafolecimab from the perspective of the Chinese healthcare system. The low-density lipoprotein cholesterol (LDL-C) lowering effect of tafolecimab was observed in the CREDIT-4 trial. The baseline and subsequent incidence and transfer probability of cardiovascular events were based on prospective observational data in China and meta-analyses from the Cholesterol Treatment Trialists Study. Cost and utility values were obtained from the China Health Statistics Yearbook, health insurance, and published articles in China. The study also performed subgroup, sensitivity, and scenario analyses.</p><p><strong>Results: </strong>The annual price thresholds for tafolecimab as an adjunctive therapy to statins were Chinese yuan (CNY) 3304 and CNY 7022 at WTP thresholds of CNY 89,358 and CNY 268,074 per quality-adjusted life year (QALY), respectively. The corresponding annual price thresholds for patients with hypercholesterolemia with acute myocardial infarction were CNY 10,355 and CNY 21,793 per year. Sensitivity analyses showed that the time horizon significantly impacted price thresholds, with a several-fold difference.</p><p><strong>Conclusions: </strong>From the perspective of the Chinese healthcare system, the cost-effective annual price threshold for tafolecimab for patients with hypercholesterolemia was CNY 7022, at a threshold of CNY 268,074 per QALY.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143770915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author's Reply to Freund and Gorlicki: \"Door-to-Diuretic Time and Outcomes in Acute Heart Failure: A Scoping Review\".","authors":"Mary Tiffany Oduah, Onyedika J Ilonze","doi":"10.1007/s40256-025-00730-3","DOIUrl":"https://doi.org/10.1007/s40256-025-00730-3","url":null,"abstract":"","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on: \"Door-to-Diuretic Time and Outcomes in Acute Heart Failure: A Scoping Review\".","authors":"Yonathan Freund, Judith Gorlicki","doi":"10.1007/s40256-025-00729-w","DOIUrl":"10.1007/s40256-025-00729-w","url":null,"abstract":"","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Safety Profile of Semaglutide and Variations by Sex, Race, and Kidney Function: A Systematic Review and Meta-analysis.","authors":"Muhammad Hamayal, Chaudhary Humayun Akhtar, Naveed Ahmad, Muhammad Awwab, Warda Shahid, Hasan Shaukat Abbasi, Esha Nadeem, Erum Siddiqui, Wadana Zafar, Saima Hussain","doi":"10.1007/s40256-025-00727-y","DOIUrl":"https://doi.org/10.1007/s40256-025-00727-y","url":null,"abstract":"<p><strong>Background: </strong>Patients with diabetes mellitus and its complications are at increased risk for cardiovascular diseases. Semaglutide is efficacious for glycemic control and reducing the risk of major adverse cardiovascular outcomes. Although trials have provided data about cardiovascular outcomes with this agent, a meta-analysis regarding its cardiovascular safety and variations in outcomes according to sex, race and estimated glomerular filtration rate was necessary.</p><p><strong>Materials and methods: </strong>We searched the PubMed, Cochrane Library, and Clinicaltrials.gov databases and included randomized controlled trials (RCTs) where semaglutide was the intervention and major adverse cardiovascular events (MACE) or expanded MACE was the outcome. We assessed the quality of the RCTs using the Cochrane Risk of Bias tool and used the statistical software RevMan 5.4. The protocol for this review was registered on PROSPERO (CRD42024580784).</p><p><strong>Results: </strong>Of 5387 articles, four RCTs were included. The risk of MACE with semaglutide was significantly lower in patients with established or a risk of cardiovascular disease (risk ratio [RR] 0.81; 95% confidence interval [CI] 0.74-0.88; p < 0.00001). The risk of expanded MACE also reduced significantly with semaglutide (RR 0.80; 95% CI 0.75-0.86; p < 0.00001). MACE risk reduction was significant in males (RR 0.78; 95% CI 0.70-0.87; p < 0.00001) and in Asian (RR 0.61; 95% CI 0.44-0.83; p = 0.002) and white (RR 0.82; 95% CI 0.73-0.90; p = 0.0001) populations.</p><p><strong>Conclusion: </strong>Semaglutide provides significant advantages in terms of lowering the risk of MACE and expanded MACE and could possibly be used as a crucial component of cardiovascular risk management, particularly in populations that respond well, such as men and Asian and white populations.</p><p><strong>Registration: </strong>PROSPERO identifier number CRD42024580784.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Insights on DAPT Abbreviation and De-escalation from ULTIMATE-DAPT and Related Trials: Are we Heading Toward an Aspirin-Free Strategy?","authors":"Harshit Khare, Satyendra Tewari, Roopali Khanna, Aditya Kapoor","doi":"10.1007/s40256-025-00725-0","DOIUrl":"https://doi.org/10.1007/s40256-025-00725-0","url":null,"abstract":"<p><p>The results of the recently concluded ULTIMATE-DAPT and T-PASS trials strongly support the emerging concept of antiplatelet monotherapy in patients at high bleeding risk undergoing percutaneous coronary intervention. Monotherapy with more potent antiplatelets such as ticagrelor is both a safe and an equally effective strategy to circumvent major bleeding episodes in patients at high bleeding risk while guarding against ischemic events. Although these results were not replicated with low-dose prasugrel monotherapy in the STOP-DAPT-3 trial, the other major trials investigating ticagrelor monotherapy (GLOBAL-LEADERS and TWILIGHT-ACS) suggested the feasibility and appropriateness of abbreviating the dual antiplatelet therapy (DAPT) as early as 1-3 months of the index procedure. Moreover, the recent data from TICO, T-PASS, and now the ULTIMATE-DAPT trial, hint toward early switchover to ticagrelor monotherapy without any undue concern of increased ischemic events. However, on closer examination, we find that study cohorts in most trials had lower anatomical complexity of coronary lesions and most adopted imaging-based revascularization strategies. Among these trials, those that achieved convincing levels of safety in ischemic endpoints mainly administered ticagrelor monotherapy. Can monotherapy with these newer antiplatelets sufficiently obviate the need for year-long DAPT? Can such antiplatelet monotherapy remain effective in all coronary artery disease subsets? Can we start patients solely on a single antiplatelet from day one of the procedure? These are some of the questions we attempt to answer by revisiting the results from these trials.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mineralocorticoid Receptor Antagonism with Finerenone: A New Era in the Management of Patients with Heart Failure with Mildly Reduced or Preserved Ejection Fraction.","authors":"Panagiotis I Georgianos, Christodoula Kourtidou, Ioannis Kontogiorgos, Vasilios Vaios, Konstantinos Leivaditis, Thomas Gossios, Vassilios Liakopoulos","doi":"10.1007/s40256-025-00723-2","DOIUrl":"https://doi.org/10.1007/s40256-025-00723-2","url":null,"abstract":"<p><p>Finerenone is a novel nonsteroidal mineralocorticoid receptor (MR) antagonist (MRA) with unique pharmacological properties that offer potent and selective blockade of the MR with a more favorable side effect profile than spironolactone and eplerenone. In a large phase III clinical trial involving 13,026 patients with type 2 diabetes mellitus and a broad spectrum of chronic kidney disease, finerenone provoked a substantial placebo-subtracted reduction in the risk of hospitalization for heart failure (HF). These preliminary clinical trial data, along with the ongoing uncertainty about the safety and efficacy of MR antagonism in patients with HF and higher levels of ejection fraction have provided the rationale for the design of the FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients with Heart Failure) trial. In this multicenter, double-blind, randomized, phase III trial involving 6001 patients with HF and mildly reduced or preserved ejection fraction, finerenone was superior to placebo in improving the primary composite outcome of total (first and recurrent) worsening HF events and death from cardiovascular causes. This benefit was similar in magnitude in patients receiving and in patients not receiving background treatment with a sodium-glucose co-transporter type 2 inhibitor, suggesting a potential additive benefit with combination therapy. We explore the emerging role of the nonsteroidal MRA finerenone as a new therapeutic opportunity to improve the risk of adverse cardiovascular outcomes in patients with HF and mildly reduced or preserved ejection fraction. We discuss preliminary clinical trial data and provide a critical evaluation of the main results of the FINEARTS-HF trial.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143584355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Administration of Evolocumab in Patients with STEMI After Emergency PCI: A Real-World Cohort Study.","authors":"Xuefeng Sun, Shiru Bai, Haibo Wu, Tingting Wang, Rongpin Du","doi":"10.1007/s40256-025-00722-3","DOIUrl":"https://doi.org/10.1007/s40256-025-00722-3","url":null,"abstract":"<p><strong>Background and objective: </strong>Evolocumab can reduce low-density lipoprotein cholesterol (LDL-C) levels and improve cardiovascular (CV) outcomes. While its benefits are well established in broader populations, its potential impact on patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI) remains underexplored, particularly in real-world settings. This study aimed to evaluate its efficacy and safety in this specific patient group on the basis of real-world clinical experience.</p><p><strong>Methods: </strong>A total of 384 patients with STEMI who underwent emergency PCI at Hebei General Hospital between 1 July 2021 and 23 September 2022 were enrolled in this retrospective, single-center study. Of these, 85 patients received evolocumab (140 mg every 2 weeks) plus standard of care (SOC), while 299 received SOC alone. Patients were monitored for CV events and lipid levels during follow-up. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were used to balance covariates.</p><p><strong>Results: </strong>The experimental group had a lower cumulative incidence of the primary composite endpoint over 18 months in the unadjusted analysis (hazard ratio [HR] = 0.353; 95% confidence interval [CI] 0.180-0.693; P = 0.002), as well as after adjustment for PSM (HR = 0.341; 95% CI 0.165-0.706; P = 0.004) and IPTW (HR = 0.461; 95% CI 0.241-0.881; P = 0.019). The 18-month cumulative incidence was 10 (12%) for evolocumab + SOC and 95 (32%) for SOC. LDL-C levels in the evolocumab + SOC group showed significant reductions across different cohorts, compared with the SOC group. No significant differences in adverse events were observed between the two groups.</p><p><strong>Conclusions: </strong>Evolocumab plus SOC significantly reduced postoperative CV events and LDL-C levels in patients with STEMI after emergency PCI.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and Efficacy of DOAC Versus VKA in Adult Congenital Heart Disease: A Systematic Review and Meta-Analysis.","authors":"Aamina Shakir, Jacinthe Khater, Fatima Iqbal, Erin Ware, George Mina, Khagendra Dahal, Kalgi Modi","doi":"10.1007/s40256-025-00720-5","DOIUrl":"https://doi.org/10.1007/s40256-025-00720-5","url":null,"abstract":"<p><strong>Background: </strong>Patients with adult congenital heart disease (CHD) have various indications for anticoagulation (e.g., presence of Fontan circuit, atrial fibrillation due to surgical scar). Guidelines recommend vitamin K antagonists (VKA) for thromboprophylaxis in adult CHD, as trial data comparing safety/efficacy of direct oral anticoagulants (DOAC) to VKA are not available in this population.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Embase, Web of Science, and Google Scholar were searched for trials comparing DOAC with VKA in patients with ACHD. Outcomes of interest were efficacy endpoints (thromboembolic complications) and safety endpoints (bleeding complications). Results were meta-analyzed and sensitivity analyses were performed.</p><p><strong>Results: </strong>A total of 4 retrospective studies comprising 6004 patients (2566 DOAC, 3438 VKA) were analyzed. Compared with VKA, DOAC did not cause a statistically significant difference in incidence of thromboembolism (risk ratio, RR, 0.76; 95% confidence intervals, CI, 0.28, 2.07); composite bleeding (RR 1.02, 95% CI 0.71, 1.47); major bleeding (RR 1.05, 95% CI 0.92, 1.21); minor bleeding (RR 1.12, 95% CI 0.51, 2.44); or intracranial bleeding (RR 0.86, 95% CI 0.50, 1.46). Numerically, the DOAC arm had fewer thromboembolisms/intracranial bleeds but more major/composite bleeds. However, upon removal of the largest study, the DOAC arm had fewer major/composite bleeds.</p><p><strong>Conclusions: </strong>DOAC did not confer a significant increase in either thromboembolic or bleeding risk as compared with VKA. Sensitivity analysis showed notable heterogeneity among studies. Large-scale trials comparing DOAC with VKA in patients with adult CHD are needed.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143447736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}