American Journal of Cardiovascular Drugs最新文献

{"title":"Formulation-Specific Cardiovascular Outcomes with High-Dose Eicosapentaenoic Acid: A Systematic Review and Meta-analysis.","authors":"Muhammad Anas Faheem, Bazil Azeem, Talha Ali, Rabia Asim, Tazheen Saleh Muhammad, Mata-E-Alla Dogar, Muhammad Abdullah Naveed","doi":"10.1007/s40256-026-00798-5","DOIUrl":"https://doi.org/10.1007/s40256-026-00798-5","url":null,"abstract":"<p><strong>Background/objective: </strong>Residual cardiovascular risk persists despite intensive statin therapy in patients with established atherosclerotic cardiovascular disease (CVD). Omega-3 fatty acids, particularly high-dose eicosapentaenoic acid (EPA), have been proposed as adjunctive therapy, yet trial results conflict, likely due to formulation differences. We conducted a formulation-focused meta-analysis to determine whether high-dose EPA-dominant supplementation reduces cardiovascular events and to quantify the impact of mixed EPA/docosahexaenoic acid (DHA) regimens on efficacy.</p><p><strong>Methods: </strong>Following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 guidelines, we searched MEDLINE, Embase, CENTRAL, and trial registries through May 2025 for randomized controlled trials, including placebo-controlled and open-label designs, of high-dose EPA-dominant omega-3 (≥ 1.8 g/day; ≥ 50% EPA) in adults with established CVD or other high-risk settings. Six trials (n = 42,738; 31-85% male) were eligible. Random-effects models generated pooled risk ratios (RRs), with I² assessing heterogeneity; sensitivity analyses excluded mixed EPA/DHA formulations. Imaging surrogate outcomes were summarized narratively when study modalities were not directly comparable.</p><p><strong>Results: </strong>EPA-based therapy significantly reduced hospitalizations for unstable angina (RR 0.75, 95% CI 0.66-0.87; I² = 0%). Overall effects on recurrent myocardial infarction and revascularization were not statistically significant, but both became significant after exclusion of STRENGTH, the only mixed EPA/DHA cardiovascular outcomes trial. No significant effect was observed for ischemic stroke, cardiovascular death, or high-sensitivity C-reactive protein (hs-CRP). CHERRY and EVAPORATE both suggested attenuation of plaque progression, but these imaging studies were not pooled because intravascular ultrasound and coronary computed tomography angiography-derived measures were not directly comparable.</p><p><strong>Conclusion: </strong>High-dose EPA-dominant therapy was associated with fewer unstable angina hospitalizations, and formulation appeared to modify clinical benefit. Among blinded, placebo-controlled, cardiovascular outcomes trials, 4 g/day icosapent ethyl is the only formulation independently associated with reduced cardiovascular events. Larger formulation-specific trials are needed to clarify the roles of purified EPA, mixed EPA/DHA regimens, and patient selection.</p><p><strong>Registration: </strong>PROSPERO identifier number: CRD420251063069.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147809546","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":"Rapid Access Atrial Fibrillation Clinics in Australia - Modelling Outcomes and Cost-Effectiveness.","authors":"Adam C Livori, Ansu Alex, Tamrat Abebe, J Simon Bell, Zanfina Ademi, Jedidiah I Morton","doi":"10.1007/s40256-026-00796-7","DOIUrl":"https://doi.org/10.1007/s40256-026-00796-7","url":null,"abstract":"<p><strong>Aims: </strong>Stroke prevention in patients with atrial fibrillation (AF) requires both estimation of risk and the initiation of anticoagulation treatment where indicated. Rapid access atrial fibrillation (RAAF) clinics are an accepted model of multidisciplinary care to reduce time at risk of stroke, but their clinical outcomes and cost-effectiveness are uncertain. This study aimed to perform a cost-effectiveness evaluation, from a healthcare system perspective, of an RAAF clinic within a large regional health service in Australia.</p><p><strong>Methods: </strong>We developed a microsimulation model using a cohort of 274 individuals referred to the RAAF clinic between 2022 and 2023. Clinic data were used to determine risk of stroke, major bleeding and death from the GARFIELD equation. A comparator was designed by duplicating the cohort and changing the time from referral to consultation to a general cardiology clinic within the same health service (i.e. standard of care). The model ran in daily cycles over a 2-year time horizon, with individuals replicated 1000 times from an initial cohort of 274. The outcomes were strokes, bleeding events, quality-adjusted life years (QALYs) and healthcare costs for the RAAF compared with standard of care, which were used to determine incremental cost-effectiveness ratios (ICER), with 5% annual discounting.</p><p><strong>Results: </strong>The RAAF clinic participants experienced fewer strokes (5198 versus 5303), bleeding events (5369 versus 5491) and deaths (14,158 versus 14,413). There were marginal increases in QALYs gained (1.67 versus 1.66 QALYs/person), and cost savings of AUD$74 per person (AUD$14,187 versus AUD$14,261), resulting in a dominant ICER. The ICER remained dominant across one-way and probabilistic sensitivity analyses.</p><p><strong>Conclusions: </strong>RAAF clinics are likely to prevent strokes and bleeding, are cost-saving and could lead to returns on investment. Adoption of this model of care by policy-makers can ensure the delivery of safe, effective and cost-saving care that reduces stroke, bleeding and death in people with atrial fibrillation.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760050","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":"A Comprehensive, Updated Review of Ezetimibe: Evidence-Based Clinical Use for Atherosclerotic Cardiovascular Disease.","authors":"Hui-Hui Liu, Zhao-Hong Liu, Si-Si Chen, Cheng-Gang Zhu, Jian-Jun Li","doi":"10.1007/s40256-026-00793-w","DOIUrl":"https://doi.org/10.1007/s40256-026-00793-w","url":null,"abstract":"<p><p>Elevated low-density lipoprotein cholesterol (LDL-C) is a key modifiable risk factor in atherosclerotic cardiovascular diseases. While statins are the first-line therapy for LDL-C management, challenges such as limited additional benefits with dose escalation and an increased risk of adverse drug reactions at higher doses remain. Ezetimibe is widely recommended in clinical guidelines and has become an essential component of lipid-lowering therapy, particularly for patients requiring additional LDL-C reduction beyond what statins alone can achieve. Ezetimibe monotherapy reduces LDL-C levels by approximately 17.1-25.9% and significantly lowers the risk of major adverse cardiovascular events compared with placebo. For patients whose LDL-C levels remain uncontrolled with statin therapy, adding ezetimibe not only achieves greater LDL-C reduction but also improves goal attainment, reduces plaque burden, enhances plaque stability, and lowers the incidence of cardiovascular events. Furthermore, combining ezetimibe with statins into one tablet offers advantages in medication management, improving patient compliance and convenience. In addition, combining ezetimibe with nonstatin lipid-lowering agents also offers a comprehensive approach to lipid management, especially in complex cases of dyslipidemia or cardiovascular risk management. Despite robust clinical evidence and good tolerability, the adoption of ezetimibe combination therapy in real-world practice remains limited, likely owing to insufficient awareness among clinicians and patients. In this review, we summarize the current evidence to support clinical decision-making and promote the optimal use of ezetimibe in the management of atherosclerotic cardiovascular diseases.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147760023","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 Benefit and Gastrointestinal Risk of Colchicine in Secondary Prevention: Risk Associated with Dose and Treatment Duration.","authors":"Ce Bian, Qi Shen, Xin-Xin Liu, Mengjun Zhou, Zhexue Ren, Zhe Dong, Xiaodong Jin, Beibei Song, Bo Li","doi":"10.1007/s40256-026-00794-9","DOIUrl":"https://doi.org/10.1007/s40256-026-00794-9","url":null,"abstract":"<p><strong>Aims: </strong>This meta-analysis aims to evaluate the efficacy and safety of colchicine for the secondary prevention of cardiovascular and cerebrovascular diseases, and examines how dose and treatment duration modify its risk-benefit profile.</p><p><strong>Methods: </strong>A meta-analysis comparing colchicine to placebo or standard care was performed. The primary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction (MI), or non-fatal stroke. The secondary endpoint was expanded MACE (eMACE), defined as MACE plus ischemia-driven coronary revascularization.</p><p><strong>Results: </strong>Colchicine significantly reduced the risk of MACE (relative risk [RR] 0.83, 95% confidence interval [CI] 0.72-0.96) and eMACE (RR 0.78, 95% CI 0.64-0.96), with benefits driven by reductions in non-fatal MI and ischemia-driven coronary revascularization. No significant effect was observed on cardiovascular or all-cause mortality. Colchicine increased gastrointestinal adverse reactions (RR 1.90, 95% CI 1.41-2.55) and drug-related adverse event (DAE)-related colchicine discontinuation (RR 1.54, 95% CI 1.06-2.25). Sensitivity analyses revealed that the guideline-recommended dosage (0.5 mg once daily) for > 6 months maintained cardiovascular benefit (MACE RR 0.77, 95% CI 0.62-0.96), while gastrointestinal risk (RR 1.51, 95% CI 0.97-2.33) and DAE-related colchicine discontinuation risk (RR 1.42, 95% CI 0.80-2.51) became non-significant.</p><p><strong>Conclusion: </strong>Colchicine provides lasting benefit for patients with cardiovascular and cerebrovascular diseases. Gastrointestinal risk is dose and time dependent, and higher early in treatment. Tolerating and maintaining long-term standard-dose therapy improves the benefit-risk balance. These findings highlight the early treatment phase as a period of higher gastrointestinal risk, suggesting that strategies to support adherence during this period warrant further investigation.</p><p><strong>Registration: </strong>PROSPERO registration number CRD42024623329.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759962","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":"Impact of Aspirin on Primary Prevention of Cardiovascular Events in Patients with Elevated Lipoprotein(a): A Systematic Review and Meta-analysis.","authors":"Daniel Caldeira, Mariana Alves, Rita Avó-Baião, Andreia Lopes, Luisa Prada, Fausto J Pinto","doi":"10.1007/s40256-026-00795-8","DOIUrl":"https://doi.org/10.1007/s40256-026-00795-8","url":null,"abstract":"<p><strong>Introduction: </strong>Elevated lipoprotein(a) (Lp(a)) and Lp(a)-raising genetic variants (e.g. rs3798220) are independent cardiovascular risk factors lacking preventive strategies. Given the prothrombotic properties attributed to high Lp(a), aspirin was hypothesized to confer benefit in primary prevention. We performed a systematic review and meta-analysis to evaluate the impact of aspirin on cardiovascular and bleeding outcomes in this population.</p><p><strong>Methods: </strong>MEDLINE, Web of Science and CENTRAL were searched (November 2025) for randomized and observational studies assessing aspirin use in primary prevention among individuals with Lp(a) ≥ 50 mg/dL or Lp(a)-associated genetic variants. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included myocardial infarction (MI), coronary artery disease (CAD), cardiovascular mortality, and bleeding. Random-effects meta-analyses pooled the Hazard ratios (HR) with 95% confidence intervals (CI). Certainty of evidence was assessed using GRADE.</p><p><strong>Results: </strong>Seven studies including 6498 participants met inclusion criteria. Aspirin was not associated with a reduction in MACE (HR 0.99, 95% CI 0.79-1.24; I² = 23%; four studies). MACE reduction was associated with aspirin in rs3798220-C carriers (HR 0.39, 95% CI 0.19-0.77, two studies). Aspirin was also associated with significant reduction of events regarding MI (HR 0.60, 95% CI 0.41-0.88, two studies) and cardiovascular mortality (HR 0.48, 95% CI 0.28-0.83, one study), whereas CAD was not significantly reduced (HR 0.82, 95% CI 0.59-1.12). Bleeding risk was numerically higher but not statistically significant (HR 1.13, 95% CI 0.89-1.44). Overall certainty of evidence was very low.</p><p><strong>Conclusions: </strong>Aspirin was not associated with a reduction of MACE among individuals with elevated Lp(a). A potential benefit for MI requires confirmation in adequately designed and powered prospective studies. Pooled data from rs3798220-C carriers suggest a potential significant benefit that warrants further investigation REGISTRATION: PROSPERO identifier no. CRD42024520731.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759959","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":"Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Transplant Recipients: A Systematic Review and Meta-analyses.","authors":"Nelson Luis Cahuapaza-Gutierrez, Cielo Cinthya Calderon-Hernandez, Mariam Miyanay Umeres-Bravo, Tatiana Vanessa Villavicencio-Escudero","doi":"10.1007/s40256-026-00792-x","DOIUrl":"https://doi.org/10.1007/s40256-026-00792-x","url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have demonstrated efficacy and safety in patients with type 2 diabetes mellitus, chronic kidney disease, and heart failure. However, their effects in heart transplant recipients, a population with high cardiovascular risk, remain poorly understood.</p><p><strong>Methods: </strong>Clinical trials and observational studies were included. A systematic search was conducted in PubMed, Scopus, EMBASE, and Web of Science. Mean differences (MD) were calculated for continuous outcomes and risk ratios (RR) for binary outcomes, both with 95% confidence intervals (CI). Analyses were performed using RevMan version 5.4.1.</p><p><strong>Results: </strong>Five retrospective cohort studies including 1512 heart transplant recipients (312 SGLT2i users and 1200 controls) were analyzed. SGLT2i use was not associated with significant changes in renal function (MD in eGFR: 3.96 mL/min/1.73 m²; 95% CI: - 2.33 to 10.26; p = 0.22) or glycemic control (MD in HbA1c: - 0.20%; 95% CI: - 0.73 to 0.34; p = 0.47). Mortality was comparable between groups (RR: 0.64; 95% CI: 0.29-1.40; p = 0.26), with no significant increase in urinary tract infections (RR: 1.40; 95% CI: 0.25-7.72; p = 0.70). However, SGLT2i use was associated with significant reductions in body mass index (MD: - 0.90 kg/m²; 95% CI: - 1.67 to - 0.14; p = 0.02) and systolic blood pressure (MD: - 4.69 mmHg; 95% CI: - 7.27 to - 2.12; p < 0.001).</p><p><strong>Conclusions: </strong>In heart transplant recipients, the use of SGLT2 inhibitors was not associated with significant improvements in renal function or glycemic control and did not increase mortality or the incidence of urinary tract infections. However, SGLT2 inhibitor therapy was associated with significant reductions in body mass index and systolic blood pressure, suggesting a potential cardiometabolic benefit in this high-risk population. Given that hypertension and obesity are well-established cardiovascular risk factors and that hypertension, in particular, is a common complication among heart transplant recipients, these blood pressure and weight-lowering effects may be clinically meaningful.</p><p><strong>Systematic review registration: </strong>PROSPERO CRD420251057335.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147490379","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":"Direct Oral Anticoagulants Versus Warfarin in Patients with Atrial Fibrillation and Hypertrophic Cardiomyopathy: A Retrospective Cohort Study","authors":"Rahmeh Alasmar,&nbsp;Ramzi Ibrahim,&nbsp;Hashim AlHammouri,&nbsp;Fares B Qubbaj,&nbsp;Mahmoud Abdelnabi,&nbsp;Hoang Nhat Pham,&nbsp;Eiad Habib,&nbsp;Abdul Hakim Almakadma,&nbsp;Juan Farina,&nbsp;Carola Gianni,&nbsp;Justin Z. Lee,&nbsp;Justin Shipman,&nbsp;Rohit Mital,&nbsp;Said Alsidawi,&nbsp;Chadi Ayoub,&nbsp;Steven J. Lester,&nbsp;Charles R. Cannan,&nbsp;Kwan Lee,&nbsp;Luis Scott,&nbsp;Amin Al-Ahmad,&nbsp;Dan Sorajja,&nbsp;Reza Arsanjani","doi":"10.1007/s40256-026-00791-y","DOIUrl":"10.1007/s40256-026-00791-y","url":null,"abstract":"<div><h3>Background</h3><p>The optimal anticoagulation strategy for patients with atrial fibrillation (AF) and obstructive hypertrophic cardiomyopathy (oHCM) remains unclear. This study compared the outcomes of direct oral anticoagulants (DOACs) versus warfarin in this patient population.</p><h3>Methods</h3><p>Data from the TriNetX Research Network were used to identify patients with AF and oHCM treated with either DOACs or warfarin. Patients with a prior history of stroke were excluded. Propensity score matching (PSM) was performed to balance baseline characteristics. The primary outcome was ischemic stroke. Secondary outcomes included: all-cause death, all-cause hospitalization, acute myocardial infarction, gastrointestinal bleed, hematuria, and brain hemorrhage. Hazard ratios (HRs) were estimated by Cox proportional hazard models.</p><h3>Results</h3><p>A total of 7090 patients in the DOAC group and 3350 in the warfarin group were included prior to PSM. Following PSM, each cohort included 3307 patients. The incidence of ischemic stroke was lower in the DOAC group (3.5%) compared with the warfarin group (4.8%), with a hazard ratio (HR) of 0.74 (95% confidence interval [CI]: 0.58–0.95). All-cause mortality was similar between groups, with 555 (16.8%) deaths in the DOAC group and 575 (17.4%) in the warfarin group (HR: 0.996, 95% CI: 0.89–1.12). All-cause hospitalization rates were lower in the DOAC group (64.5%) compared with the warfarin group (68.7%) (HR: 0.90, 95% CI: 0.85–0.95). No significant differences were observed in the rates of acute myocardial infarction (12.1% versus 12.2%; HR: 1.01, 95% CI: 0.88–1.16), gastrointestinal bleeding (6.9% versus 7.9%; HR: 0.89, 95% CI: 0.74–1.06), hematuria (8.0% versus 8.5%; HR: 0.96, 95% CI: 0.82–1.14), or intracranial hemorrhage (1.5% versus 2.0%; HR: 0.75, 95% CI: 0.52–1.09) between groups.</p><h3>Conclusions</h3><p>DOACs demonstrated a lower risk of ischemic stroke and all-cause hospitalization rates compared with warfarin in patients with AF and oHCM, supporting the use of DOACs in this patient population.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 3","pages":"375 - 381"},"PeriodicalIF":3.0,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147466656","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":"Beta-Blockers After Myocardial Infarction Without Reduced Ejection Fraction: A Meta-Analysis of Kaplan–Meier Reconstructed Individual Patient Data","authors":"Ameer Awashra,&nbsp;Ahmed Emara,&nbsp;Ahmed Mazen Amin,&nbsp;Ahmed W. Hageen,&nbsp;Mohamed S. Elgendy,&nbsp;Mohamed Saad Rakab,&nbsp;Khadeeja Ali Hamzah,&nbsp;Abdullah Faisal Albukhari,&nbsp;Abubakar Nazir,&nbsp;Abdalhakim Shubietah,&nbsp;Anan Abu Rmilah,&nbsp;Mohammed Ruzieh","doi":"10.1007/s40256-026-00789-6","DOIUrl":"10.1007/s40256-026-00789-6","url":null,"abstract":"<div><h3>Background</h3><p>The long-term benefit of beta-blockers (β-blockers) after myocardial infarction (MI) in patients with preserved left-ventricular ejection fraction (LVEF ≥ 40%) remains uncertain in the modern reperfusion era. Earlier trials showed mortality benefits, but contemporary therapies may have altered their effect.</p><h3>Methods</h3><p>We conducted a meta-analysis of randomized controlled trials (RCTs) comparing β-blockers versus no β-blockers in adults with MI and LVEF ≥ 40%. PubMed, Scopus, Web of Science, and Cochrane CENTRAL were searched through October 2025. Primary outcomes were all-cause mortality, recurrent MI, and heart failure (HF). Individual patient data (IPD) were reconstructed from Kaplan–Meier curves for time-to-event analysis, and pooled risk ratios (RRs) and hazard ratios (HRs) were estimated using random-effects models. Trial sequential analysis (TSA), meta-regression, and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) certainty assessments were performed.</p><h3>Results</h3><p>Five RCTs (<i>n</i> = 23,524 patients) met inclusion criteria. β-Blockers did not significantly reduce recurrent acute myocardial infarction (AMI) (HR: 0.89 with 95% confidence interval [CI 0.78, 1.02], <i>P</i> = 0.1), HF (HR: 0.92 with 95% CI [0.71, 1.20], <i>P</i> = 0.54), and all-cause mortality (HR: 0.97 with 95% CI [0.85, 1.10], <i>P</i> = 0.63). Secondary endpoints—including major adverse cardiovascular events (MACE), cardiovascular death, stroke, and revascularization—were neutral (<i>P</i> &gt; 0.05). TSA boundaries were not crossed, and meta-regression identified no significant effect modifiers. Evidence certainty was rated low to moderate.</p><h3>Conclusions</h3><p>Among patients with MI and preserved LVEF, β-blockers did not reduce mortality or ischemic or HF events. Routine long-term use offers no prognostic advantage and should be reserved for specific indications such as reduced LVEF, angina, arrhythmia, or hypertension.</p><h3>Registration</h3><p>International Prospective Register of Systematic Reviews (PROSPERO) identifier no. CRD420251175415.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 3","pages":"345 - 358"},"PeriodicalIF":3.0,"publicationDate":"2026-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146225304","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":"Defining the Role of Intravenous Iron in The Treatment of Patients with Heart Failure with Reduced Ejection Fraction and Iron Deficiency.","authors":"Andrew Sephien, Tea Reljic, Rhea Sancassani, Joanna M Joly, Jason N Katz, Ambuj Kumar","doi":"10.1007/s40256-026-00790-z","DOIUrl":"https://doi.org/10.1007/s40256-026-00790-z","url":null,"abstract":"<p><p>Iron deficiency has been reported in up to 50% of patients with heart failure (HF), irrespective of the presence of anemia. Although no formally validated definition for iron deficiency in patients with HF exists, both the American and European Heart Failure Guidelines define iron deficiency as a serum ferritin of < 100 ng/ml, or a ferritin of 100-299 ng/ml, provided that the transferrin saturation (TSAT) is less than 20%. The presence of iron deficiency has been associated with poor patient-oriented outcomes, prompting the assessment of intravenous (IV) iron as a treatment for iron deficiency. This review summarizes the totality of the evidence on the diagnosis, evaluation and treatment of patients with iron deficiency. In addition, we highlight our approach to patients with HF with reduced ejection fraction and highlight areas for both clinical improvement and research.</p>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":" ","pages":""},"PeriodicalIF":3.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146200093","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":"Cimlanod, a Second-Generation Nitroxyl Donor, in Heart Failure with Reduced Ejection Fraction: A Meta-Analysis of Hemodynamic Efficacy and Safety Profile","authors":"Mrunalini Dandamudi,&nbsp;Vinh Q. T. Ho,&nbsp;Miguel A. Samaniego-Laguna,&nbsp;Giang Son Arrighini,&nbsp;Salomon Chamay,&nbsp;Hemank Walia,&nbsp;Juliana M. Giorgi,&nbsp;Alejandro Barbagelata","doi":"10.1007/s40256-026-00788-7","DOIUrl":"10.1007/s40256-026-00788-7","url":null,"abstract":"<div><h3>Introduction</h3><p>Heart failure (HF), a leading cause of morbidity and mortality worldwide, continues to pose a therapeutic challenge. Nitroxyl (HNO) donors, such as Cimlanod (BMS-986231 or CXL-1427), are emerging as promising agents owing to their unique vasodilatory, inotropic, and lusitropic properties.</p><h3>Purpose</h3><p>This meta-analysis assesses the safety, tolerability, and hemodynamic effects of Cimlanod, in patients with heart failure with reduced ejection fraction (HFrEF).</p><h3>Methods</h3><p>This study consists of four studies, including 459 patients (278 receiving Cimlanod and 181 receiving placebo). The mean age was 63.9 years, 85% were male, and common comorbidities included hypertension (77%) and diabetes (45.7%). Outcomes were evaluated using risk ratios (RR) for binary end points and mean differences (MD) for continuous variables, with 95% confidence intervals (CI) and <i>I</i>² for heterogeneity. Study quality followed Cochrane methods. Primary outcomes included cardiovascular mortality, hemodynamic measures, and severe adverse events. The protocol was prospectively registered in PROSPERO (CRD420250652675; Feb 2025).</p><h3>Results</h3><p>Cimlanod did not significantly reduce all-cause mortality (RR = 0.96; 95% CI 0.88–1.04; <i>p</i> = 0.15), cardiac death (RR = 0.75; 95% CI 0.37–1.54; <i>p</i> = 0.43), adverse events (RR = 1.51; 95% CI 0.94–2.44; <i>p</i> = 0.073), or serious adverse events (RR = 0.83; 95% CI 0.46–1.48; <i>p</i> = 0.429), when compared with placebo. Although a significantly increased risk of symptomatic hypotension was observed with the use of Cimlanod (RR = 2.22; 95% CI 1.56–3.15; <i>p</i> &lt; 0.01) but no significant effect on systolic or diastolic blood pressure or heart rate was observed in the pooled analyses, whereas significant drop in systolic blood pressure (SBP) (MD − 10.41, 95% CI − 19.89 to − 0.93) was observed with highest dose of Cimlanod i.e. 12 μcg/kg/min.</p><h3>Conclusions</h3><p>Cimlanod did not improve mortality, major hemodynamic end points, or biomarkers and increased the risk of symptomatic hypotension. Although a modest improvement in cardiac index was observed, evidence does not currently support routine clinical use, and further studies are required to identify whether any specific subgroup may benefit.</p><h3>Registration</h3><p>PROSPERO identifier number CRD420250652675.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 3","pages":"335 - 343"},"PeriodicalIF":3.0,"publicationDate":"2026-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40256-026-00788-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146177498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}