American Journal of Cardiovascular Drugs最新文献

{"title":"Additive Effects of Angiotensin Receptor–Neprilysin Inhibitors and Sodium–Glucose Cotransporter 2 Inhibitors on Neurohormonal Inhibition Therapy in Severe HFrEF: A Systematic Review and Network Meta-analysis","authors":"Koji Suzuki,&nbsp;Sumika Osa,&nbsp;Shunya Takeshita,&nbsp;Makoto Noda,&nbsp;Tatsuya Yagi,&nbsp;Yuichiro Maekawa,&nbsp;Junichi Kawakami","doi":"10.1007/s40256-025-00784-3","DOIUrl":"10.1007/s40256-025-00784-3","url":null,"abstract":"<div><h3>Background</h3><p>Randomized controlled trials (RCTs) have identified the additive effects of angiotensin receptor–neprilysin inhibitors (ARNIs) and sodium–glucose cotransporter 2 (SGLT2) inhibitors on neurohormonal inhibition therapy in patients with heart failure with reduced ejection fraction (HFrEF). However, their additive effects on conventional baseline therapies in patients with severe HFrEF remain unclear.</p><h3>Methods</h3><p>A systematic review was conducted using the PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases until February 2025. Our review included RCTs that evaluated the effects of ARNIs or SGLT2 inhibitors in patients with severe HFrEF. The primary outcome was the composite endpoint of cardiovascular death or hospitalization for heart failure. The pooled hazard ratio (HR) was estimated through a network meta-analysis conducted using a frequentist statistical approach.</p><h3>Results</h3><p>Five relevant trials, or their New York Heart Association class III–IV subgroups, were identified, comprising a total of 4894 patients with severe HFrEF. For the addition of SGLT2 inhibitors to neurohormonal inhibitors, the HR was 0.87 (95% confidence interval 0.75–1.01). For the addition of ARNIs, the HR was 0.96 (95% confidence interval 0.83–1.12). The certainty of evidence was moderate for SGLT2 inhibitors and low for ARNIs according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.</p><h3>Conclusions</h3><p>Evidence for the additive effects of SGLT2 inhibitors and ARNIs in severe HFrEF remains limited, and therefore, treatment intensification with these agents should be approached with caution.</p><h3>Registration</h3><p>International Prospective Register of Systematic Reviews (PROSPERO) identifier no. CRD42025641240.</p><h3>Graphical Abstract</h3>\u0000<div><figure><div><div><picture><source><img></source></picture><span>The alternative text for this image may have been generated using AI.</span></div></div></figure></div></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 3","pages":"323 - 333"},"PeriodicalIF":3.0,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145997022","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":"Hypertension in Diabetes: Numbers or Outcomes?","authors":"Theocharis Koufakis,&nbsp;Michael Doumas","doi":"10.1007/s40256-025-00785-2","DOIUrl":"10.1007/s40256-025-00785-2","url":null,"abstract":"<div><p>Hypertension is one of the most frequent and consequential comorbidities in people with diabetes, yet its management remains less straightforward than guideline tables might suggest. Epidemiological evidence confirms the high prevalence and the disproportionate burden of cardiovascular and renal complications in this dual condition. The pathophysiology is complex: insulin resistance, endothelial dysfunction, and activation of the renin–angiotensin–aldosterone system (RAAS) interact, often with cumulative effects. Most recommendations endorse a blood pressure (BP) target below 130/80 mmHg, but whether strict numerical thresholds should dominate practice remains debated. Therapies such as RAAS inhibitors and sodium–glucose cotransporter-2 inhibitors demonstrate consistent benefits, extending beyond BP reductions. Given this multifactorial background, combination therapy carries a strong rationale, as it allows simultaneous targeting of multiple pathophysiological abnormalities. This article argues that success should be judged not only by BP values but by the outcomes that alter prognosis.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 3","pages":"249 - 255"},"PeriodicalIF":3.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951287","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 “Evaluating the Effectiveness and Safety of Evinacumab in Treating Hypercholesterolemia and Hypertriglyceridemia: A Systematic Review and Meta-analysis of Randomized Controlled Trials”","authors":"Eeman Ahmad,&nbsp;Shahzaib Ahmed,&nbsp;Iftikhar Khan","doi":"10.1007/s40256-025-00780-7","DOIUrl":"10.1007/s40256-025-00780-7","url":null,"abstract":"","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 2","pages":"243 - 244"},"PeriodicalIF":3.0,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896094","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":"Authors’ Reply to Khan et al. “Evaluating the Effectiveness and Safety of Evinacumab in Treating Hypercholesterolemia and Hypertriglyceridemia: A Systematic Review and Meta-analysis of Randomized Controlled Trials”","authors":"Hussain Sohail Rangwala,&nbsp;Hareer Fatima,&nbsp;Mirha Ali,&nbsp;Muhammad Ashir Shafique,&nbsp;Burhanuddin Sohail Rangwala,&nbsp;Vikash Virwani,&nbsp;Aashish Kumar,&nbsp;Syed Ali Arsal,&nbsp;Adarsh Raja,&nbsp;Sandesh Raja,&nbsp;Muhammad Saqlain Mustafa","doi":"10.1007/s40256-025-00779-0","DOIUrl":"10.1007/s40256-025-00779-0","url":null,"abstract":"","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 2","pages":"245 - 247"},"PeriodicalIF":3.0,"publicationDate":"2026-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145896089","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":"Redefining Cardiac Sarcoidosis with Advanced Imaging and Therapeutic Strategies","authors":"Claudio Tana,&nbsp;Vasilis Kouranos,&nbsp;Nicol Bernardinello,&nbsp;Cesare Mantini,&nbsp;Riccardo Scarpa,&nbsp;Francesco Cinetto,&nbsp;Dominique Israël-Biet,&nbsp;Paolo Spagnolo","doi":"10.1007/s40256-025-00783-4","DOIUrl":"10.1007/s40256-025-00783-4","url":null,"abstract":"<div><p>Cardiac sarcoidosis (CS) is an elusive, yet potentially life-threatening disease marked by granulomatous inflammation of the myocardium, which can lead to arrhythmias, heart failure, and sudden cardiac death. Although corticosteroids have long been the mainstay of treatment, the therapeutic landscape is rapidly evolving. Recent insights have underscored the role of alternative immunosuppressants and biologic agents in enhancing disease control while minimizing long-term toxicity. Advances in imaging, particularly cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) are transforming both diagnosis and follow-up, enabling earlier detection and personalized monitoring of therapeutic response. At the same time, arrhythmia management and device implantation, especially implantable cardioverter-defibrillators (ICDs), have become central to risk stratification and prevention of fatal outcomes. This review explores the latest developments in the management of CS, highlighting a paradigm shift toward integrated, multidisciplinary care. From immunomodulation to advanced imaging and electrophysiological strategies, we emphasize the importance of tailoring interventions to disease severity and patient risk. Special focus is given to high-risk cases and evolving criteria for heart transplantation, grounded in the most up-to-date clinical evidence.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 3","pages":"283 - 304"},"PeriodicalIF":3.0,"publicationDate":"2025-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145861620","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 of PCSK9 Inhibitors on Clinical Outcomes in Patients with Established Atherosclerotic Cardiovascular Disease: A Network Meta-analysis","authors":"Luca Raone,&nbsp;Valeria Gritti,&nbsp;Alessandro Mandurino-Mirizzi,&nbsp;Francesco Maria Sparasci,&nbsp;Valeria Scotti,&nbsp;Alessia Currao,&nbsp;Giuseppe Colonna,&nbsp;Marco Ferlini,&nbsp;Leonardo De Luca","doi":"10.1007/s40256-025-00778-1","DOIUrl":"10.1007/s40256-025-00778-1","url":null,"abstract":"<div><h3>Aims</h3><p>Residual cardiovascular risk remains substantial in patients with atherosclerotic cardiovascular disease (ASCVD) despite high-intensity statin therapy. Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), including monoclonal antibodies and small-interfering RNA agents, offer additional risk reduction, yet comparative evidence across individual regimens remains limited.</p><h3>Methods and Results</h3><p>We conducted a systematic review and network meta-analysis of randomized controlled trials evaluating approved PCSK9i dosages in patients with ASCVD. The primary outcome was major adverse cardiovascular events (MACE); the secondary outcomes included myocardial infarction, stroke, coronary revascularization, cardiovascular mortality, and all-cause death. A total of eight trials involving 49,847 patients were included. Evolocumab (140 mg every 2 weeks or 420 mg monthly) and alirocumab 150 mg every 2 weeks significantly reduced MACE compared with placebo (risk ratios (RR): 0.78, 95% confidence intervals (CI): 0.66–0.93 and RR: 0.47, 95% CI 0.25–0.86, respectively). Evolocumab was also associated with reductions in myocardial infarction, stroke, and revascularization. Alirocumab 150 mg demonstrated the most pronounced effect on revascularization and was superior to both evolocumab and the lower alirocumab dose in this outcome. No regimen significantly reduced cardiovascular or all-cause mortality.</p><h3>Conclusions</h3><p>These findings suggest that PCSK9 inhibitors are effective in ASCVD, with generally similar efficacy across agents; however, regimens achieving lower and sustained low-density lipoprotein cholesterol levels may confer greater benefit, in line with the concept that “the lower, the better.”</p><h3>Trial Registration</h3><p>PROSPERO identifier no. CRD420251022108.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 2","pages":"193 - 203"},"PeriodicalIF":3.0,"publicationDate":"2025-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12920393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793022","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}

{"title":"The Role of Sodium–Glucose Cotransporter 2 Inhibitors in Patients with Sarcoid Cardiomyopathy: A Multicenter Retrospective Cohort Study","authors":"Ahmed K. Mahmoud,&nbsp;Ibrahim Kamel,&nbsp;Kamal Awad,&nbsp;Mohab Elnashar,&nbsp;Ahmed Younes,&nbsp;Juan Farina,&nbsp;Ramzi Ibrahim,&nbsp;Mahmoud Abdelnabi,&nbsp;Mohamed Allam,&nbsp;Hoang Nhat Pham,&nbsp;Mohammed Tiseer Abbas,&nbsp;Chadi Ayoub,&nbsp;Reza Arsanjani,&nbsp;Richard D. Patten","doi":"10.1007/s40256-025-00781-6","DOIUrl":"10.1007/s40256-025-00781-6","url":null,"abstract":"<div><h3>Background</h3><p>Cardiac involvement in sarcoidosis can manifest as new-onset heart failure (HF) due to inflammatory dilated cardiomyopathy (sarcoid cardiomyopathy [SCM]), conduction abnormalities, ventricular arrhythmias, and sudden death. Sodium–glucose cotransporter 2 (SGLT2) inhibitors are known to improve HF outcomes and reduce mortality. Current guidelines endorse dapagliflozin and empagliflozin for HF management. However, their role in SCM is not known. This study evaluates SGLT2 inhibitors in patients with sarcoid cardiomyopathy and reduced left ventricular ejection fraction (LVEF).</p><h3>Methods</h3><p>We utilized the TriNetX research network database from which we formed a cohort of patients with established SCM and a LVEF of less than 50%. Patients were divided into two groups on the basis of the presence or absence of SGLT2 inhibitors in their medical regimen. We analyzed the data for 12-month outcomes, including all-cause mortality, all-cause hospitalization, and HF hospitalization.</p><h3>Results</h3><p>Propensity score matching yielded a total of 636 subjects with balanced baseline characteristics. Mean age was 60 ± 12 years, and 37% were female individuals. At 12 months, SGLT2 inhibitor use was associated with lower all-cause mortality (4.1 versus 8.8%, hazard ratio [HR] = 0.46, <i>p</i> = 0.019), total hospitalizations (HR = 0.79, <i>p</i> = 0.043), and HF hospitalizations (HR = 0.67, <i>p</i> = 0.016). Use of SGLT2 inhibitors was associated with a significant reduction in arrhythmic events (ventricular tachycardia, fibrillation, cardiac arrest, and second- or third-degree heart block) (HR = 0.59, <i>p</i> = 0.007) along with an improvement in LVEF.</p><h3>Conclusions</h3><p>SGLT2 inhibitor use is associated with improved outcomes in SCM with reduced LVEF, including lower mortality, hospitalization, and incidence of arrhythmic events. Our data support the use of SGLT2 inhibitors in this specific HF population.</p><h3>Graphical abstract</h3>\u0000<div><figure><div><div><picture><source><img></source></picture></div></div></figure></div></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 2","pages":"225 - 232"},"PeriodicalIF":3.0,"publicationDate":"2025-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145762017","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 Pharmacotherapy and Glucose Metabolism: The Good, the Bad and the Unsightly","authors":"Rosana G. Bianchettin,&nbsp;Paul Poirier,&nbsp;Francisco Lopez-Jimenez,&nbsp;Carl J. Lavie,&nbsp;Marie-Eve Piché","doi":"10.1007/s40256-025-00777-2","DOIUrl":"10.1007/s40256-025-00777-2","url":null,"abstract":"<div><p>Cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) are two prevalent and interrelated conditions that share common pathophysiological mechanisms, including insulin resistance and chronic inflammation. While newer glucose-lowering agents such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown promise in improving insulin sensitivity and cardiovascular outcomes, a number of commonly used cardiovascular pharmacologic agents such as thiazide diuretics, beta-blockers, and statins have been associated with adverse effects on glucose metabolism, including increased insulin resistance and elevated risk of T2DM. This narrative review examines both the detrimental and beneficial metabolic effects of various cardiovascular drugs, explores their underlying mechanisms, and discusses the implications for the prevention and management of metabolic dysfunction in patients at high cardiometabolic risk. A clearer understanding of these effects is crucial for optimizing therapeutic strategies in individuals with or at risk for both CVD and T2DM.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 3","pages":"269 - 281"},"PeriodicalIF":3.0,"publicationDate":"2025-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145538642","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":"An Updated Review of Novel Triglyceride-Lowering Therapies in Adults with Familial Chylomicronemia Syndrome","authors":"Sharmane Joubert,&nbsp;Jeremy Ninan,&nbsp;Natalie Rosario,&nbsp;Shantera Davis,&nbsp;Joshua Wollen,&nbsp;Elisabeth M. Wang","doi":"10.1007/s40256-025-00774-5","DOIUrl":"10.1007/s40256-025-00774-5","url":null,"abstract":"<div><p>Familial chylomicronemia syndrome (FCS) is a rare autosomal recessive disorder resulting in hypertriglyceridemia. Historically, treatment options for this patient population have been limited as available triglyceride-lowering medications are often ineffective. Recently, new pharmacological agents targeting apolipoprotein C-III (apoC-III) production have been found to effectively and substantially lower triglyceride levels. A literature search in PubMed and EMBASE was conducted from January 2013 to July 2025 using keywords “familial chylomicronemia syndrome”, “olezarsen”, “volanesorsen”, and “plozasiran”. Phase III trials evaluating safety and efficacy of volanesorsen, olezarsen, and plozasiran were included. From 1376 articles, 4 phase III trials fulfilled the inclusion criteria. Triglyceride (TG) levels were reduced by 73–77% with volanesorsen, a least-square means reduction in TGs between 22.4 and 43.5 percentage points with olezarsen, and a 78–80% reduction in TGs with plozasiran when compared with placebo. The number of acute pancreatitis events was also lower with the study medications versus placebo. These new apoC-III lowering medications provide a novel treatment approach for patients with FCS, a population long without effective pharmacological treatment options. Provider familiarity with the availability and purpose of these medications will allow patients to receive the best therapy available to manage FCS.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 3","pages":"257 - 268"},"PeriodicalIF":3.0,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522635","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":"BCAA Metabolic Dyshomeostasis in Cardiovascular Disease: Pathogenic Mechanisms and Intervention","authors":"Yun Yin,&nbsp;Huimin Li,&nbsp;Qingxun Hu,&nbsp;Dan Wu","doi":"10.1007/s40256-025-00775-4","DOIUrl":"10.1007/s40256-025-00775-4","url":null,"abstract":"<div><p>Branched-chain amino acids (BCAAs), comprising leucine, isoleucine, and valine, are essential nutrients whose metabolic homeostasis is critical to cardiovascular health. This review synthesizes the dietary sources, physiological roles, and metabolic pathways of BCAAs, explores mechanisms driving their accumulation, and evaluates current detection techniques. We highlight the regulatory impact of BCAAs and their metabolites on cardiovascular disease (CVD) through multiple pathways. We propose a combinatorial strategy integrating dietary modulation, administration of BCAA-catabolizing enzymes (e.g., BT2, JK-1), mammalian target of rapamycin (mTOR) pathway modulation, and utilization of natural compounds (e.g., Salvia miltiorrhiza, Panax notoginseng) to counteract BCAA metabolic dysregulation-induced cardiovascular pathologies. This review provides a theoretical framework for understanding BCAA metabolism in CVD, emphasizes the importance of combined monitoring of BCAAs and their metabolites (branched-chain α-keto acids [BCKAs], 3-hydroxyisobutyrate [3-HIB]), and advances precision cardiology strategies targeting metabolic pathways.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"26 2","pages":"179 - 191"},"PeriodicalIF":3.0,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450160","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}