American Journal of Cardiovascular Drugs最新文献

{"title":"Advancing Guideline-Directed Medical Therapy in Heart Failure: Overcoming Challenges and Maximizing Benefits","authors":"Zixi Zhang,&nbsp;Cancan Wang,&nbsp;Tao Tu,&nbsp;Qiuzhen Lin,&nbsp;Jiabao Zhou,&nbsp;Yunying Huang,&nbsp;Keke Wu,&nbsp;Zeying Zhang,&nbsp;Wanyun Zuo,&nbsp;Na Liu,&nbsp;Yichao Xiao,&nbsp;Qiming Liu","doi":"10.1007/s40256-024-00646-4","DOIUrl":"10.1007/s40256-024-00646-4","url":null,"abstract":"<div><p>The delayed titration of guideline-directed drug therapy (GDMT) is a complex event influenced by multiple factors that often result in poor prognosis for patients with heart failure (HF). Individualized adjustments in GDMT titration may be necessary based on patient characteristics, and every clinician is responsible for promptly initiating GDMT and titrating it appropriately within the patient’s tolerance range. This review examines the current challenges in GDMT implementation and scrutinizes titration considerations within distinct subsets of HF patients, with the overarching goal of enhancing the adoption and effectiveness of GDMT. The authors also underscore the significance of establishing a novel management strategy that integrates cardiologists, nurse practitioners, pharmacists, and patients as a unified team that can contribute to the improved promotion and implementation of GDMT.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"329 - 342"},"PeriodicalIF":2.8,"publicationDate":"2024-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s40256-024-00646-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140585746","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":"Comment on: “Aspirin for the Primary Prevention of Cardiovascular Diseases in Patients with Chronic Kidney Disease: An Updated Meta-analysis”","authors":"Hussain Sohail Rangwala,&nbsp;Hareer Fatima,&nbsp;Burhanuddin Sohail Rangwala","doi":"10.1007/s40256-024-00644-6","DOIUrl":"10.1007/s40256-024-00644-6","url":null,"abstract":"","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"465 - 466"},"PeriodicalIF":2.8,"publicationDate":"2024-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140334371","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 Intravenous Iron in Patients with Heart Failure with Reduced Ejection Fraction and Iron Deficiency: A Systematic Review and Meta-Analysis of Randomized Control Trials","authors":"Andrew Sephien,&nbsp;Denisse Camille Dayto,&nbsp;Tea Reljic,&nbsp;Xavier Prida,&nbsp;Joanna M. Joly,&nbsp;Matthew Tavares,&nbsp;Jason N. Katz,&nbsp;Ambuj Kumar","doi":"10.1007/s40256-024-00635-7","DOIUrl":"10.1007/s40256-024-00635-7","url":null,"abstract":"<div><h3>Background</h3><p>The European Society of Cardiology (ESC) provided a focused update to the 2021 Guideline for the Management of Heart Failure, now providing a 1A recommendation for intravenous iron in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency (ID). However, the findings from randomized controlled trials (RCT) are mixed. This systematic review of RCTs aims to provide an update and synthesize the evidence addressing the association of intravenous iron with patient-based outcomes in patients with HFrEF and ID.</p><h3>Methods</h3><p>Any RCT evaluating the effect of intravenous iron in patients with HFrEF and ID was eligible for inclusion. A complete search of the EMBASE and PubMed databases was conducted from inception until 15 September 2023. The primary outcome was the composite of the quality of life (QoL) questionnaires, while the secondary outcomes included first heart failure (HF) hospitalizations and all-cause mortality. Data extraction was performed independently by two reviewers. Data were pooled using a random-effects model.</p><h3>Results</h3><p>Of the 1035 references, 15 RCTs enrolling 6649 patients were included in this study. Intravenous iron was associated with significant improvement in the composite of QoL (standardized mean difference − 1.36, 95% confidence interval [CI] − 2.24 to − 0.48; <i>p </i>= 0.002), a significant reduction in first HF hospitalizations (hazard ratio [HR] 0.73, 95% CI 0.56–0.95; <i>p</i> = 0.02), and with no change in all-cause mortality (HR 0.90, 95% CI 0.79–1.03; <i>p</i> = 0.12). The certainty of the evidence ranged from moderate to very low.</p><h3>Conclusion</h3><p>Intravenous iron is possibly associated with improved QoL and reduced HF hospitalizations, without impacting all-cause mortality. These findings not only support the use of intravenous iron in patients with HFrEF but also emphasize the need for well-designed and executed RCTs with granular outcome reporting and powered sufficiently to address the impact of intravenous iron on mortality in patients with HFrEF and ID.</p><h3>Registration</h3><p>PROSPERO identifier number CRD42023389</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"285 - 302"},"PeriodicalIF":2.8,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140193116","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":"The Rationale for Using Fixed-Dose Combination Therapy in the Management of Hypertension in Colombia: A Narrative Review","authors":"Dora Inés Molina de Salazar,&nbsp;Antonio Coca,&nbsp;Luis Alcocer,&nbsp;Daniel Piskorz","doi":"10.1007/s40256-024-00634-8","DOIUrl":"10.1007/s40256-024-00634-8","url":null,"abstract":"<div><p>Hypertension is a major risk factor for cardiovascular disease and the leading cause of death in Colombia. While the rate of hypertension awareness in Colombia is generally high, rates of treatment initiation, adherence, and blood pressure (BP) control are suboptimal. Major international hypertension guidelines recommend starting treatment with a combination of antihypertensive agents, and the use of a single-pill combination (SPC) to maximize adherence. In contrast, Colombian hypertension guidelines recommend starting treatment with diuretic monotherapy in most patients, and only initiating combination therapy in those with BP &gt; 160/100 mmHg. Therefore, the aim of the current narrative review is to examine the rationale for using SPCs to treat hypertension in Colombia, in the context of the major issues for BP control there. There is evidence of widespread therapeutic inertia in hypertension management, particularly in primary care, in Colombia. Moreover, combination therapy, angiotensin-converting enzyme inhibitors, and long-acting calcium channel blockers, which are internationally recommended as first-line drug therapies, are underutilized there. Adherence to antihypertensive therapy is low in Colombia and may be enhanced by use of SPCs as well as better patient education and follow-up. While there are promising national initiatives to improve BP management, more needs to be done by individual physicians. Antihypertensive SPCs are available on the national essential medicines list and may help to overcome some of the problems with suboptimal adherence, therapeutic inertia, and low rates of BP control that contribute to the high cardiovascular death rate in Colombia.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"197 - 209"},"PeriodicalIF":2.8,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10972912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140136346","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":"New Perspectives on the Role and Therapeutic Potential of Melatonin in Cardiovascular Diseases","authors":"Pengchen Gu,&nbsp;Yuxin Wu,&nbsp;Weiwei Lu","doi":"10.1007/s40256-024-00631-x","DOIUrl":"10.1007/s40256-024-00631-x","url":null,"abstract":"<div><p>Cardiovascular diseases (CVDs) are the leading cause of death and disability worldwide. It is essential to develop novel interventions to prevent/delay CVDs by targeting their fundamental cellular and molecular processes. Melatonin is a small indole molecule acting both as a hormone of the pineal gland and as a local regulator molecule in various tissues. It has multiple features that may contribute to its cardiovascular protection. Moreover, melatonin enters all cells and subcellular compartments and crosses morphophysiological barriers. Additionally, this indoleamine also serves as a safe exogenous therapeutic agent. Increasing evidence has demonstrated the beneficial effects of melatonin in preventing and improving cardiovascular risk factors. Exogenous administration of melatonin, as a result of its antioxidant and anti-inflammatory properties, has been reported to decrease blood pressure, protect against atherosclerosis, attenuate molecular and cellular damage resulting from cardiac ischemia/reperfusion, and improve the prognosis of myocardial infarction and heart failure. This review aims to summarize the beneficial effects of melatonin against these conditions, the possible protective mechanisms of melatonin, and its potential clinical applicability in CVDs.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"171 - 195"},"PeriodicalIF":2.8,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140020777","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":"Acetazolamide as an Adjunctive Diuretic Therapy for Patients with Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis","authors":"Ahmed Kamal Siddiqi,&nbsp;Muhammad Talha Maniya,&nbsp;Muhammad Tanveer Alam,&nbsp;Andrew P. Ambrosy,&nbsp;Marat Fudim,&nbsp;Stephen J. Greene,&nbsp;Muhammad Shahzeb Khan","doi":"10.1007/s40256-024-00633-9","DOIUrl":"10.1007/s40256-024-00633-9","url":null,"abstract":"<div><h3>Background</h3><p>Recent evidence suggests that acetazolamide may be beneficial as an adjunctive diuretic therapy in patients with acute decompensated heart failure (HF). We aim to pool all the studies conducted until now and provide updated evidence regarding the role of acetazolamide as adjunctive diuretic in patients with acute decompensated HF.</p><h3>Methods</h3><p>PubMed/Medline, Cochrane Library, and Scopus were searched from inception until July 2023, for randomized and nonrandomized studies evaluating acetazolamide as add-on diuretic in patients with acute decompensated HF. Data about natriuresis, urine output, decongestion, and the clinical signs of congestion were extracted, pooled, and analyzed. Data were pooled using a random effects model. Results were presented as risk ratios (RRs), odds ratios (ORs), or weighted mean differences (WMD) with 95% confidence intervals (95% CIs). Certainty of evidence was assessed using the grading of recommendation, assessment, development, and evaluation (GRADE) approach. A <i>P</i> value of &lt; 0.05 was considered significant in all cases.</p><h3>Results</h3><p>A total of 5 studies (<i>n</i> = 684 patients) were included with a median follow-up time of 3 months. Pooled analysis demonstrated significantly increased natriuresis (MD 55.07, 95% CI 35.1–77.04, <i>P</i> &lt; 0.00001; <i>I</i>² = 54%; moderate certainty), urine output (MD 1.04, 95% CI 0.10–1.97, <i>P</i> = 0.03; <i>I</i>² = 79%; moderate certainty) and decongestion [odds ratio (OR) 1.62, 95% CI 1.14–2.31, <i>P</i> = 0.007; <i>I</i>² = 0%; high certainty] in the acetazolamide group, as compared with controls. There was no significant difference in ascites (RR 0.56, 95% CI 0.23–1.36, <i>P</i> = 0.20; <i>I</i>² = 0%; low certainty), edema (RR 1.02, 95% CI 0.52–2.0, <i>P</i> = 0.95; <i>I</i>² = 45%; very low certainty), raised jugular venous pressure (JVP) (RR 0.86, 95% CI 0.63–1.17, <i>P</i> = 0.35; <i>I</i>² = 0%; low certainty), and pulmonary rales (RR 0.82, 95% CI 0.44–1.51, <i>P</i> = 0.52; <i>I</i>² = 25%; low certainty) between the two groups.</p><h3>Conclusions</h3><p>Acetazolamide as an adjunctive diuretic significantly improves global surrogate endpoints for decongestion therapy but not all individual signs and symptoms of volume overload.</p><h3>Systematic Review Registration</h3><p>This systematic review was prospectively registered on the PROSPERO (https://www.crd.york.ac.uk/PROSPERO/), registration number CRD498330.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"273 - 284"},"PeriodicalIF":2.8,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982164","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":"Eligibility and Cost-Utility Analysis of Dapagliflozin in Patients with Heart Failure Across the Whole Spectrum of Ejection Fraction in South Korea","authors":"Eui-Soon Kim,&nbsp;Sun-Kyeong Park,&nbsp;Daniel Sung-ho Cho,&nbsp;Jong-Chan Youn,&nbsp;Hye Sun Lee,&nbsp;Hae-Young Lee,&nbsp;Hyun-Jai Cho,&nbsp;Jin-Oh Choi,&nbsp;Eun-Seok Jeon,&nbsp;Sang Eun Lee,&nbsp;Min-Seok Kim,&nbsp;Jae-Joong Kim,&nbsp;Kyung-Kuk Hwang,&nbsp;Myeong-Chan Cho,&nbsp;Shung Chull Chae,&nbsp;Seok-Min Kang,&nbsp;Jin Joo Park,&nbsp;Dong-Ju Choi,&nbsp;Byung-Su Yoo,&nbsp;Jae Yeong Cho,&nbsp;Kye Hun Kim,&nbsp;Byung-Hee Oh,&nbsp;Barry Greenberg,&nbsp;Sang Hong Baek","doi":"10.1007/s40256-024-00632-w","DOIUrl":"10.1007/s40256-024-00632-w","url":null,"abstract":"<div><h3>Background</h3><p>The DAPA-HF and DELIVER trials demonstrated the clinical benefits of dapagliflozin in heart failure (HF) patients across the entire ejection fraction (EF) spectrum. However, further investigation is needed for the real-world application of dapagliflozin in HF patients. This study examines the proportion of real-world HF patients eligible for dapagliflozin and evaluates the cost-effectiveness of adding dapagliflozin to current HF therapy.</p><h3>Methods</h3><p>Data from the nationwide prospective registry, the Korean Acute Heart Failure (KorAHF) registry, were used to determine dapagliflozin eligibility based on the enrollment criteria of the DAPA-HF/DELIVER trials. A cost-utility analysis was conducted using a Markov model to assess the cost-effectiveness of dapagliflozin by comparing it to the standard of care.</p><h3>Results</h3><p>Out of 5178 KorAHF patients, 48.7% met the enrollment criteria of the DAPA-HF/DELIVER trials, while 89.5% met the label criteria (US Food and Drug Administration, European Medicines Agency, and Korean Ministry of Food and Drug Safety). Eligibility was highest among HF patients with preserved EF (55.3% vs. HF with mildly reduced EF and HF with reduced EF 46.4%). Dapagliflozin proved to be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 4557 US dollar (US$) per quality-adjusted life year, which falls below the US$18,182 willingness-to-pay threshold. The cost-effectiveness benefit was more pronounced in patients with a left ventricular EF (LVEF) ≤ 40% (ICER US$3279 for LVEF ≤ 40% vs. US$8383 for LVEF &gt; 40%).</p><h3>Conclusions</h3><p>Discrepancies in dapagliflozin eligibility were observed between real-world data and clinical trial results. The addition of dapagliflozin to HF therapy proved to be highly cost-effective across the entire EF spectrum.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"313 - 324"},"PeriodicalIF":2.8,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139982165","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":"Comparative Effectiveness and Safety of Direct Oral Anticoagulants Compared with Warfarin in Patients with Low Bodyweight who have Atrial Fibrillation: A Systematic Review and Meta-analysis","authors":"Mohamed Nabil Elshafei,&nbsp;Ahmed El-Bardissy,&nbsp;Muhammad Salem,&nbsp;Mohamed S. Abdelmoneim,&nbsp;Ahmed Khalil,&nbsp;Sherine Elhadad,&nbsp;Mohammed Danjuma","doi":"10.1007/s40256-024-00628-6","DOIUrl":"10.1007/s40256-024-00628-6","url":null,"abstract":"<div><h3>Introduction</h3><p> oral anticoagulant (DOAC) agents are becoming the anticoagulation strategy of choice for most clinical risks for which they are indicated. However, residual uncertainty remains regarding their use in preventing stroke in patients with low bodyweight [&lt; 60 kg or body mass index (BMI) &lt; 18 kg/m²]. We have carried out pooled systematic analyses of published studies to determine the efficacy and safety of these agents compared with warfarin in stroke prevention in patients with low bodyweight.</p><h3>Methods</h3><p>We carried out a comprehensive search of electronic databases from inception to June 2023 for eligible studies reporting on the efficacy and safety of direct oral anticoagulants versus warfarin in patients with atrial fibrillation who had low bodyweight. These include PubMed, EMBASE, the Cochrane Database of Systematic Reviews, the Science Citation Index, and the Database of Abstracts of Reviews of Effectiveness. Using the random effects model, derived pooled odd ratios (with their corresponding confidence intervals) of mortality outcomes in patient cohorts exposed to direct oral anticoagulants versus warfarin in patients with atrial fibrillation who had low bodyweight.</p><h3>Results</h3><p>Nine studies (<i>n</i> = 159,514 patients) were included in our meta-analysis. DOAC analogs were associated with lower stroke recurrence compared with warfarin [odds ratio (OR) 0.66, 95% confidence interval (CI) 0.49–0.9]; however, there was no significant difference in the composite outcome (OR 0.81, 95% CI 0.59–1.09) and mortality (OR 0.82, 95% CI 0.48–1.41). Additionally, DOAC analogs showed a significant reduction in major bleeding events by 30% compared with warfarin (OR 0.70, 95% CI 0.62–0.80).</p><h3>Conclusion</h3><p>In this pooled meta-analytical synthesis of studies comprising both real-world and randomized controlled data, the use of DOAC analogs in patients with atrial fibrillation and low bodyweight (&lt; 60 kg or BMI &lt; 18 kg/m²) was associated with a significant reduction in risks of stroke and major bleeding compared with patient cohorts stabilized on warfarin-based therapy. There was uncertainty regarding the composite outcome and mortality point estimate between these two anticoagulation strategies. This finding helps to resolve the uncertainty associated with the use of DOACs in this cohort. Additionally, it suggests the need for confirmatory non-inferiority randomized controlled trials evaluating DOACs versus warfarin in this cohort of patients.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"255 - 271"},"PeriodicalIF":2.8,"publicationDate":"2024-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139929593","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":"Management of Hypertension in the Asia-Pacific Region: A Structured Review","authors":"Abdul R. A. Rahman,&nbsp;Jose Donato A. Magno,&nbsp;Jun Cai,&nbsp;Myint Han,&nbsp;Hae-Young Lee,&nbsp;Tiny Nair,&nbsp;Om Narayan,&nbsp;Jiampo Panyapat,&nbsp;Huynh Van Minh,&nbsp;Rohit Khurana","doi":"10.1007/s40256-023-00625-1","DOIUrl":"10.1007/s40256-023-00625-1","url":null,"abstract":"<div><p>This article reviews available evidence regarding hypertension management in the Asia-Pacific region, focussing on five research questions that deal with specific aspects: blood pressure (BP) control, guideline recommendations, role of renin–angiotensin–aldosterone system (RAAS) inhibitors in clinical practice, pharmacological management and real-world adherence to guideline recommendations. A PubMed search identified 2537 articles, of which 94 were considered relevant. Compared with Europeans, Asians have higher systolic/diastolic/mean arterial BP, with a stronger association between BP and stroke. Calcium channel blockers are the most-commonly prescribed monotherapy in Asia, with significant variability between countries in the rates of angiotensin-converting enzyme inhibitors (ACEis)/angiotensin-receptor blockers (ARBs) and single-pill combination (SPC) use. In clinical practice, ARBs are used more commonly than ACEis, despite the absence of recommendation from guidelines and clinical evidence supporting the use of one class of drug over the other. Ideally, antihypertensive treatment should be tailored to the individual patient, but currently there are limited data on the characteristics of hypertension in Asia-Pacific individuals. Large outcome studies assessing RAAS inhibitor efficacy and safety in multi-national Asian populations are lacking. Among treated patients, BP control rates were ~ 35 to 40%; BP control in Asia-Pacific is suboptimal, and disproportionately so compared with Western nations. Strategies to improve the management of hypertension include wider access/availability of affordable treatments, particularly SPCs (which improve adherence), effective public health screening programs targeting patients to drive health-seeking behaviours, an increase in physician/patient awareness and early implementation of lifestyle changes. A unified Asia-Pacific guideline on hypertension management with pragmatic recommendations, particularly in resource-limited settings, is essential.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"141 - 170"},"PeriodicalIF":2.8,"publicationDate":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10973088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139705831","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":"Serum Cystatin C as a Risk Factor for Supratherapeutic Digoxin Concentration in Elderly Patients with Heart Failure and Chronic Kidney Disease","authors":"Jie-Jiu Lu,&nbsp;Tao-Tao Liu","doi":"10.1007/s40256-024-00629-5","DOIUrl":"10.1007/s40256-024-00629-5","url":null,"abstract":"<div><h3>Background</h3><p>Digoxin is primarily metabolized by the kidney, and its toxicity is strongly associated with high concentrations, particularly in elderly patients. The purpose of this study was to evaluate the predictive performance of renal function biomarkers for supratherapeutic digoxin concentrations in elderly patients with heart failure (HF) and chronic kidney disease (CKD).</p><h3>Methods</h3><p>Data were retrospectively obtained from elderly patient with HF and CKD who received digoxin treatment from January 2022 and December 2022. Logistic regression was used to assess independent risk factors for supratherapeutic concentrations. The predictive performance of serum creatinine, serum cystatin C, and blood urea nitrogen on supratherapeutic concentrations was compared by receiver operating characteristic analysis.</p><h3>Results</h3><p>A total of 115 elderly patients with HF and CKD were enrolled in our study. Supratherapeutic concentrations were detected in 49 patients. Logistic regression analysis showed that estimated glomerular filtration rate calculated by serum cystatin C [eGFR_CysC, odds ratio (OR): 0.962, <i>P</i> = 0.006], heart rate (OR: 1.024, <i>P</i> = 0.040), and NYHA class (OR: 3.099, <i>P</i> = 0.010) were independent risk factors for supratherapeutic concentration. Cutoff value for eGFR_CysC between the two groups was 41 ml/min/1.73m². Predictive performance of serum cystatin C was further improved in patients with obesity, CKD stage 4–5, and older than 75 years compared with normal weight, CKD stage 3, and aged 60–75-year-old patients.</p><h3>Conclusions</h3><p>Serum cystatin C is a sensitive renal function biomarker to predict supratherapeutic digoxin concentration in elderly patients with HF and CKD.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 2","pages":"303 - 311"},"PeriodicalIF":2.8,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139650088","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}