American heart journal最新文献

{"title":"High Medication Burden in Individuals With Difficult-to-Control Type 2 Diabetes: Clinical Characteristics From the CATALYST Study","authors":"Ralph A. DeFronzo ,&nbsp;John Buse ,&nbsp;Bradley Eilerman ,&nbsp;Vivian Fonseca ,&nbsp;Yehuda Handelsman ,&nbsp;Harold J. Miller ,&nbsp;John C. Parker ,&nbsp;Richard Pratley ,&nbsp;Julio Rosenstock ,&nbsp;Michael H. Shanik ,&nbsp;Guillermo Umpierrez ,&nbsp;Iulia Cristina Tudor ,&nbsp;Austin L. Hand ,&nbsp;Daniel Einhorn","doi":"10.1016/j.ahj.2025.07.046","DOIUrl":"10.1016/j.ahj.2025.07.046","url":null,"abstract":"<div><div>CATALYST (NCT05772169) was the largest prospective study to date to assess the prevalence of hypercortisolism in individuals with difficult-to-control type 2 diabetes (T2D), finding a prevalence of 23.8% (n=252/1,057). With a participant cohort of &gt;1,000, the study was uniquely positioned to explore demographic and clinical characteristics associated with difficult-to-control T2D. Here we describe the characteristics of the CATALYST Part 1 population. Individuals with hemoglobin A1c (HbA1c) 7.5–11.5%, despite taking multiple antihyperglycemic medications, were screened for hypercortisolism using the 1-mg overnight dexamethasone suppression test (DST). Those with known causes of false-positive DSTs were excluded. The study population had a mean age of 60.7 years, 45% were female, 71% were White, 19% were African American, and 24% were Hispanic/Latino. Mean HbA1c was 8.8%, and mean systolic blood pressure (SBP) was 127.6 mmHg. 31% had SBP ≥135 mm/Hg. 43% were taking ≥4 glucose-lowering medications, including sodium-glucose cotransporter 2 inhibitors (52%), glucagon-like peptide-1 receptor agonists (48%), and tirzepatide (10%). Antihypertensive medications were used by 82% of participants, with 27% taking ≥3 antihypertensives. Lipid-modifying medications (primarily statins) were used by 83%, psychiatric medication by 30%, and analgesic medications by 30% of participants. Cardiac disorders were present in 33% and 21% of participants and hypertension was present in 89% and 79% of participants with and without hypercortisolism, respectively. In summary, CATALYST participants had a high medication and comorbid disease burden, with T2D that remained difficult to control despite multiple glucose-lowering medications. In addition, many participants had elevated SBP despite extensive use of antihypertensive medications.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 18"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Trends and Sociodemographic Disparities in LDL-Attributable Cardiovascular Disease: GBD 2021 Analysis (1990–2021)","authors":"Rohan Raj ,&nbsp;Ujjwal Mishra ,&nbsp;Nikhil Jain ,&nbsp;Kanishka Kumar Awasthi","doi":"10.1016/j.ahj.2025.07.047","DOIUrl":"10.1016/j.ahj.2025.07.047","url":null,"abstract":"<div><h3>Background</h3><div>Elevated low-density lipoprotein (LDL) cholesterol is a major modifiable risk factor for cardiovascular disease (CVD). While global trends in LDL-attributable CVD have been previously reported, disparities across sociodemographic development levels remain insufficiently explored.</div></div><div><h3>Objective</h3><div>To assess global, regional, and SDI-specific trends in the CVD burden attributable to high LDL cholesterol from 1990 to 2021.</div></div><div><h3>Methods</h3><div>We utilized Global Burden of Disease (GBD) 2021 data to evaluate CVD mortality and disability-adjusted life years (DALYs) attributable to high LDL cholesterol. Trends were assessed using annual percentage change (APC) in age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR), and age-standardized years lived with disability (ASYLD) by Socio-demographic Index (SDI), sex, and location.</div></div><div><h3>Results</h3><div>From 1990 to 2021, global ASMR and ASDR attributable to high LDL cholesterol declined. In 2021, ASMR and ASDR were lowest in high SDI regions. Israel recorded the largest decrease in APC for both ASMR and ASDR, while Lesotho exhibited the highest increase. Over the same period, Singapore showed the greatest decline in APC of ASYLD, whereas Tanzania had the most pronounced increase. The greatest reductions in APC of ASMR and ASDR from 1990 to 2021 were observed in high SDI countries, particularly during the decade 2000–2010. Females consistently showed declining APCs of ASMR across all SDI quintiles, whereas in males, APCs declined only in high and high-middle SDI countries.</div></div><div><h3>Conclusion</h3><div>Persistent disparities in CVD burden attributable to high LDL across SDI quintiles highlight the need for equitable, tailored lipid-lowering and cardiometabolic prevention strategies.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 18-19"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Analysis of Arrhythmia Risk: SGLT2 inhibitors versus GLP-1 Receptor Agonists in Patients with Type 2 Diabetes and Inflammatory Arthritis","authors":"Godbless Ajenaghughrure M.D. ,&nbsp;Sila Mateo Faxas M.D. ,&nbsp;Kim Nguyen M.D. ,&nbsp;Gurjot Singh M.D. ,&nbsp;Nirys Mateo Faxas M.D. ,&nbsp;Dharana Gelal M.D. ,&nbsp;Karldon Nwazeaupu M.D. ,&nbsp;Nicole Tejeda Zoz M.D. ,&nbsp;Kimberly Ramirez Bonetti M.D. ,&nbsp;Erick Perez Mejias M.D.","doi":"10.1016/j.ahj.2025.07.021","DOIUrl":"10.1016/j.ahj.2025.07.021","url":null,"abstract":"<div><h3>Background</h3><div>Both SGLT2 inhibitors and GLP-1 receptor agonists have demonstrated cardiovascular benefits in type 2 diabetes (T2D), but their comparative arrhythmogenic profiles in patients with comorbid inflammatory polyarthropathy remain unclear. This study aimed to evaluate the differential risk of cardiac arrhythmias between these two drug classes in this specific patient population.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study using the TriNetX global federated health research network, we identified adult patients with T2D and inflammatory polyarthropathy who were initiated on either SGLT2 inhibitors (n=3,278) or GLP-1 receptor agonists (n=4,612). After propensity score matching (n=2,838 per group), we compared the incidence of various arrhythmias including atrial fibrillation, ventricular tachycardia, ventricular fibrillation, sick sinus syndrome, and need for pacemaker implantation over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>Patients treated with SGLT2 inhibitors demonstrated significantly higher rates of atrial fibrillation (10.4% vs 7.8%, HR 1.552, 95% CI 1.303-1.848, p&lt;0.001) and ventricular tachycardia (4.8% vs 2.2%, HR 2.467, 95% CI 1.825-3.334, p&lt;0.001) compared to those receiving GLP-1 receptor agonists. Ventricular fibrillation was also more common in the SGLT2 inhibitor group (2.4% vs 0.8%, HR 3.451, 95% CI 2.131-5.590, p&lt;0.001). Sick sinus syndrome occurred more frequently in SGLT2 inhibitor users (1.0% vs 0.7%), though this difference was not statistically significant. Pacemaker implantation rates were higher in the SGLT2 inhibitor cohort (5.1% vs 3.9%, HR 1.466, 95% CI 1.144-1.878, p=0.002).</div></div><div><h3>Conclusion</h3><div>Among patients with T2D and inflammatory polyarthropathy, treatment with GLP-1 receptor agonists was associated with significantly lower risk of major cardiac arrhythmias compared to SGLT2 inhibitors. These findings suggest that GLP-1 receptor agonists may represent a preferred option for patients with T2D and inflammatory arthritis who are at increased risk for cardiac arrhythmias. Further investigation is warranted to elucidate the mechanisms underlying these differences.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 4"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Possibilities of Screening and Intervention Strategies in Patients with Coronary Artery Disease and Type 2 Diabetes Mellitus with the Risk of HF","authors":"R.Kh. Trigulova ,&nbsp;A.A. Ikramov ,&nbsp;D.T. Akhmedova ,&nbsp;Sh.Sh. Mukhtarova ,&nbsp;D.A. Alimova ,&nbsp;Sh.S. Akhmedova","doi":"10.1016/j.ahj.2025.07.023","DOIUrl":"10.1016/j.ahj.2025.07.023","url":null,"abstract":"<div><h3>Introduction</h3><div>The practical use of NT-proBNP in different clinical situations should be interpreted depending on the patient profile.</div></div><div><h3>Objective</h3><div>analysis of NT-proBNP in the intervals of parameters of phenotypes of preserved and moderately reduced LVEF in patients with coronary artery disease and type 2 diabetes mellitus.</div></div><div><h3>Material and Methods</h3><div>130 patients with coronary artery disease (ESC) and type 2 diabetes mellitus (WHO, 1999), age 63,9±8,8 years, duration of coronary artery disease and type 2 diabetes mellitus – 9,69±0,49 and 7,3±3,89 years, HF with moderately reduced (group A, n-60) and preserved LVEF (group B (1), n-70). According to the H2FPEF scale, patients in group B were divided into the probability of HF &gt;50% (2) and &lt;50% (3). Demographic, NP-proBNP, sodium, eGFR, lipid and carbohydrate profile, LVEDP indicators (E/A, E/e′, LP index, ILVMM) were analyzed. Basic therapy: antiplatelet agents, beta-blockers, RAAS blockers, statins, empagliflozin, i-DPP-4, metformin. Duration of observation is 2 years.</div></div><div><h3>Results</h3><div>The difference between groups A and B was shown in NP-proBNP (outcome): 1293,96±1658,80 vs. 396,21±477,97 pg /ml (t=36,979; p=0,000) and observation 1374,21±1967,36 vs. 362,86±624,96 (t=27,766; p=0,000), respectively. Comparison of group B with (2) and 3 subgroups did not register intergroup differences in NP-proBNP before and after 2 years of observation. During basic therapy, LVEF in the EF &lt;50% group increased from 45,2 [43,2; 47,8] to 47,9% [45,2; 54,3] (t=15,892; p=0,000), and did not change in 2 and 3. Intergroup differences (2 and 3) were revealed in LA (t=2,905; p=0,088), LA volume (t=6,20; p=0,01), EDD (t=4,72; p=0,03) and ESD (t=7,36; p=0,007) before and (t=6,72; p=0.01) after (t=5,17; p=0,02), E/e` before (t=9,917; p=0,002) and after (t=3,996; p=0,046) 2 years of observation.</div></div><div><h3>Conclusion</h3><div>For patients with coronary artery disease and type 2 diabetes mellitus, it is important to evaluate E/e' screening to monitor the progression of LVEF; when empagliflozin is prescribed, LVEF indicators improve.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 5"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Cardiovascular Benefits of Semaglutide Adjunctive to Bariatric Surgery: A Real-World Analysis Using TriNetX","authors":"Ekow Essien,&nbsp;Justice Owusu-Achiaw,&nbsp;Abraham Carboo,&nbsp;Karldon Nwaezeapu,&nbsp;Abena Agyekum,&nbsp;Patrick Berchie,&nbsp;Kwame Mensa-Yawson,&nbsp;Edmund Mireku Bediako","doi":"10.1016/j.ahj.2025.07.063","DOIUrl":"10.1016/j.ahj.2025.07.063","url":null,"abstract":"<div><h3>Background</h3><div>Bariatric surgery provides significant benefits for patients with obesity, but cardiovascular outcomes might be further improved with adjunctive pharmacotherapy. This study aimed to evaluate the cardiovascular benefits of semaglutide as an adjunct to bariatric surgery compared to bariatric surgery alone.</div></div><div><h3>Methods</h3><div>Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of patients with obesity (BMI ≥30 kg/m²) who underwent bariatric surgery. The semaglutide cohort (n=37,026) included patients who received semaglutide after bariatric surgery, while the control cohort (n=273,513) included those who underwent bariatric surgery without semaglutide. After propensity score matching (n=36,744 per group), we analyzed cardiovascular outcomes over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>Semaglutide use was associated with significantly lower all-cause mortality (1.0% vs 2.2%; HR 0.362, 95% CI 0.320-0.410; p&lt;0.001) and cardiogenic shock (0.1% vs 0.2%; HR 0.470, 95% CI 0.330-0.671; p&lt;0.001). Patients receiving semaglutide demonstrated lower incidence of pulmonary complications, including pulmonary edema (HR 0.595), pulmonary hypertension (HR 0.600), and pulmonary embolism (HR 0.709). Semaglutide was also associated with reduced risk of acute kidney injury (HR 0.742) and atrial fibrillation (HR 0.781).</div></div><div><h3>Conclusion</h3><div>In patients with obesity who underwent bariatric surgery, adjunctive semaglutide therapy was associated with significantly lower mortality and reduced incidence of major cardiovascular and renal complications. These findings suggest that combining semaglutide with bariatric surgery may provide additive cardiovascular protection.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 28"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiometabolic Risk Reduction with Digital Twinning: A Narrative Review","authors":"Seyed Arsalan Seyedi ,&nbsp;Juan P. González-Rivas ,&nbsp;Pranav Mellacheruvu ,&nbsp;Ananya Mellacheruvu ,&nbsp;Seyed Pedram Aledavood ,&nbsp;Jeffrey I. Mechanick","doi":"10.1016/j.ahj.2025.07.033","DOIUrl":"10.1016/j.ahj.2025.07.033","url":null,"abstract":"<div><div>Digital twin (DT) technology—real-time, data-driven virtual models of individuals—offers transformative potential in managing cardiometabolic-based chronic disease (CMBCD), a progressive continuum including abnormal adiposity (ABCD), hypertension (HBCD), dysglycemia (DBCD), dyslipidemia (LBCD), residual risk states, and cardiovascular diseases (CVDs). Type 2 diabetes (T2D), central in this cascade, requires individualized, integrative strategies where DT may serve as a precision-medicine tool. A systematic search across PubMed, Embase, Web of Science, Scopus, and Cochrane identified 12 eligible studies. Due to data duplication (five studies using the same cohort) and lack of homogeneity, meta-analysis was not feasible, prompting a narrative synthesis. DT-guided interventions were categorized across the CMBCD spectrum: (1) ABCD – DT reduced visceral fat and lowered BMI by 1.8 kg/m²; (2) DBCD – HbA1c dropped up to 1.8%, 89% achieved glycemic targets, fewer medications were used, time-in-range improved from 69.7% (±30.7) to 86.9% (±24.5), time-above-range decreased (p&lt;0.001), and time-below-range slightly increased (p&lt;0.001); (3) HBCD – normal blood pressure cases increased from 108 (46.4%) to 147 (63.1%), outperforming standard care, with 30 patients stopping antihypertensive drugs; (4) LBCD – triglycerides dropped 18.8% and HDL increased 6.8% (p&lt;0.001); (5) Residual risk – DT improved liver fat/fibrosis (via imaging and fibrosis scores), and predicted CKD with area under the curves (AUCs) range from 0.80 to 0.86, retinopathy (AUC: 0.84), and cataracts (AUC: 0.93); (6) CVD outcomes – early trials show improved risk factors and medication de-escalation. DT appears promising for cardiometabolic risk management and personalized T2D care. Broader validation in diverse populations and refined implementation strategies are needed for clinical integration.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 10-11"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Premature Menopause and Risk of Cardiovascular Outcomes: A Propensity-Matched Analysis Using the TriNetX Research Network","authors":"Abena Korwaa Agyekum MD ,&nbsp;Ekow Essien MD ,&nbsp;Karldon Nwaezeapu MD ,&nbsp;Godbless Ajenaghughrure MD ,&nbsp;Nana Osei MD ,&nbsp;Esther Obeng-Danso MD ,&nbsp;Awuradjoa Ayirebi-Acquah MD ,&nbsp;Gloria Amoako MD ,&nbsp;Suzette Graham-Hill MD","doi":"10.1016/j.ahj.2025.07.035","DOIUrl":"10.1016/j.ahj.2025.07.035","url":null,"abstract":"<div><h3>Background</h3><div>Premature menopause (PM) affects approximately 1% of women under 40 years of age and may increase cardiovascular risk but specific outcomes remain incompletely characterized. This study aimed to compare mortality and cardiovascular events between women with premature menopause and age-matched controls.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the TriNetX Research Network (130 healthcare organizations). Women with PM (ICD-10 codes E28.31, E28.3, E28.319, E28.310) were compared to age-matched controls without PM. After propensity score matching for baseline demographics and comorbidities, cohorts of 9,245 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included heart failure (HF), arrhythmias, cerebrovascular disease (CVD), and other cardiovascular events. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a 10-year period.</div></div><div><h3>Results</h3><div>In propensity-matched cohorts, PM was associated with significantly higher all-cause mortality compared to controls (1.8% vs 0.6%; risk ratio [RR] 3.08, 95% CI 2.26-4.19; p&lt;0.001). Women with PM had higher risks of CVD (RR 1.39, 95% CI 1.07-1.82; p=0.014), HF (RR 1.22, 95% CI 0.91-1.63; p=0.192), peripheral arterial disease (PAD; RR 1.43, 95% CI 1.06-1.95; p=0.019), and coronary artery disease (CAD; RR 1.54, 95% CI 1.01-2.34; p=0.044). No statistically significant differences were observed in atrial fibrillation or ventricular tachycardia rates.</div></div><div><h3>Conclusion</h3><div>PM is associated with significantly higher all-cause mortality and increased risk of CVD, HF, PAD and CAD. These findings highlight the importance of cardiovascular risk assessment and prevention in women with PM.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 11-12"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Cardiovascular Outcomes of Tirzepatide vs Liraglutide in Obese Patients with Sleep Apnea: A Propensity-Matched Analysis Using the TriNetX Research Network","authors":"Ekow Essien MD,&nbsp;Karldon Nwaezeapu MD,&nbsp;Abena Agyekum MD,&nbsp;Godbless Ajenaghughrure MD,&nbsp;Justice Owusu-Achiaw MD,&nbsp;Edmund Mireku Bediako MD","doi":"10.1016/j.ahj.2025.07.038","DOIUrl":"10.1016/j.ahj.2025.07.038","url":null,"abstract":"<div><h3>Background</h3><div>Both tirzepatide (a dual GIP/GLP-1 receptor agonist) and liraglutide (a GLP-1 receptor agonist) have demonstrated cardiometabolic benefits, but their comparative cardiovascular outcomes in high-risk populations remain poorly characterized. This study compared mortality and cardiovascular outcomes between obese patients with sleep apnea treated with tirzepatide versus liraglutide.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data across 128 healthcare organizations. Obese patients (BMI ≥30 kg/m²) with sleep apnea who were prescribed either tirzepatide or liraglutide were identified. After propensity score matching for demographics and comorbidities, cohorts of 21,356 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiac events, arrhythmias, and other clinical outcomes. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a five-year follow-up period.</div></div><div><h3>Results</h3><div>Tirzepatide use was associated with significantly lower all-cause mortality compared to liraglutide (0.7% vs 1.4%; risk ratio [RR] 0.479, 95% CI 0.394-0.582; p&lt;0.001). Tirzepatide-treated patients also had reduced risks of heart failure (RR 0.658, 95% CI 0.583-0.743), atrial fibrillation (RR 0.706, 95% CI 0.605-0.823), ventricular tachycardia (RR 0.749, 95% CI 0.585-0.958), and cerebrovascular disease (RR 0.781, 95% CI 0.683-0.893). Additionally, tirzepatide was associated with lower risks of acute kidney injury, hypertension, coronary artery disease, and peripheral arterial disease (all p&lt;0.05).</div></div><div><h3>Conclusion</h3><div>In obese patients with sleep apnea, tirzepatide was associated with significantly lower all-cause mortality and reduced cardiovascular events compared to liraglutide. These findings suggest potential cardiovascular advantages of dual GIP/GLP-1 receptor agonism over GLP-1 receptor agonism alone in this high-risk population.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 13-14"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrhythmia Risk in Non-Obese versus Obese Patients with Psoriatic Arthritis and Type 2 Diabetes","authors":"Godbless Ajenaghughrure M.D. ,&nbsp;Sila Mateo Faxas M.D. ,&nbsp;Kim Nguyen M.D. ,&nbsp;Gurjot Singh M.D. ,&nbsp;Nirys Mateo Faxas M.D. ,&nbsp;Dharana Gelal M.D. ,&nbsp;Karldon Nwazeaupu M.D. ,&nbsp;Nicole Tejeda Zoz M.D. ,&nbsp;Kimberly Ramirez Bonetti M.D. ,&nbsp;Erick Perez Mejias M.D.","doi":"10.1016/j.ahj.2025.07.025","DOIUrl":"10.1016/j.ahj.2025.07.025","url":null,"abstract":"<div><h3>Background</h3><div>Both psoriatic arthritis (PsA) and type 2 diabetes mellitus (T2DM) are associated with increased cardiovascular risk, but the impact of body mass index (BMI) on cardiac arrhythmias in this population remains unclear. This study examines the relationship between BMI status and risk of cardiac arrhythmias in patients with both PsA and T2DM.</div></div><div><h3>Methods</h3><div>Using the TriNetX global federated health research network accessing electronic medical records across 100 healthcare organizations, we conducted a retrospective cohort study. After propensity score matching, we compared two cohorts of patients with PsA and T2DM: non-obese (BMI &lt;30 kg/m²; n=9,762) and obese (BMI 30-60 kg/m²; n=9,762). The primary outcomes were various cardiac arrhythmias, including atrial fibrillation, ventricular tachycardia, supraventricular tachycardia, and sick sinus syndrome during a 5-year follow-up period.</div></div><div><h3>Results</h3><div>Non-obese patients with PsA and T2DM had significantly higher rates of atrial fibrillation (10.8% vs 9.7%, risk difference [RD]=1.1%, 95% CI 0.3-2.0%, p=0.009) compared to matched obese patients. The non-obese cohort also showed numerically higher rates of ventricular tachycardia (1.6% vs 1.3%, RD=0.3%, p=0.137), supraventricular tachycardia (1.8% vs 1.3%, RD=0.5%, p=0.001), and sick sinus syndrome (1.1% vs 0.9%, RD=0.2%, p=0.196). Kaplan-Meier analysis demonstrated significantly lower arrhythmia-free survival for non-obese patients (log-rank test p&lt;0.05 for atrial fibrillation and supraventricular tachycardia). Additionally, non-obese patients had a 40.5% higher likelihood of requiring pacemaker implantation (hazard ratio 1.41, 95% CI 1.18-1.86).</div></div><div><h3>Conclusions</h3><div>Contrary to conventional wisdom, non-obese patients with concurrent PsA and T2DM demonstrated higher risk of cardiac arrhythmias compared to their obese counterparts. This suggests a potential protective effect of higher BMI in this specific patient population or reflects differences in underlying disease pathophysiology. Clinicians should consider more aggressive arrhythmia screening and monitoring in non-obese patients with PsA and T2DM, regardless of their apparently healthier weight profile.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 6"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability in Clinical Parameters as Predictors of Cardiovascular Disease in Type 2 Diabetes: A Machine Learning Approach","authors":"Masab A Mansoor DBA ,&nbsp;Affan Rizwan MD","doi":"10.1016/j.ahj.2025.07.026","DOIUrl":"10.1016/j.ahj.2025.07.026","url":null,"abstract":"<div><h3>Background</h3><div>Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Traditional risk prediction models often underperform in diabetic populations. This study aimed to develop and validate a machine learning (ML) model to predict CVD risk in T2DM patients using routinely collected clinical data with focus on parameter variability rather than absolute values.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative public dataset, selecting 5,426 T2DM patients without prior CVD (2015-2020). Multiple ML algorithms were trained to predict 3-year CVD risk. Input variables included demographic data, comorbidities, medications, and crucially, both median values and ranges (maximum minus minimum) of clinical parameters including HbA1c, creatinine, liver enzymes, and lipid profiles. Models were validated using 5-fold cross-validation.</div></div><div><h3>Results</h3><div>The random forest model demonstrated superior performance with an area under the receiver operating characteristic curve of 0.81 (95% CI: 0.79–0.83). Parameter variability provided stronger predictive value than median values for key variables. The top five predictors were creatinine variability, HbA1c variability, AST variability, ALP variability, and ALT variability, highlighting the importance of metabolic stability in CVD risk reduction.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that fluctuations in routine clinical parameters, particularly renal and glycemic markers, outperform traditional static measurements in predicting CVD risk among T2DM patients. Implementation of this ML model could enhance clinical decision-making by identifying high-risk patients who might benefit from more intensive monitoring and earlier therapeutic interventions.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 6-7"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}