American heart journal最新文献

{"title":"SGLT2 Inhibitors in Patients with Hypertrophic Cardiomyopathy and Type 2 Diabetes: Mortality Benefit Despite Increased Cardiovascular Risk Profile","authors":"Karldon Iwuchukwu Nwaezeapu,&nbsp;Godbless Ajenaghughrure,&nbsp;Ekow Essien,&nbsp;Abena Agyekum","doi":"10.1016/j.ahj.2025.07.029","DOIUrl":"10.1016/j.ahj.2025.07.029","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose co-transporter 2 (SGLT2) inhibitors have shown cardiovascular benefits in various populations, but their effects in hypertrophic cardiomyopathy (HCM) patients with type 2 diabetes remain understudied. This retrospective cohort study evaluated clinical outcomes in HCM patients with type 2 diabetes treated with SGLT2 inhibitors compared to those without SGLT2 therapy.</div></div><div><h3>Methods</h3><div>We utilized electronic medical records from the TriNetX Global Collaborative Network (136 healthcare organizations). Patients aged 18-79 with hypertrophic cardiomyopathy (ICD-10 codes I42.1, I42.2, or ICD-9 code 425.1) and type 2 diabetes mellitus were included. The SGLT2 inhibitor group (n=7,906) was compared with propensity-matched controls (n=7,906) who did not receive SGLT2 inhibitors. Outcomes were analyzed over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>After propensity score matching, analysis revealed a significant reduction in all-cause mortality in the SGLT2 group compared to the control group (Risk Ratio 0.718, 95% CI 0.653-0.790, p&lt;0.001). However, SGLT2 use was associated with significantly increased risk of cardiogenic shock (Risk Ratio 1.736, 95% CI 1.383-2.180, p&lt;0.001). Smaller but statistically significant increases were observed in heart failure (p=0.001), syncope (p=0.013), ventricular tachycardia (p=0.002), atrial fibrillation (p=0.021), and acute kidney failure (p=0.003).</div></div><div><h3>Conclusion</h3><div>SGLT2 inhibitor use in HCM patients with type 2 diabetes was associated with significantly reduced all-cause mortality despite increased risk of cardiogenic shock and other cardiovascular complications. This may be due to the reduced pre-load caused by the diuretic effect of SGLT2 inhibitor. This complex cardiovascular risk profile warrants further investigation through prospective randomized controlled trials.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 8-9"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060764","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":"Association Between Menstrual Cycle Irregularities and Cardiometabolic Risks: A Systematic Review and Meta-Analysis","authors":"Ahson Afzal ,&nbsp;Omar Khalid Samir Abdelkader ,&nbsp;Mohamed Abd-ElGawad ,&nbsp;Yomna E. Dean ,&nbsp;Moataz Aboeldahb ,&nbsp;Helen A.O. Popoola-Samuel ,&nbsp;Anas Hamdy ,&nbsp;Rafeek Walid Elmezayen ,&nbsp;Amir Elalem ,&nbsp;Nadir Zulfiqar Aziz ,&nbsp;Anandita Thakur ,&nbsp;Armaan Jain ,&nbsp;Hassan Nassr Al Dhneem ,&nbsp;Hamza Mohamed Hamed Elkasaby ,&nbsp;Raneem Atta ,&nbsp;Ileana Anghel ,&nbsp;Webster Donaldy ,&nbsp;Eman Toraih ,&nbsp;Hani Aiash","doi":"10.1016/j.ahj.2025.07.018","DOIUrl":"10.1016/j.ahj.2025.07.018","url":null,"abstract":"<div><h3>Background</h3><div>Menstrual irregularities are associated with various health risks, but their connection to cardiovascular disease (CVD) remains unclear. This meta-analysis aims to evaluate the link between irregular menstruation and cardiovascular and metabolic outcomes in women.</div></div><div><h3>Methods</h3><div>A systematic search of online databases was conducted for studies comparing cardiovascular and metabolic outcomes between women with irregular and regular menstrual cycles. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated adopting a random effects model.</div></div><div><h3>Results</h3><div>Eight observational studies involving 354,419 women were analyzed. Women with irregular menstrual cycles had a significantly higher risk of developing cardiovascular disease overall (RR: 1.43, 95% CI: 1.01–2.03) compared to those with regular cycles. Subgroup analyses showed an increased risk of coronary artery disease (RR: 1.29, 95% CI: 1.14–1.46), hypertension (RR: 1.50, 95% CI: 1.23–1.82), and heart failure (RR: 1.45, 95% CI: 1.11–1.89) among women with irregular cycles. Cerebrovascular disease risk was elevated in this group (RR: 1.62, 95% CI: 1.10–2.40). Furthermore, women with irregular cycles demonstrated a greater likelihood of developing diabetes mellitus (RR: 1.75, 95% CI: 1.31–2.34) and hypercholesterolemia (RR: 1.33, 95% CI: 1.16–1.52).</div></div><div><h3>Conclusion</h3><div>Menstrual irregularities are linked to an increased risk of various cardiovascular, cerebrovascular, and metabolic conditions. This underscores the need for regular medical check-ups to aid in early detection and prevention of these diseases.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 1-2"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061302","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":"Impact of Obesity on Cardiovascular Outcomes in Patients with Psoriatic Arthritis and Type 2 Diabetes Mellitus","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.2025.07.022","DOIUrl":"10.1016/j.ahj.2025.07.022","url":null,"abstract":"<div><h3>Background</h3><div>Psoriatic arthritis (PsA) and type 2 diabetes mellitus (T2DM) are independently associated with increased cardiovascular risk. However, the impact of obesity on cardiovascular outcomes in patients with both conditions remains poorly understood.</div></div><div><h3>Methods</h3><div>Using the TriNetX global federated health research network, we conducted a retrospective cohort study comparing cardiovascular outcomes between patients with PsA and T2DM stratified by BMI. Cohort 1 included non-obese patients (BMI &lt;30 kg/m²; n=9,762) and Cohort 2 included obese patients (BMI 30-60 kg/m²; n=9,762) matched by propensity score across demographic and clinical characteristics. Outcomes were assessed over a 5-year follow-up period.</div></div><div><h3>Results</h3><div>After propensity score matching, the risk of all-cause mortality was significantly higher in non-obese patients compared to obese patients (9.1% vs 5.9%, risk difference 3.2%, 95% CI 2.5-4.0%; p&lt;0.001). Non-obese patients demonstrated lower survival probability at the end of the 5-year follow-up (84.7% vs 90.2%, p&lt;0.001) with a hazard ratio of 1.65 (95% CI 1.49-1.83). The non-obese cohort also exhibited higher incidence of cardiac arrest (2.5% vs 1.1%), cerebral infarction (6.6% vs 4.3%), heart failure (17.1% vs 9.6%), and pulmonary embolism (3.3% vs 2.0%) compared to the obese cohort (all p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>In patients with concurrent PsA and T2DM, those with BMI &lt;30 kg/m² demonstrated significantly higher cardiovascular risk compared to matched obese patients. This apparent \"obesity paradox\" warrants further investigation into underlying mechanisms, including potential disease severity, inflammatory burden, and metabolic differences between these populations.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 4-5"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061390","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":"Evaluating the Cardiovascular Efficacy of GLP-1 and Dual GLP-1/GIP Agonists in Type 2 Diabetes: A Critical Review","authors":"Manahil Bahrawar,&nbsp;Amna Inayat,&nbsp;Mushaim Gillani,&nbsp;Haris Aslam,&nbsp;Ahmad Akhtar","doi":"10.1016/j.ahj.2025.07.043","DOIUrl":"10.1016/j.ahj.2025.07.043","url":null,"abstract":"<div><div>GLP-1RAs have emerged as a significant therapeutic option for managing cardiovascular outcomes in patients with T2DM, demonstrating promise in preserving ejection fraction and reducing the risk of MACE</div><div><strong>Methods:</strong> Databases such as Pubmed and Cochrane were used.</div><div>Studies like SOUL, SUSTAIN-6, and REWIND trials helped to assess the clinical outcomes of GLP-1RAs. The SOUL trial focused on semaglutide, a GLP-1RA in patients with established ASCVD or CKD, and STEP-HFpEF trial, centered on its effectiveness against obesity related heart failure, revealed 101 serious adverse effects in contrast to 301 in the placebo group. Tirzepatide, the first approved dual therapy for T2DM, shows better glycemic control and weight loss than GLP-1RAs, hence potentially a better treatment option for obesity related heart failure. While these therapies have a proven effect on reducing systolic blood pressure and MACE, one study showed that there was no significant effect on unstable angina. An ongoing study, the SURPASS-CVOT, is underway for the cardiovascular safety of tirzepatide, a GIP/GLP-1RA, and its superiority to dulaglutide. Statistical evidence supports the role tirzepatide has in mitigating ischemic stroke, however, customized RCTs are required to unveil the effects of GLP-1RAs</div><div><strong>Conclusion:</strong> Some variability in patients’ results, depending on the quality of evidence shows that personalized treatment plans are the best approach. For cost-effective scientific trials, predictive analysis may be used, such as mathematical models that may lead to early termination of the SOUL trial.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 16"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061512","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":"Prediabetes in Takotsubo Syndrome: Impact on Cardiovascular Outcomes and Mortality in a Propensity-Matched Cohort Study","authors":"Karldon Iwuchukwu Nwaezeapu,&nbsp;Godbless Ajenaghughrure,&nbsp;Ekow Essien,&nbsp;Abena Agyekum","doi":"10.1016/j.ahj.2025.07.055","DOIUrl":"10.1016/j.ahj.2025.07.055","url":null,"abstract":"<div><h3>Background</h3><div>Takotsubo syndrome (TTS) is associated with significant cardiovascular morbidity. While diabetes has been identified as a risk factor in TTS patients, the impact of prediabetes on outcomes remains poorly characterized. This study investigated whether prediabetes affects cardiovascular outcomes and mortality in patients with TTS.</div></div><div><h3>Methods</h3><div>Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of TTS patients aged 18-79 years. Patients with prediabetes (n=3,316) were compared to those without prediabetes (n=34,909) after propensity score matching (3,316 per cohort). Outcomes were analyzed over a 5-year follow-up period (1-1,825 days post-diagnosis). Statistical analyses included risk ratios, hazard ratios, and survival analyses.</div></div><div><h3>Results</h3><div>After matching, prediabetic TTS patients demonstrated significantly lower all-cause mortality (11.5% vs 19.4%; RR=0.59, p&lt;0.001), acute kidney injury (7.7% vs 10.0%; RR=0.77, p=0.008), and acute myocardial infarction (9.3% vs 12.1%; RR=0.77, p=0.018) compared to non-prediabetic patients. Heart failure trended toward significance (19.3% vs 22.2%; RR=0.87, p=0.051). Kaplan-Meier survival analysis showed significantly better outcomes for prediabetic patients in mortality (HR=0.53, p&lt;0.001), heart failure (HR=0.79, p=0.003), syncope (HR=0.73, p=0.005), atrial fibrillation/flutter (HR=0.80, p=0.042), acute kidney injury (HR=0.69, p&lt;0.001), acute myocardial infarction (HR=0.69, p=0.001), and pulmonary hypertension (HR=0.75, p=0.031). No significant differences were observed in cardiogenic shock, ventricular tachycardia, or stroke risks.</div></div><div><h3>Conclusion</h3><div>Contrary to expected outcomes, TTS patients with prediabetes demonstrated significantly better cardiovascular outcomes and lower mortality compared to those without prediabetes. This finding suggests a potential metabolic paradox in TTS that warrants further investigation. Possible explanations include earlier medical intervention, more aggressive risk factor management, or distinct pathophysiological mechanisms in prediabetic TTS patients.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 23-24"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060951","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 Cardiovascular Outcomes Between Patients Diagnosed with Spontaneous Coronary Artery Dissection and Those with Peripartum Cardiomyopathy: 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;Gloria Amoako MD ,&nbsp;Nana Osei MD ,&nbsp;Esther Obeng-Danso MD ,&nbsp;Suzette Graham-Hill MD ,&nbsp;Samy Macfarlane MD","doi":"10.1016/j.ahj.2025.07.051","DOIUrl":"10.1016/j.ahj.2025.07.051","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous coronary artery dissection (SCAD) and peripartum cardiomyopathy (PPCM) are distinct cardiovascular conditions affecting predominantly female patients, yet comparative data on their long-term outcomes remains limited. This study compared mortality, arrhythmic events, and other cardiovascular outcomes between propensity-matched cohorts of patients with these conditions.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized the TriNetX Research Network, analyzing de-identified electronic health record data from 131 healthcare organizations. We identified 12,250 patients with PPCM and 8,261 with SCAD. After propensity score matching for age, race, ethnicity, and key comorbidities, cohorts of 2,814 patients each were analyzed. 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>All-cause mortality did not differ significantly between groups (PPCM 3.8% vs SCAD 3.9%, p=0.883). Patients with PPCM had significantly higher risks of cardiogenic shock (HR 1.654, 95% CI 1.093-2.504, p=0.016), heart failure (HR 2.072, 95% CI 1.755-2.447, p&lt;0.001), ventricular tachycardia (HR 1.498, 95% CI 1.126-1.994, p=0.005), acute kidney injury (HR 1.738, 95% CI 1.336-2.261, p&lt;0.001), and pacemaker implantation (HR 1.848, 95% CI 1.377-2.480, p&lt;0.001). Conversely, SCAD patients demonstrated higher risks of cerebrovascular disease (HR 0.378, 95% CI 0.299-0.479, p&lt;0.001) and coronary artery disease (HR 0.132, 95% CI 0.110-0.158, p&lt;0.001).</div></div><div><h3>Conclusion</h3><div>Despite similar mortality rates, PPCM and SCAD exhibit distinct cardiovascular outcome profiles, suggesting different pathophysiological mechanisms and highlighting the need for condition-specific management strategies. PPCM patients face greater risks of heart failure, arrhythmias, and device therapy, while SCAD patients have higher cerebrovascular and progressive coronary disease burdens.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 21-22"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061015","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":"High-Sensitivity C-Reactive Protein as a Prognostic Indicator in Heart Failure with Reduced Ejection Fraction: Evidence from the TriNetX Database","authors":"Ekow Essien,&nbsp;Abraham Carboo,&nbsp;Karldon Nwaezeapu,&nbsp;Abena Agyekum,&nbsp;Patrick Berchie,&nbsp;Justice Owusu-Achiaw,&nbsp;Kwame Mensa-Yawson,&nbsp;Edmund Mireku Bediako","doi":"10.1016/j.ahj.2025.07.059","DOIUrl":"10.1016/j.ahj.2025.07.059","url":null,"abstract":"<div><h3>Background</h3><div>Inflammation plays a crucial role in heart failure pathophysiology, but the prognostic value of high-sensitivity C-reactive protein (hs-CRP) in heart failure with reduced ejection fraction (HFrEF) remains incompletely characterized. This study aimed to compare clinical outcomes between HFrEF patients with elevated versus normal hs-CRP levels.</div></div><div><h3>Methods</h3><div>We performed a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing electronic medical records across 130 healthcare organizations. Adult patients (18-90 years) with HFrEF (left ventricular ejection fraction ≤40%) were stratified by hs-CRP levels: high (≥3.1 mg/L) versus low (≤3.0 mg/L). After propensity score matching for baseline characteristics, cohorts of 2,374 patients each were analyzed. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular, respiratory, and renal complications over a five-year follow-up period.</div></div><div><h3>Results</h3><div>Elevated hs-CRP was associated with significantly higher all-cause mortality (39.0% vs 28.7%; HR 1.542, 95% CI 1.396-1.704; p&lt;0.001). Patients with high hs-CRP demonstrated increased risk of acute kidney injury (27.0% vs 21.2%; HR 1.511, 95% CI 1.299-1.757; p&lt;0.001), chronic kidney disease (21.7% vs 17.3%; HR 1.495, 95% CI 1.268-1.762; p&lt;0.001), coronary artery disease (24.4% vs 19.0%; HR 1.591, 95% CI 1.253-2.020; p&lt;0.001), pulmonary edema (12.3% vs 9.5%; HR 1.489, 95% CI 1.219-1.818; p&lt;0.001), and pulmonary embolism (2.4% vs 1.4%; HR 1.966, 95% CI 1.260-3.068; p=0.002).</div></div><div><h3>Conclusion</h3><div>In HFrEF patients, elevated hs-CRP levels independently predict higher all-cause mortality and increased risk of cardiovascular, pulmonary, and renal complications. These findings suggest that hs-CRP may serve as a valuable prognostic marker to identify high-risk patients who might benefit from more intensive monitoring and targeted anti-inflammatory interventions.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 26"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061474","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":"Cardiovascular Risk in Obstructive Sleep Apnea: Impact of Glycemic Control in Diabetes — Insights from the TriNetX Network","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.2025.07.061","DOIUrl":"10.1016/j.ahj.2025.07.061","url":null,"abstract":"<div><h3>Background</h3><div>Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) frequently coexist and independently increase cardiovascular risk. However, the impact of glycemic control on cardiovascular outcomes in patients with both conditions remains incompletely characterized.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, analyzing data from 128 healthcare organizations. Patients with OSA and T2DM were stratified by glycemic control (HbA1c ≥7.0% vs. ≤6.9%). After propensity score matching for demographics and comorbidities, cohorts of 404,399 patients each were analyzed. Outcomes were assessed using risk analysis and Kaplan-Meier survival analysis with a 5-year follow-up period.</div></div><div><h3>Results</h3><div>In propensity-matched populations, poorly-controlled diabetes was associated with significantly higher all-cause mortality compared to well-controlled diabetes (11.3% vs. 10.8%; Risk Ratio [RR] 1.046, 95% CI 1.033-1.059; p&lt;0.001). Poorly-controlled diabetes was also associated with increased risk of heart failure (12.4% vs. 11.1%; RR 1.118, 95% CI 1.103-1.134; p&lt;0.001), acute kidney injury (13.8% vs. 12.0%; RR 1.152, 95% CI 1.137-1.166; p&lt;0.001), chronic kidney disease (13.6% vs. 11.8%; RR 1.159, 95% CI 1.143-1.174; p&lt;0.001), and coronary artery disease (13.4% vs. 12.3%; RR 1.085, 95% CI 1.070-1.100; p&lt;0.001). No significant difference was observed in ventricular tachycardia risk between groups.</div></div><div><h3>Conclusion</h3><div>Among OSA patients with T2DM, poor glycemic control is associated with significantly worse cardiovascular and renal outcomes. These findings emphasize the importance of optimal diabetes management in OSA patients to mitigate cardiovascular risk.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 27"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061476","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":"Diagnostic Approaches for Spontaneous Coronary Artery Dissection: A Systematic Review of Multimodality Imaging","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.2025.07.027","DOIUrl":"10.1016/j.ahj.2025.07.027","url":null,"abstract":"<div><h3>Background</h3><div>Spontaneous coronary artery dissection (SCAD) increasingly causes acute coronary syndrome, especially in young women without traditional cardiovascular risk factors. This systematic review examines multimodality imaging approaches for SCAD diagnosis and management.</div></div><div><h3>Methods</h3><div>Following PRISMA-DTA guidelines, we searched four databases (MEDLINE, Embase, Cochrane Library, Web of Science) using comprehensive search terms. Independent reviewers screened studies, extracted data, and assessed quality with QUADAS-2. Eligible studies evaluated diagnostic approaches including invasive coronary angiography (ICA), optical coherence tomography (OCT), intravascular ultrasound (IVUS), coronary computed tomographic angiography (CCTA), and cardiac magnetic resonance (CMR).</div></div><div><h3>Results</h3><div>Multidetector Computed Tomography showed superior diagnostic performance to Coronary Angiography for SCAD detection (sensitivity 98.6% vs 77.8%, specificity 89.7% vs 79.4%). MDCT identified “sleeve-like” wall thickening in 71% of cases, along with “plaque-like” appearances, visible intimal flaps, or total occlusions. CMR revealed myocardial delayed enhancement in 83% of patients with 44% showing microvascular obstruction. OCT and IVUS served as reference standards, revealing intramural hematoma as the predominant finding. MDCT and CAG showed excellent correlation in stenosis grading (ICC = 0.8; p = 0.004). CCT identified SCAD in 78% of acute presentation lesions.</div></div><div><h3>Conclusions</h3><div>Each imaging modality offers unique diagnostic strengths. While invasive coronary angiography remains first-line, MDCT shows promise as a non-invasive alternative with high sensitivity and specificity. CMR provides valuable information about myocardial injury, while OCT and IVUS offer detailed vessel wall characterization. A multimodality imaging approach optimizes diagnosis, guides management, and assesses prognosis in SCAD.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 7"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060762","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":"GLP-1 Receptor Agonists in Hypertrophic Cardiomyopathy: Mortality Benefit with Complex Cardiovascular Risk Profile","authors":"Karldon Iwuchukwu Nwaezeapu,&nbsp;Godbless Ajenaghughrure,&nbsp;Ekow Essien,&nbsp;Abena Agyekum","doi":"10.1016/j.ahj.2025.07.028","DOIUrl":"10.1016/j.ahj.2025.07.028","url":null,"abstract":"<div><h3>Background</h3><div>Glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated cardiovascular benefits in various cardiac conditions, but their effects in hypertrophic cardiomyopathy (HCM) remain incompletely characterized. This study evaluated clinical outcomes in HCM patients with type 2 diabetes treated with GLP-1 receptor agonists compared to those without GLP-1 therapy.</div></div><div><h3>Methods</h3><div>This retrospective cohort study utilized electronic medical records from the TriNetX Global Collaborative Network, encompassing 129 healthcare organizations. Patients with hypertrophic cardiomyopathy (ICD-10 codes I42.1, I42.2, or ICD-9 code 425.1) and type 2 diabetes mellitus were included. The GLP-1 agonist group (n=8,293) was compared with propensity-matched controls (n=8,293) who did not receive GLP-1 agonists. Outcomes were analyzed over a 5-year follow-up period (1,825 days).</div></div><div><h3>Results</h3><div>After propensity score matching, analysis revealed a significant reduction in all-cause mortality in the GLP-1 group compared to the control group (Risk Ratio 0.521, 95% CI 0.469-0.578 p&lt;0.001). GLP-1 use was also associated with significantly reduced risk of cardiogenic shock (Risk Ratio 0.670, 95% CI 0.518-0.868; p=0.002). No significant differences were observed in rates of heart failure (p=0.643), syncope (p=0.980), ventricular tachycardia (p=0.104), atrial fibrillation (p=0.211), or acute kidney failure (p=0.795).</div></div><div><h3>Conclusion</h3><div>GLP-1 receptor agonist use in HCM patients with type 2 diabetes was associated with significantly reduced all-cause mortality and lower risk of cardiogenic shock compared to non-users. The favorable risk-benefit profile of GLP-1 agonists in this patient population warrants further investigation through prospective randomized controlled trials.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 7-8"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060763","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}