American heart journal最新文献

{"title":"Adiponectin as a Biomarker for Subclinical Atherosclerosis in Obese Adults with Type 2 Diabetes Mellitus","authors":"Neeraj Pavan Reddy Telugu ,&nbsp;Shruthi Reddy Gatla ,&nbsp;Charan Lingutla ,&nbsp;Bala Sathvika Duggimpudi ,&nbsp;Nitish Nichenametla ,&nbsp;Yethindra Vityala","doi":"10.1016/j.ahj.2025.07.042","DOIUrl":"10.1016/j.ahj.2025.07.042","url":null,"abstract":"<div><h3>Background</h3><div>Obesity and type 2 diabetes mellitus (T2DM) increase cardiovascular risk. T2DM patients with excess fat show early atherosclerotic changes. Adiponectin from fat cells exerts anti-inflammatory effects. Obese individuals have lower adiponectin levels, which cause vascular inflammation. The carotid intima–media thickness (cIMT) is an indicator of subclinical atherosclerosis. While adiponectin levels show an inverse relationship with cardiovascular risk, its predictive value in obese T2DM patients without cardiovascular disease requires further study.</div></div><div><h3>Objective</h3><div>This study assessed the association between serum adiponectin levels and cIMT in obese adults with T2DM to determine the potential of adiponectin as a biomarker for early vascular changes.</div></div><div><h3>Methods</h3><div>In this cross-sectional study, 102 obese individuals (Body mass index ≥30 kg/m²) with T2DM were enrolled. Participants underwent serum adiponectin testing and high-resolution carotid ultrasonography. The cIMT was analyzed across adiponectin level tertiles. Multivariate linear regression was used to control for variables, including age, sex, low-density lipoprotein cholesterol, blood pressure, and hemoglobin A1C.</div></div><div><h3>Results</h3><div>A significant association was observed between lower serum adiponectin and increased cIMT (mean cIMT: 0.88 ± 0.09 mm in the lowest tertile compared to 0.69 ± 0.12 mm in the highest tertile; p&lt;0.001). Adiponectin remained an independent inverse predictor of cIMT in the multivariate analysis (β = −0.41; p&lt;0.01). No participant showed clinical signs of cardiovascular disease during the evaluation.</div></div><div><h3>Conclusion</h3><div>Decreased adiponectin levels are independently associated with subclinical atherosclerosis in obese patients with T2DM. Including adiponectin measurements in cardiovascular risk assessments may improve early detection and prevention strategies for this high-risk group.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 15-16"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061511","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":"A Second Look: Cardiac Catheterization and Survival After Kidney Transplantation","authors":"Sudhanvan Iyer BSA ,&nbsp;Ali Shirafkan MD, MPH ,&nbsp;Philong Nguyen BS ,&nbsp;Joshua Wang MS ,&nbsp;Cristiana Rastellini MD ,&nbsp;George Golovko PhD ,&nbsp;Luca Cicalese MD, FACS","doi":"10.1016/j.ahj.2025.07.048","DOIUrl":"10.1016/j.ahj.2025.07.048","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac risk stratification before kidney transplantation lacks transplant-specific guidelines. Current practices are founded on studies of end-stage renal disease patients undergoing vascular surgery, rather than evidence-based data on transplant candidates. Under these guidelines, a positive stress test does not consistently prompt cardiac catheterization. We conducted a retrospective cohort study to evaluate whether cardiac catheterization following a positive stress test improves survival in this population.</div></div><div><h3>Methods</h3><div>Adults undergoing kidney transplantation between 2004 and 2024 with a positive stress test within five years pretransplant were identified from the TriNetX Research Network. Patients were stratified by receipt of cardiac catheterization (n = 11,171) versus no catheterization (n = 47,833). Propensity score matching based on demographics and cardiovascular comorbidities yielded 10,847 patients per group. The primary outcome was one-year mortality post-transplant.</div></div><div><h3>Results</h3><div>Among matched patients with a positive stress test, the catheterization group experienced 42 fewer deaths at one year than those who did not undergo catheterization (176 vs 214 deaths), corresponding to a mortality rate of 1.6% vs 2.0% (HR, 1.273; 95% CI, 1.043–1.554).</div></div><div><h3>Discussion</h3><div>Following positive stress test, cardiac catheterization was associated with improved one-year survival and may help identify patients who benefit from revascularization or intensified medical management. This association may also reflect the effects of closer cardiovascular monitoring, optimized therapy, and improved risk stratification enabled by minimally invasive assessment. In the absence of transplant-specific cardiac evaluation guidelines, our findings suggest that selective use of cardiac catheterization after a positive stress test may play a critical role in improving outcomes among transplant candidates.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Page 19"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061535","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":"Total Plaque Score, Total Stenosis Score, and Coronary Artery Calcium Score in the Setting of Diabetes","authors":"Jonathan Phan,&nbsp;April Kinninger,&nbsp;Sion Roy,&nbsp;Mrinal Bhandari,&nbsp;Beshoy Iskander,&nbsp;Natdanai Punnanithinont,&nbsp;Logan Schwarzman,&nbsp;Matthew J. Budoff","doi":"10.1016/j.ahj.2025.07.040","DOIUrl":"10.1016/j.ahj.2025.07.040","url":null,"abstract":"<div><div>Diabetes mellitus (DM) is a significant risk factor for atherosclerotic cardiovascular disease (ASCVD). Using data from Coronary Computed Tomography Angiography (CCTA), we aim to evaluate the effects of DM on the severity of ASCVD as measured by Total Plaque Score (TPS), Total Stenosis Score (TSS), and Coronary Artery Calcium (CAC) Score.</div><div>We performed a large retrospective single-center cohort study, including patients who underwent CCTA from 2004 to 2024. Multivariable logistic regression was used to evaluate the incidence of DM and categorized TPS, TSS and CAC Score.</div><div>Among the cohort of 14,407 subjects, average age was 62.2±12.3 years, 63% male, and 19% had DM. Controlling for age, gender, race, hyperlipidemia, hypertension, chest pain and past smoking, participants with TPS&gt;0 had significantly higher incidence of DM (Adjusted OR 1.90; 95% CI 1.67 – 2.16: p&lt; 0.001). Participants with TSS&gt;0 also had significantly higher odds of DM (Adjusted OR 1.94; 95% CI 1.70 – 2.21: p&lt; 0.001). Participants with CAC 1-100, 101-400 and &gt;400 had increasingly higher incidence of DM (CAC 1-100 OR 1.44; 95% CI 1.25 – 1.65, CAC 101-400 OR 1.77; 95% CI 1.52 – 2.07, and CAC &gt;400 OR 3.34; 95% CI 2.87 – 3.88).</div><div>DM is significantly associated with higher plaque burden, arterial stenosis, and coronary artery calcium deposition. The increasingly higher DM incidence seen with increasing CAC score highlights a strong tendency towards high severity of calcification in our cohort. These findings emphasize a need for thorough screening and individualized prevention of ASCVD in those with diabetes.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"290 ","pages":"Pages 14-15"},"PeriodicalIF":3.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145061582","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":"Catheter-based left atrial appendage CLOSURE in patients with Atrial Fibrillation at high risk of stroke and bleeding as compared to best medical therapy: Rationale and design of the prospective randomized CLOSURE-AF trial.","authors":"Ulf Landmesser, Carsten Skurk, Paulus Kirchhof, Thorsten Lewalter, Johannes-Jakob Hartung, Andi Rroku, Burkert Pieske, Johannes Brachmann, Ibrahim Akin, Claudius Jacobshagen, Benjamin Meder, Andreas Zeiher, Stefan D Anker, Holger Thiele, Stefan Blankenberg, Steffen Massberg, Heribert Schunkert, Norbert Frey, Alexander Joost, Martin Bergmann, Karl Georg Haeusler, Matthias Endres, Karl Wegscheider, Leif-Hendrik Boldt, Ingo Eitel","doi":"10.1016/j.ahj.2025.09.005","DOIUrl":"https://doi.org/10.1016/j.ahj.2025.09.005","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous catheter-based left atrial appendage (LAA) closure is a potential alternative to oral anticoagulation for stroke prevention in patients with atrial fibrillation (AF). The effectiveness and safety of LAA closure in patients with AF at high risk of stroke (CHA2DS2-VASc Score ≥ 2) and high risk of bleeding compared to best medical care including a non-vitamin K antagonist oral anticoagulant [NOAC] when considered eligible is not known.</p><p><strong>Methods/design: </strong>The prospective, multicenter, randomized clinical Left atrial appendage CLOSURE in patients with Atrial Fibrillation at high risk of stroke and bleeding compared to medical therapy (CLOSURE-AF) trial compared catheter-based LAA closure to best medical care (including NOAC therapy if considered eligible) in patients with AF at high risk of stroke and with either a history of bleeding or a high estimated bleeding risk (HASBLED >3). The primary endpoint is time to a composite of first stroke (ischemic or hemorrhagic), systemic embolism, cardiovascular or unexplained death or major bleeding (Bleeding Academic Research Consortium 3-5). Secondary outcomes include components of the primary outcome and total mortality. The primary efficacy analysis will be performed in the intention-to-treat population using Cox regression models for non-inferiority with an option to test for superiority once non-inferiority has been proven.</p><p><strong>Results: </strong>The first patient in the CLOSURE-AF trial was enrolled in March 2018. By April 2025 the complete study cohort of n=912 patients had been enrolled in 46 sites.</p><p><strong>Conclusion: </strong>CLOSURE-AF will contribute evidence on the effectiveness and safety of LAA occlusion compared to optimal medical therapy in patients with AF at high risk of stroke and bleeding. The trial results will help to define the clinical use of catheter-based LAA closure in the future.</p><p><strong>Trial registration: </strong>clinicaltrials.gov Identifier: NCT03463317.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063412","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":"Developing therapeutics for rare cardiovascular diseases","authors":"Joseph B Lerman MD ,&nbsp;Dwight D. Koeberl MD, PhD ,&nbsp;Shilpi Epstein MD ,&nbsp;Lothar Roessig MD ,&nbsp;Rodica Stan PhD ,&nbsp;Meghan Halley PhD ,&nbsp;Anjali T. Owens MD ,&nbsp;Barry Greenberg MD ,&nbsp;Kevin M. Alexander MD ,&nbsp;Sharlene M. Day MD ,&nbsp;Mathew S. Maurer MD ,&nbsp;Eric D. Adler MD ,&nbsp;Adrian F. Hernandez MD ,&nbsp;Euan A Ashley MD, PhD ,&nbsp;G. Michael Felker MD","doi":"10.1016/j.ahj.2025.09.004","DOIUrl":"10.1016/j.ahj.2025.09.004","url":null,"abstract":"<div><div>Rare cardiovascular diseases, while individually uncommon, collectively affect millions of people worldwide and are associated with significant morbidity, mortality, and economic burden. Despite this considerable impact, most rare cardiovascular diseases lack approved treatments. Developing therapies for rare cardiovascular diseases requires overcoming a unique set of challenges<strong>.</strong> This includes barriers to accurate patient diagnosis (and therefore to trial cohort generation), small cohort sizes, the choice of effective clinical trial endpoints, unique ethical and regulatory concerns, and the often-substantial costs of such therapies (which may limit public access to treatment). Despite such challenges, the past decade has witnessed a significant increase in the successful development of rare cardiovascular disease therapies. This review provides an overview of the challenges, while also highlighting potential strategies to advance the field.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107272"},"PeriodicalIF":3.5,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145063085","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":"Design and Rationale of Aspirin versus Aspirin and Fondaparinux Prior to Early Invasive Strategy in Patients with NSTEMI - The FOXY trial.","authors":"Christian Byskov Fur, Niels Thue Olsen, Jens Flensted Lassen, Ashkan Eftekhari, Carsten Stengaard, Claus Kjær Pedersen, Martin Bøhme Rasmussen, Christian Juhl Terkelsen","doi":"10.1016/j.ahj.2025.09.006","DOIUrl":"https://doi.org/10.1016/j.ahj.2025.09.006","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines recommend a combination therapy with aspirin and a parenteral anticoagulant in patients with non-ST-elevation myocardial infarction (NSTEMI) prior to invasive assessment. However, these recommendations are based on clinical trials conducted at a time when NSTEMI patients were not routinely assessed invasively. Today, nearly all NSTEMI patients in Denmark undergo coronary angiography within 72 hours, and the necessity of routine anticoagulation remains uncertain. The FOXY trial aims to assess whether aspirin alone is non-inferior to a combination therapy with aspirin and fondaparinux in preventing death, recurrent myocardial infarction, and refractory ischemia while lowering the risk of bleeding.</p><p><strong>Trial design: </strong>The FOXY trial is a multicenter, open-label, non-inferiority, randomized controlled trial enrolling 5,076 patients with NSTEMI. Participants will be randomized 1:1 to receive either aspirin alone or aspirin plus fondaparinux before invasive evaluation. The primary endpoint is a composite of 30-day mortality, recurrent MI, and refractory ischemia. Secondary outcomes include long-term ischemic events, cerebrovascular accidents, left ventricular function, hospital length of stay, and major bleeding. The study will be conducted across multiple cardiology centers, with the first patients enrolled in spring 2025.</p><p><strong>Conclusion and perspective: </strong>The FOXY trial is the first study to investigate parenteral anticoagulant use in NSTEMI patients undergoing routine invasive management. By comparing aspirin alone to combination therapy, the study seeks to challenge current guideline recommendations and potentially simplify NSTEMI treatment. If non-inferiority is demonstrated, the trial may support a shift toward a safer and more cost-effective management of NSTEMI patients. This could lead to a revision of clinical guidelines, minimizing bleeding risk, improving patient safety, and reducing healthcare costs.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058249","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":"Myocardial work indexes in elite athletes: An emerging echocardiographic tool to confirm physiologic cardiac remodeling in elite athletes with mildly reduced systolic function","authors":"Giuseppe Di Gioia MD ,&nbsp;Armando Ferrera MD ,&nbsp;Viviana Maestrini MD, PhD ,&nbsp;Sara Monosilio MD, PhD ,&nbsp;Federica Mango MD ,&nbsp;Davide Ortolina MD ,&nbsp;Antonio Pelliccia MD ,&nbsp;Maria Rosaria Squeo MD","doi":"10.1016/j.ahj.2025.09.003","DOIUrl":"10.1016/j.ahj.2025.09.003","url":null,"abstract":"<div><h3>Background</h3><div>Athlete's heart, characterized by cardiac chambers adaptations to exercise has some diagnostic overlaps with dilated cardiomyopathy (DCM). In the setting of differential diagnosis, myocardial work indexes (MWI), afterload-independent tool, could be helpful to identify early subclinical alterations. The aim of our study was to assess the utility of MWI in athletes with mildly reduced left ventricular ejection fraction (LVEF).</div></div><div><h3>Methods</h3><div>We enrolled 306 Olympic athletes (55.5% males) practicing endurance and mixed disciplines, mean age 26.3 ± 4.3 years old, who underwent cardio-pulmonary exercise test (CPET) and transthoracic echocardiogram. Athletes were divided in those with lower (&lt;55%) and normal LVEF (≥55%). Strain rate and MWI were performed and the following parameters collected: global longitudinal strain, global myocardial work index (GWI), constructive myocardial work (CMW), wasted myocardial work (WMW) and global cardiac work efficiency (GWE).</div></div><div><h3>Results</h3><div>Twenty-seven athletes had LVEF&lt;55% (mean 51.5% ± 2.6%). Athletes with EF &lt; 55% presented larger LVEDVi (79.1 ± 15.7 vs. 73.2 ± 13.8 mm/m2, <em>P</em> = .035), LV mass (<em>P</em> = .049) and LAVi (<em>P</em> = .016). No differences were found in GWI (1,757.9 ± 242 vs 1,839.8 ± 255.6 mmHg%, <em>P</em> = .112), GCW (2,121.6 ± 269.3 vs. 2,209.3 ± 281 mmHg%, <em>P</em> = .124), GWW (95.2 ± 40.7 vs. 87.1 ± 47.4 mmHg%, <em>P</em> = .394) or GWE (95.2 ± 1.7 vs. 95.7 ± 2%, <em>P</em> = .181). At CPET, in those with EF &lt; 55%, higher Watts (340.0 ± 83.7 vs. 291.6 ± 84.8, <em>P</em> = .004), VO₂ mL/min/Kg (51.0 ± 13.5 vs. 46.0 ± 10.1, <em>P</em> = .020) and O2 pulse (23.5 ± 4.6 vs. 21 ± 5.3, <em>P</em> = .020) were found.</div></div><div><h3>Conclusions</h3><div>MWI could be used as additive tool to characterize the physiologic nature of mildly reduced EF of endurance athletes, presenting with better functional parameters but preserved MWI values. MWI may be helpful in differential diagnosis of athlete’s heart from DCM.</div></div>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":"292 ","pages":"Article 107271"},"PeriodicalIF":3.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032573","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":"Rationale and design of the comparative effectiveness of ICD vs non-ICD therapy in contemporary heart failure patients at a low risk for arrhythmic death (CONTEMP-ICD) trial.","authors":"Ilan Goldenberg, Wojciech Zareba, Justin A Ezekowitz, Christine Albert, Jeffrey D Alexis, Lisa Anderson, Elijah R Behr, James Daubert, Katherine E Di Palo, Kenneth A Ellenbogen, Dillon J Dzikowicz, Joseph M Harrington, Eileen Hsich, David T Huang, James L Januzzi, Anas Jawaid, Valentina Kutyifa, Anuradha Lala-Trindade, Alex Nakonechnyi, Anekwe Onwuanyi, Ileana L Piña, Roopinder K Sandhu, Samuel Sears, Jakub Sroubek, Tina Baykaner, Robert Strawderman, Christopher Beck, Javed Butler","doi":"10.1016/j.ahj.2025.08.020","DOIUrl":"10.1016/j.ahj.2025.08.020","url":null,"abstract":"<p><strong>Background: </strong>Current recommendations for a prophylactic (primary prevention) implantable cardioverter defibrillator (ICD) in patients with both ischemic and nonischemic heart failure with reduced ejection fraction (HFrEF) originate from clinical trials conducted in selected patients over 20 years ago that showed an overall statistically significant survival benefit associated with a primary prevention ICD in the range of 23%-34%. The recent introduction of angiotensin receptor-neprilysin inhibitors [ARNI] and sodium glucose co-transporter 2 inhibitors [SGLT2i]) was shown to further reduce the risk of sudden cardiac death (SCD) in patients with HFrEF. Thus, there is an unmet need appropriately designed comparative effectiveness clinical trials aimed to reassess the survival benefit of a primary prevention ICD in contemporary patients with HFrEF.</p><p><strong>Methods: </strong>The comparative effectiveness of ICD vs non-ICD therapy in contemporary heart failure patients at a low risk for arrhythmic death (CONTEMP-ICD) trial is a prospective, multicenter, open-label, randomized-controlled trial; enrolling 3,290 participants with HFrEF who are treated with optimal stable GDMT and are eligible for a primary prevention ICD, but have a lower predicted risk of life-threatening ventricular tachyarrhythmia (VTA) than nonarrhythmic mortality. Enrolled participants will be randomized to non-ICD vs ICD treatment arms and will be followed over an average period of 3.5 years. The specific aims of the proposed clinical trial are to: (1) Compare the risk of all-cause mortality of non-ICD vs ICD in HFrEF patients who have a lower predicted risk of VTA than nonarrhythmic mortality per the MADIT-ICD Benefit Score; (2) Evaluate whether non-ICD vs ICD is associated with improved survival free of major CV events in patients with HFrEF who are at a lower predicted arrhythmic risk; (3) Assess healthcare utilization and quality of life implications of non-ICD vs ICD management approaches in HFrEF patients who are at a lower predicted arrhythmic risk; and (4) Determine the effect of non-ICD vs ICD management on all-cause mortality in prespecified subgroups.</p><p><strong>Conclusions: </strong>We hypothesize that, in patients with HFrEF who are at a lower predicted arrhythmic risk, non-ICD vs ICD is noninferior with respect to the primary endpoint of all-cause mortality and superior with respect to the secondary endpoint of survival free of major CV events. NCT06543446; https://contemp-icd.org.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"162-174"},"PeriodicalIF":3.5,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008061","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":"Extra-virgin olive oil and additional cardiovascular outcomes in the PREDIMED Trial: An outcome-wide perspective.","authors":"Javier Pérez de Rojas, Estefania Toledo, Ramón Estruch, Marta Guasch-Ferré, Jordi Salas-Salvadó, Enrique Gómez-Gracia, Emilio Ros, Montse Fitó, Fernando Arós, Miquel Fiol, José Lapetra, Lluis Serra-Majem, Xavier Pintó, José V Sorlí, Nancy Babio, Olga Castañer, Ángel M Alonso-Gómez, Miguel Ángel Martínez-González, José Juan Jiménez-Moleón","doi":"10.1016/j.ahj.2025.08.021","DOIUrl":"10.1016/j.ahj.2025.08.021","url":null,"abstract":"<p><strong>Background: </strong>Olive oil, increasingly consumed in the U.S., has been inversely associated with cardiovascular disease (CVD) risk. However, previous studies did not assess a broad spectrum of CVD outcomes, incorporated repeated annual dietary assessments, or distinguished between polyphenol-rich EVOO and common olive oil (COO), which lacks these compounds.</p><p><strong>Methods: </strong>We assessed 7102 high-risk participants from the PREDIMED trial (57.5% women; aged 55-80 years), all free of CVD at baseline. Olive oil consumption was assessed annually, and cumulative average intakes of EVOO and COO were calculated. The primary outcome was a composite of myocardial infarction, stroke, peripheral arterial disease, heart failure, atrial fibrillation, or cardiovascular death, whichever occurred first. Individual outcomes were also evaluated. Time-dependent Cox models were adjusted for major confounders, including trial intervention arm.</p><p><strong>Results: </strong>Over a median follow-up of 4.7 years, 621 participants experienced at least one CVD event. Participants in the highest tertile of cumulative EVOO intake (mean: 49.2 g/d) had a 25% lower risk of the composite outcome (HR: 0.75; 95% CI: 0.60-0.94), with significant reductions in several individual CVD outcomes. In the decile analysis, the highest (mean: 60.9 g/d) versus lowest decile had a 48% lower risk (HR: 0.52; 95% CI: 0.35 to 0.79). COO consumption was not significantly associated with CVD risk when mutually adjusted for EVOO (HR_{per 10 g/d}: 0.93; 95% CI: 0.87-1.00).</p><p><strong>Conclusions: </strong>High consumption of EVOO is associated with a substantial reduction in the risk of an outcome-wide composite of CVD events among high-risk individuals. In contrast, COO, which lacks polyphenols, showed weaker associations, highlighting the importance of differentiating olive oil types in CVD prevention strategies.</p><p><strong>Trial registration: </strong>This trial was registered in the ISRCTN registry (ISRCTN 35739639): https://www.isrctn.com/ISRCTN35739639.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":"175-185"},"PeriodicalIF":3.5,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144999432","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":"Design and rationale of a randomized clinical trial assessing the effect of inclisiran on atherosclerotic plaque in individuals without previous cardiovascular event and without flow- limiting lesions identified in an in-hospital screening: The VICTORION-PLAQUE primary prevention trial.","authors":"Pruthvi C Revaiah, Patrick W Serruys, Yoshinobu Onuma, Daniele Andreini, Matthew J Budoff, Faisal Sharif, Ariel Chernofsky, Sheikh Vikarunnessa, Andrea J Wiethoff, Denise Yates, Assya Achouba","doi":"10.1016/j.ahj.2025.08.001","DOIUrl":"10.1016/j.ahj.2025.08.001","url":null,"abstract":"<p><strong>Background: </strong>The impact of low-density lipoprotein cholesterol (LDL-C) on atherosclerotic cardiovascular disease (ASCVD) risk is influenced by both the magnitude and duration of exposure. Patients with nonobstructive coronary artery disease (NOCAD) and a CT-adapted Leaman score (CT-LeSc) >5 have a higher risk of cardiac events. The CT-LeSc semi-quantitatively assesses total coronary atherosclerotic burden via coronary computed tomography angiography (CCTA). Treatment with an antiproprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibody (mAb) leads to significant reductions in LDL-C levels. The addition of an anti-PCSK9 mAb to statin therapy produced greater LDL-C lowering and significant reduction in percent atheroma volume (PAV) and total atheroma volume (TAV) in patients with CAD. Inclisiran, a small-interfering ribonucleic acid (siRNA) therapy, targets PCSK9 messenger ribonucleic acid (mRNA) to reduce LDL-C levels by approximately 50% providing sustained and effective long-term LDL-C reduction after an initial and 90-day dose and a favorable safety profile alongside maximally tolerated statins. A similar treatment impact on total atheroma volume reduction is therefore hypothetically expected with inclisiran, given its exceptional dosing interval.</p><p><strong>Methods: </strong>VICTORION-PLAQUE is a multicenter, international, randomized, double-blind, placebo-controlled trial assessing inclisiran's efficacy in reducing total coronary atheroma volume in patients with NOCAD without prior cardiovascular (CV) events. Patients receive inclisiran or placebo in addition to maximally tolerated high-intensity statin therapy. The primary objective is to demonstrate inclisiran's superiority compared to placebo in reducing total coronary atheroma volume, measured by CCTA, from baseline to Month 24. The primary endpoint is percentage change from baseline to Month 24 in total coronary atheroma volume. Secondary endpoints include percentage change in LDL-C from baseline to Month 24, percentage change in low attenuation plaque volume evaluated by CCTA, percentage of participants with progression, regression, or no change in total plaque atheroma volume, and incidence and severity of treatment-emergent adverse event (TEAEs) and serious adverse event (SAEs) and their relationship with the study drug. In total, 608 patients have been randomized at 96 sites across 18 countries worldwide and enrolment was closed on October 25, 2024.</p><p><strong>Summary: </strong>The VICTORION-PLAQUE study evaluates the efficacy of inclisiran, compared with placebo, on top of maximally tolerated statin therapy, in reducing total coronary atheroma volume in NOCAD patients, as assessed by CCTA.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov. Identifier: NCT05360446.</p>","PeriodicalId":7868,"journal":{"name":"American heart journal","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793302","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}