BMC Cardiovascular Disorders最新文献

{"title":"The incidence and risk factor of atrial fibrillation after percutaneous coronary intervention.","authors":"Sheng Su, Le Li, Xi Peng, Likun Zhou, Yulong Xiong, Zhenhao Zhang, Yan Yao","doi":"10.1186/s12872-025-05051-6","DOIUrl":"https://doi.org/10.1186/s12872-025-05051-6","url":null,"abstract":"<p><strong>Background: </strong>Patients with coronary artery disease and atrial fibrillation (AF) have poor clinical outcomes. However, the incidence of new-onset AF occurring after hospital discharge following percutaneous coronary intervention (PCI) has not been well characterized. The aim of this study was to investigate the incidence and risk factors of AF developing after PCI discharge.</p><p><strong>Methods: </strong>Patients undergoing PCI enrolled from January 2013 to December 2013. The primary endpoint was new-onset AF occurring after hospital discharge following PCI, defined as AF documented during follow-up and not present during the index PCI hospitalization. Cox proportional hazards regression models with covariate adjustments, complemented by Fine-Gray competing risk analyses, were employed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for assessing AF risk factors.</p><p><strong>Results: </strong>Among 8,367 patients, 94 (1.1%) developed new-onset AF during 3-year follow-up, with no significant incidence difference between acute/chronic coronary syndromes (1.1% vs. 1.2%, P = 0.59). Age > 56.5 years (HR 2.97, 95%CI 1.72-5.12) and prior PCI (HR 1.73, 95%CI 1.13-2.65) independently predicted AF. Recalibration modestly improved all scores (the Postoperative Atrial Fibrillation score, CHA2DS2-VASc score, Atrial Fibrillation Risk Index, CHARGE-AF score) without statistical significance. CHARGE-AF outperformed other scores (all P < 0.05), while an age/ prior PCI-only model demonstrated non-inferior predictive capability versus CHARGE-AF.</p><p><strong>Conclusions: </strong>In this large PCI cohort, a simplified model using only age > 56.5 years and prior PCI demonstrated non-inferior AF prediction compared to the best-performing CHARGE-AF score, supporting streamlined risk stratification for new-onset AF.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"711"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A nomogram integrating the CHA₂DS₂-VASc score for predicting atrial fibrillation recurrence following catheter ablation.","authors":"Lin-Qian Jiang, Yu-Hong Zhong, Xue-Hai Chen, Zhe Xu, Ke-Zeng Gong, Fei-Long Zhang","doi":"10.1186/s12872-025-05071-2","DOIUrl":"https://doi.org/10.1186/s12872-025-05071-2","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to explore the predictive efficacy of a nomogram based on the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke, transient ischemic attack or thromboembolism, vascular disease, age, and sex category (CHA₂DS₂-VASc) score in predicting atrial fibrillation (AF) recurrence following first-time catheter ablation in patients with symptomatic AF.</p><p><strong>Methods: </strong>Clinical data of 398 patients were collected and analyzed. Patients were divided into a recurrence group (n = 81) and a non-recurrence group (n = 317). Key predictive factors were identified through univariate and multivariate analyses, and a nomogram was subsequently constructed using the R programming language.</p><p><strong>Results: </strong>The duration of AF, recurrence during the blanking period, neutrophil granulocyte count, neutrophil-to-lymphocyte ratio (NLR), red blood cell distribution width, and left atrial diameter (LAD) were identified as independent risk factors for AF recurrence (p < 0.05). A predictive model incorporating the CHA₂DS₂-VASc score, AF duration, NLR, and LAD was constructed. Among these variables, NLR exhibited the highest predictive value for postoperative recurrence of AF, followed by LAD, AF duration, and the CHA₂DS₂-VASc score. The concordance index (C-index) of the nomogram was 0.707 (95% CI: 0.566-0.847), which was significantly higher than that of the CHA₂DS₂-VASc score (C-index: 0.499; 95% CI: 0.359-0.640). The prediction model that was developed demonstrated clinical utility for assessing the risk of late recurrence across different AF subtypes and ablation techniques (AUC > 0.5).</p><p><strong>Conclusion: </strong>A nomogram incorporating the CHA₂DS₂-VASc score was developed to predict the recurrence of AF following ablation. It demonstrated promise in predicting the probability of recurrence 12 months post-ablation. However, further validation is required to confirm its reliability and generalizability.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"713"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between cardiovascular health defined by life's essential 8 and frailty among US adults: a cross-sectional study.","authors":"Qihang Yang, Pengfei Shi, Lanxia Pan, Zongqiang Huang","doi":"10.1186/s12872-025-05130-8","DOIUrl":"https://doi.org/10.1186/s12872-025-05130-8","url":null,"abstract":"<p><strong>Background: </strong>With the rapid growth of aging populations, frailty has emerged as a significant global public health concern. However, the relationship between frailty and Life's Essential 8 (LE8), a recently updated measure of cardiovascular health (CVH) introduced by American Heart Association, remains unclear. This study aimed to investigate the association between LE8 and frailty among adult participants.</p><p><strong>Method and results: </strong>Data from the National Health and Nutrition Examination Survey (NHANES) 2007 to 2018 were analyzed in this study, including adults aged ≥ 20 years. Frailty was assessed using a frailty index (FI), with frailty defined as a FI ≥ 0.21 and moderate/severe frailty defined as FI ≥ 0.30. Multiple Linear, multivariable logistic and restricted cubic spline models were employed to evaluate the associations. A total of 12,707 participants were included. Those in the high-LE8 group exhibited lower FI, frailty prevalence, and moderate/severe frailty prevalence. After adjusting for potential confounders, higher LE8 was significantly associated with lower FI, frailty prevalence, and moderate/severe frailty prevalence. Similar patterns were observed for several components of LE8. Additionally, nonlinear dose-response relationships were identified. Subgroup analyses revealed that the inverse associations between LE8 and FI were consistent across different populations, with stronger associations observed among females, older participants, and those with a lower poverty-income ratio.</p><p><strong>Conclusion: </strong>LE8 was inversely associated with the risk of frailty among adult participants. Encouraging the maintenance of optimal cardiovascular health levels may help alleviate the burden of frailty.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"710"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and burden of myocarditis in the Middle East and North Africa: a secondary analysis of global burden of diseases study 2019.","authors":"Parvaneh Hamian Roumiani, Mohammad Yaghoubi, Fateme Nozari, Maryam Taheri, Mahgol Sadat Hassan Zadeh Tabatabaei, Ziyaoddin Ahmadi, Alireza Azarboo, Ramin Eskandari, Mohammad Amin Khadembashiri, Mohamad Mehdi Khadembashiri","doi":"10.1186/s12872-025-05116-6","DOIUrl":"https://doi.org/10.1186/s12872-025-05116-6","url":null,"abstract":"<p><strong>Background: </strong>Myocarditis poses significant challenges in diagnosis and management due to its diverse etiology and clinical manifestations. Despite advances in medical care, myocarditis remains a leading cause of heart failure and sudden cardiac death worldwide, necessitating comprehensive understanding of its regional burden. This study aims to assess the incidence and burden of myocarditis in the Middle East and North Africa (MENA) region.</p><p><strong>Methods: </strong>Data were obtained from the Global Burden of Diseases Study 2019, utilizing standardized disease criteria and statistics collected by the Institute of Health Metrics and Evaluation (IHME). Global, regional, and national estimates of myocarditis mortality, incidence, and disability-adjusted life years (DALYs) were gathered for the period from 1990 to 2019. The Socio-demographic Index (SDI) was utilized as a measure of national development.</p><p><strong>Results: </strong>The findings indicate a minor change in the age-standardized incidence rate (ASIR) of myocarditis over the three decades, while a notable decrease was observed in both the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted rate (ASDR). Females exhibited higher ASMR and ASDR compared to males, despite similar ASIR trends. Country-level variations in myocarditis incidence were observed, with some nations experiencing increased rates, while others witnessed declines. Oman, Iraq, and Egypt had the highest ASMRs, whereas Bahrain, Jordan, and Turkey had the lowest.</p><p><strong>Conclusion: </strong>This study underscores the need for targeted interventions to mitigate the burden of myocarditis in the MENA region. The observed disparities in incidence and mortality rates highlight the complex interplay between socio-demographic factors and disease outcomes, emphasizing the importance of comprehensive public health strategies tailored to regional contexts. Further research is warranted to elucidate the underlying factors driving these disparities and inform effective intervention strategies.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"715"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and factors associated with cardiometabolic multimorbidity: a cross-sectional study in older adults of the first Brazilian hypertension registry.","authors":"Sandro Rogério Rodrigues Batista, Leandro Ferreira Martins, Priscila Valverde Vitorino de Oliveira, Andréa Araújo Brandão, Eduardo Costa Duarte Barbosa, Audes Diógenes M Feitosa, Marcus Vinícius Bolivar Malachias, Marco Mota Gomes, Celso Amodeo, Rui Manoel Dos Santos Póvoa, Renato Delascio Lopes, Paulo César Brandão Veiga Jardim, Ana Luiza Lima Sousa, Weimar Kunz Sebba Barroso","doi":"10.1186/s12872-025-05144-2","DOIUrl":"https://doi.org/10.1186/s12872-025-05144-2","url":null,"abstract":"<p><strong>Background: </strong>Cardiometabolic multimorbidity (CM-MM) is defined as the coexistence of at least two of the following conditions: diabetes mellitus (DM), myocardial infarction (MI), or stroke (ST). Data on the prevalence of CM-MM and its associated factors are scarce in Brazil.</p><p><strong>Objectives: </strong>To analyse the prevalence of CM-MM and its associated factors in a population of Brazilian adults aged ≥ 65 years with hypertension.</p><p><strong>Methods: </strong>We conducted an analytical cross-sectional study from 2013 to 2015 using data from the first Brazilian Hypertension Registry (BHR). Participants were recruited from 45 public and private healthcare services in all regions of Brazil. CM-MM was the main outcome measure, analysed according to clinical and sociodemographic factors. Descriptive and association analyses were performed to compare CM-MM and the other parameters.</p><p><strong>Results: </strong>We analysed data from 1,033 individuals. The prevalence of CM-MM was 8.9%, with higher rates among males, participants self-declared as White, and those in the 65-69 years age group. DM (32.7%) was the most prevalent single condition. Dyslipidaemia (70.7%), obesity (62%), and uncontrolled blood pressure (44.6%) were also common. Among the combinations of conditions, DM + MI was the most frequent (5.6%). After adjustment, CM-MM was associated with being male, having dyslipidaemia, experiencing heart failure, and undergoing coronary artery bypass graft surgery. Chronic kidney disease was not associated with CM-MM.</p><p><strong>Conclusions: </strong>The prevalence of CM-MM in older people with hypertension was approximately 9%. CM-MM was associated with risk factors such as dyslipidaemia and obesity. These findings show the importance of comprehensive cardiometabolic management to reduce the incidence of CM-MM in this population.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"712"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lymphocyte-to-monocyte ratio is associated with all‑cause and cardiovascular mortality among individuals with diabetes mellitus in the National Health and Nutrition Examination Survey 2003-2018 cohort.","authors":"Anmin Ren, Shanshan Cao, Donghuo Gong, Xinkai Qu","doi":"10.1186/s12872-025-05088-7","DOIUrl":"https://doi.org/10.1186/s12872-025-05088-7","url":null,"abstract":"<p><strong>Background: </strong>Limited research has explored the association between the lymphocyte-to-monocyte ratio (LMR) and mortality in patients with diabetes mellitus. We investigated the association of the LMR with both all-cause and cardiovascular mortality in individuals with diabetes mellitus.</p><p><strong>Methods: </strong>This study enrolled participants from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) cycles. Mortality data were extracted from the National Death Index records. Maximally Selected Rank Statistics (MSRS) was used to identify the best LMR cutoff that was significantly associated with the survival outcomes. Multivariate Cox regression and subgroup analyses were performed to investigate the correlations of the LMR with all-cause and cardiovascular mortality. Restricted cubic splines (RCS) analysis was used to depict the non-linear relationships of the LMR with all-cause and cardiovascular mortality. Time-dependent receiver operating characteristic (ROC) curve analysis was performed to assess the accuracy of the LMR for forecasting the survival outcomes.</p><p><strong>Results: </strong>Over the median follow-up period of 76 months, 585 of 2,327 participants died, 180 of whom died of cardiovascular mortality. The participants were divided into two groups according to the MSRS: the low LMR (≤ 2.62) and the high LMR (> 2.62) groups. The multivariate Cox regression analysis showed that the high LMR group had a significantly lower risk of all-cause mortality (hazard ratio [HR] 0.62, 95% confidence interval [CI] 0.50-0.76, P < 0.001) and cardiovascular mortality (HR 0.55, 95% CI 0.38-0.81, P = 0.003) than the low LMR group. This trend remained consistent throughout the subgroup analyses, with no significant interaction (P_interaction >0.05) observed between the LMR and these subgroup factors. The RCS regression analysis demonstrated positive non-linear relationships between the LMR and all-cause and cardiovascular mortality (both P_non-linear < 0.05) in patients with diabetes mellitus. The area under the ROC curve (AUC) for all-cause mortality was 0.858, 0.807, 0.807, and 0.802 for 1-, 3-, 5-, and 10-year survival, respectively, and the AUC for cardiovascular mortality was 0.864, 0.800, 0.815, and 0.811, respectively.</p><p><strong>Conclusion: </strong>In individuals with diabetes mellitus, high LMR correlated with a reduced risk of all-cause and cardiovascular mortality.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"714"},"PeriodicalIF":2.3,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145205813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cross-sectional evaluation of overlooked risk enhancer for hypertension among primary care patients: social isolation.","authors":"Yusuf Cetin Doganer, Yusuf Kursad Yagmur, Ebru Esra Yalcin, Nilsu Atabay, Melih Karamuk, Umit Aydogan","doi":"10.1186/s12872-025-04963-7","DOIUrl":"10.1186/s12872-025-04963-7","url":null,"abstract":"","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"709"},"PeriodicalIF":2.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physical activity and dose-characteristics in free-living conditions among patients awaiting coronary artery bypass graft surgery: a cross-sectional study.","authors":"Sandra Dijkstra, Setayesh R Tasbihgou, Iris Tigchelaar, Sawal D Atmosoerodjo, Rolf Huet, Lucas H V van der Woude, Massimo A Mariani, Anthony R Absalom","doi":"10.1186/s12872-025-05136-2","DOIUrl":"10.1186/s12872-025-05136-2","url":null,"abstract":"<p><strong>Background: </strong>Physical activity prior to elective coronary artery bypass grafting (CABG) surgery can potentially improve postoperative outcomes. The aim of the study was to evaluate subjectively and objectively physical activity levels and dose-characteristics in free-living conditions in patients awaiting CABG surgery.</p><p><strong>Methods: </strong>A single-centered cross-sectional subanalysis of 32 participants awaiting elective CABG surgery. Physical activity during the preoperative period was assessed subjectively with the SQUASH questionnaire and objectively with the Sensewear activity monitor (accelerometer with physiological sensors). The Wilcoxon signed-rank test was used to assess differences and Bland-Altman plots were used to assess the agreement between the measurement methods. Descriptive statistics were used for the dose-characteristics and Cohen's Kappa for the proportion of participants fulfilling the Dutch guideline for healthy physical activity (NNGB).</p><p><strong>Results: </strong>Duration of vigorous activity was significantly higher when measured subjectively (120 min/week) than objectively (7 min/week, p = 0.001). Bland-Altman plots showed that differences between the methods increased with longer durations of moderate and total activity. The dose-characteristics of physical activity measured with the SQUASH varied widely among the participants and it consisted mainly of leisure time activities and light household activities. The percentage of participants complying with the NNGB guideline was 74% when measured subjectively and 90% when measured objectively (κ = 0.259, p = 0.089).</p><p><strong>Conclusions: </strong>Surprisingly, both measurement methods suggest that the majority of patients awaiting CABG surgery met the recommendations of the NNGB guideline. The agreement between the methods however decreased with higher physical activity levels. Despite its limitations, the study suggests the complementary value of a subjective and objective measurement of physical activity in free-living conditions among CABG patients.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"708"},"PeriodicalIF":2.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limb ischemic per-conditioning ameliorated myocardial injury induced by renal ischemia/reperfusion in rats: the role of Klotho.","authors":"Zeinab Karimi, Fatemeh Masjedi, Sahar Janfeshan","doi":"10.1186/s12872-025-05183-9","DOIUrl":"10.1186/s12872-025-05183-9","url":null,"abstract":"","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"705"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of mineralocorticoid receptor antagonists in heart failure: a meta-analysis of randomized controlled trials.","authors":"Jinfei Wu, Yibin Pei, Junqing Wu, Yongfang Huang","doi":"10.1186/s12872-025-05098-5","DOIUrl":"10.1186/s12872-025-05098-5","url":null,"abstract":"<p><strong>Background: </strong>Mineralocorticoid receptor antagonists (MRAs) are established for heart failure with reduced ejection fraction (HFrEF), but their benefits in mildly reduced/preserved EF (HFmrEF/HFpEF) and agent-specific profiles require clarification. This meta-analysis aimed to evaluate the efficacy, safety, and benefit-risk profiles of MRAs across heart failure phenotypes and agents.</p><p><strong>Methods: </strong>This meta-analysis synthesized data from randomized controlled trials (RCTs). The primary outcome was a composite of hospitalization for heart failure (HHF) or cardiovascular death. Secondary outcomes included HHF, cardiovascular/all-cause mortality, and safety endpoints. Subgroup analyses examined heart failure phenotypes and MRA agents. Benefit-risk was quantified via Number Needed to Treat/Harm (NNT/NNH).</p><p><strong>Results: </strong>Data from six RCTs (FINEARTS-HF, EPHESUS, EMPHASIS-HF, J-EMPHASIS-HF, TOPCAT, RALES; n = 20,699) were synthesized. MRAs significantly reduced the primary composite outcome (HR = 0.79, 95% CI 0.71-0.88; P < 0.001; NNT_2.24yr =22.4), with consistent effects across demographic subgroups. Reductions were also observed in cardiovascular mortality (HR = 0.82, NNT_2.24yr = 45.5), sudden cardiac death (HR = 0.78, NNT_2.24yr = 67), HHF (HR = 0.76, NNT_2.24yr = 25), and all-cause mortality (HR = 0.84, NNT_2.24yr = 39.1). Safety analyses revealed increased risks of hyperkalemia (K⁺ >5.5 mmol/L: OR = 2.29, NNH_2.24yr = 12.7), hypotension (OR = 1.52, NNH_2.24yr = 23.3), and renal impairment (creatinine ≥ 2.5 mg/dL: OR = 1.63, NNH_2.24yr = 49.2), alongside a decreased risk of hypokalemia (K⁺ < 3.5 mmol/L: OR = 0.52, NNT_2.24yr = 17.3). Subgroup analyses demonstrated significant mortality benefits in HFrEF (cardiovascular mortality HR = 0.77; all-cause mortality HR = 0.78), although hospitalization benefits extended to both HFrEF and HFmrEF/HFpEF. Eplerenone demonstrated significant mortality reduction (cardiovascular mortality HR = 0.81; all-cause mortality HR = 0.83), while spironolactone only showed significant HHF reduction (HR = 0.73).</p><p><strong>Discussion: </strong>MRAs significantly reduce composite cardiovascular outcomes across heart failure phenotypes, with mortality benefits predominantly in HFrEF. Eplerenone appears to offer stronger mortality advantages, while spironolactone is more effective in reducing hospitalizations. These findings support phenotype- and agent-specific strategies to optimize the benefit-risk profile of MRA therapy in heart failure.</p>","PeriodicalId":9195,"journal":{"name":"BMC Cardiovascular Disorders","volume":"25 1","pages":"701"},"PeriodicalIF":2.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145191136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}